Lactational Amenorrhea Method and Infant Feeding Options

1. Lactational Amenorrhea Method and Infant Feeding Options

2. Lactational Amenorrhea Method • Temporary contraceptive option • Used by postpartum women who: • are less than six months postpartum • are fully or nearly fully breastfeeding • have no menses • Safe, convenient, effective Source: Hatcher, 2007.

3. Characteristics of LAM:Advantages • Universally available • At least 98% effective, no side effects • Begins immediately postpartum • Health benefits for mother and child • No direct cost for family planning or feeding the baby • No commodities/supplies required • Bridge to other contraceptives

4. Characteristics of LAM:Disadvantages • Breastfeeding pattern may be difficult to maintain • No STI or HIV protection • Risk of HIV transmission to baby • Duration of method limited • Only useful for breastfeeding women

5. Recommended Breastfeeding Behaviors A mother should breastfeed: • Soon after delivery • Without supplementation up to six months • Frequently, upon request, not on schedule • Without long intervals between feeds both day and night • Without pacifiers or bottles

6. LAM Use by Women with HIV • Advise that children can become infected • risk of acquisition through breast milk ~16% • Exclusive breastfeeding during first 6 months may reduce risk of acquisition by infant (compared to mixed feeding) • Exclusive use of formula or other substitutes eliminates risk of transmission through breast milk (often not possible) Source: WHO, 2004, updated 2008; Nduati, 2000; De Cock, 2000; WHO, 2006.

7. 3 more babies will be infected with HIV through breastfeeding 4 babies will be infected with HIV through pregnancy and delivery 13 babies will be HIV-free Infant Infection Risks if Mother with HIV Receives No Treatment If 20 women with HIV have babies: Fewer babies are infected if mothers and babies are treated. Source: WHO, 2004.

8. Factors That Increase Transmission of HIV to Infant during Breastfeeding • High maternal viral load • Duration of breastfeeding • Mixed feeding • Breast abscesses, nipple fissures, mastitis • Poor maternal nutrition status • Infant oral sores Source: WHO, 2004.

9. Infant Feeding Options for Women with HIV Up to six months: • Exclusive breastfeeding OR • Replacement feeding • expressed, heat-treated breast milk • commercial infant formula • breastfeeding by an HIV-negative wet nurse • breast-milk banks Source: WHO, 2006.

10. Infant Feeding Options for Women with HIV Beyond six months: • Switch to replacement feeding if acceptable, feasible, affordable, sustainable, safe (AFASS) • If not AFASS, continue breastfeeding along with complementary foods • All breastfeeding should stop if adequate and safe diet without breast milk can be provided If a child is known to have HIV, the mother should be strongly encouraged to continue breastfeeding. Source: WHO, 2006.

11. Summary of Contraceptive Choices • Use two methods concurrently (condoms plus another contraceptive method) • Use one method and understand its limitations (prevent pregnancy versus prevent transmission) • effective pregnancy prevention but no STI/HIV protection • condoms protect from STIs/HIV but typically less effective preventing pregnancy than some other methods • Use no method and abstain from sexual intercourse