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APHA Scientific Session and Event Listing

Marcos Arevalo, MD, MPH and Irit Sinai, PhD. Institute for Reproductive Health, Georgetown University, 4301 Connecticut Ave., NW, Washington, DC 20008, (202)687-1392, arevalom@georgetown.edu

Women who are instructed in family planning method use can internalize information and follow guidelines differently. A pilot study to assess the acceptability, practicality and preliminary effectiveness of fertility awareness-based guidelines for postpartum women found that women in two sites in Peru used the method differently then participants in two sites in Guatemala. The guidelines were developed to bridge between LAM, which is effective in the early postpartum months for breastfeeding women, and the Standard Days Method – a fertility awareness-based method that is rapidly gaining popularity in many settings, but is inappropriate for postpartum women until they re-establish cycle regularity. The guidelines consist of three sets of instructions for the three phases of the early postpartum period: postpartum amenorrhea after LAM no longer applies, the cycle after first menstruation, and subsequent cycles.

The pilot study, which followed about 200 users for up to nine months of Guidelines use, showed the guidelines to be practical, acceptable, and to result in very few pregnancies. While participants in all sites used the guidelines correctly, different and distinct behavioral patterns were observed. Focus groups were conducted with study participants in an attempt to explain these differences. Results reveal important differences between sites in perceptions of pregnancy risk and of the protective role of breastfeeding. These differences can explain the behavioral differences, have significant implications for method counseling, and underline the need for behavioral research to inform program development.

Learning Objectives: Fertility awareness-based guidelines for postpartum women are instructions women can follow if they wish to use a simple fertility-awareness based method of family planning to avoid pregnancy after they are no longer eligible to use the Lactational Amenorrhea Method (LAM). At the conclusion of this presentation participants will understand

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• how differences in perceptions of risk of pregnancy and the protective role of breastfeeding may explain behavioral differences of users of the Guidelines in different settings; and (
• implications of these findings for method counseling.

Presenting author's disclosure statement:

Not Answered