Integration of family planning with health facility and community-based services: Multi-country data on the extent of Lactational Amenorrhea Method (LAM) counseling and postpartum family planning

Although two-thirds of women state they would like to use a family planning (FP) method within the first year postpartum, poor birth spacing contributes to a significant proportion of maternal, neonatal and child mortality and morbidity. Lactational Amenorrhea Method (LAM) supports optimal breastfeeding (BF) practices in the initial 6 months postpartum, contributes to birth spacing and provides an opportunity for women to learn about the transition to another FP method. Yet, providers are often poorly equipped to offer LAM. Evidence is needed on LAM and FP messages during routine health contacts, and whether women transition to other FP methods. We examined scale-up of LAM into FP programs in Mali, India and Rwanda in January- August 2009. We conducted household surveys, health facility assessments and provider interviews to provide a baseline measure of LAM counseling, LAM knowledge/ attitudes/ practice, and use of postpartum FP, in project areas. Although most Malian and less than half of Indian women receive exclusive BF messages, few received information on LAM and FP, (except ~40% of Malians received FP messages). Early introduction of foods, late initiation of BF and low exclusive BF rates present challenges for implementing LAM. About 44% and 61% of women reported use of FP postpartum in Mali and India, respectively, although many delayed use to one year and beyond. Emphasis on LAM and timely transition to FP in the context of optimal child survival messages is needed during routine health contacts. Community-based workers are a untapped source to increase postpartum family planning.