202364 Impact of the integration of Lactational Amenorrhea Method within a community based maternal, neonatal and child health program

Tuesday, November 10, 2009: 11:15 AM

Salahuddin Ahmed, MBBS , Department of International Health, Johns Hopkins Bloomberg School of Public Health; Based in Bangladesh, Sylhet, Bangladesh
Mohammad Rasheduzzaman Shah, Dr , PROJAHNMO Study Group, PROJAHNMO - Sylhet, Sylhet, Bangladesh
Ishtiaq Mannan, Dr , Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Angela Nash-Mercado , Access-Fp, Jhpiego, Johns Hopkins University, Baltimore, MD
Nazma Begum , Child Health Unit, Public Health Science Division, ICDDR,B, Dhaka, Bangladesh
Emma Williams , Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Peter Winch , Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Saifuddin Ahmed , Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Ahmed Al-Kabir , RTM International, Dhaka, Bangladesh
Robin Kouyate , Access-Fp, Jhpiego, Johns Hopkins University, Baltimore, MD
Catharine McKaig, DrPH , Access-Fp, Jhpiego, Johns Hopkins University, Baltimore, MD
Maureen Norton, MA, PhD , Office of Population and Reproductive Health, USAID, Alexandria, VA
Abdullah Baqui, MBBS, DrPH , International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
  
Background

In Bangladesh, median duration of breastfeeding is 32.8 months. However, the mean duration of exclusive breastfeeding is only 1.8 months. We describe an innovative intervention which attempted to integrate promotion of lactational amenorrhea method (LAM) with a community-based maternal, neonatal and child health program in a rural Bangladeshi community, where contraceptive use rate is low.

Intervention

The intervention consists of (i) training of community health workers on LAM (ii) community-based advocacy and behavior change communication targeting pregnant, postpartum women and their families. Community health workers, one per 4000 population, conduct antenatal and postpartum home visits to counsel families on maternal and newborn care, the LAM, transitional methods and healthy timing and spacing of pregnancy. Community Mobilizers organize advocacy and community meetings with influential persons including religious leaders, their wives; and identify people to serve as role models on LAM.

Evaluation Design

The study has a quasi-experimental design. It follows 4430 pregnant women longitudinally from the antenatal period to 36 months postpartum in eight time points.

Result

At three months postpartum the LAM use was 35% in the intervention group compared to zero in the comparison group. In intervention group, 56% of women at three months postpartum accepted any contraceptive method, compared to 24% in the comparison group (p=<0.001).

Conclusion

The inclusion of LAM counseling in a maternal and newborn care program, demonstrates significant potential for increasing contraceptive use among postpartum women during a particularly vulnerable period, the first six months postpartum.

Learning Objectives:
Participants will be able to- 1) identify potential programming opportunities to link family planning (FP) services within a community based maternal, neonatal and child health program (MNCH). 2) describe a model of integrated FP-MNCH program in low resources setting. 3) assess community practice of exclusive breastfeeding and use of lactational amenorrhea method (LAM) for pregnancy spacing during first six months postpartum. 4) describes approaches for supporting client transition from LAM to a modern family planning method

Keywords: Family Planning, Maternal and Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am co investigator of the study and coordinate the study and responsible for implemetation as well as supervision of the stuay
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Lactational Amenorrhea Method (LAM): Friend or Foe of Family Planning?
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