204468 Transition from Lactational Amenorrhea Method to other modern family planning methods: Pathways and barriers in Sylhet, Bangladesh

Monday, November 9, 2009

Robin Anthony Kouyaté, PhD , Access-Fp, Academy for Educational Development, Baltimore, MD
Salahuddin Ahmed, MBBS , Department of International Health, Johns Hopkins Bloomberg School of Public Health; Based in Bangladesh, Sylhet, Bangladesh
Angela Nash-Mercado , Access-Fp, Jhpiego, Johns Hopkins University, Baltimore, MD
Catharine McKaig, DrPH , Access-Fp, Jhpiego, Johns Hopkins University, Baltimore, MD
Peter Winch, MD , Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Ishtiaq Mannan, Dr , Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Abdullah Baqui, MBBS, DrPH , Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Background: Lactational Amenorrhea Method (LAM), a modern family planning method that is about 98% effective, prevents pregnancy for up to six months, as long as a woman is

- fully or nearly fully breastfeeding

- in postpartum amenorrhea

- less than six months postpartum

When any one of the three criteria changes, or when a woman decides she no longer wants to use LAM, she must switch to another method to ensure healthy spacing of pregnancies.

Although research has demonstrated that LAM can serve as a gateway method to other modern methods, little is known about how the transition occurs and factors that influence that transition. The purpose of this analysis was to better understand the pathways and critical barriers to the LAM transition in one setting, Sylhet, Bangladesh.

Methods: In-depth interviews were used to identify the different pathways to the LAM transition and understand the decision-making process for the transition to another method. A barrier analysis, using a semi-structured questionnaire, was conducted to examine common barriers to the transition.

Findings: Preliminary findings from in-depth interviews indicate that based on previous personal experiences with the return to fertility, some postpartum women wait for menses before transitioning, even if the other two criteria have changed. Other potential barriers include financial constraints, lack of husband's approval, and difficulty in reaching a health facility to obtain a method.

Programmatic Implications: Findings will serve to inform the content of household counseling messages and refine community interventions to better support the use of LAM as a means to transition to other methods

Learning Objectives:
At the end of the presentation, participants will be able to - 1. describe at least two pathways that women take to transition from lactational amenorrhea method (LAM). 2. identify at least three common barriers to the transition from LAM to another modern method. 3. formulate one message or describe one intervention that addresses a common barrier to the transition from LAM to other modern methods.

Keywords: Family Planning, Maternal and Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As the Behavior Change Communications Advisor for the ACCESS-FP Project on postpartum family planning, I lead efforts to design and integrate messages on Lactational Amenorrhea Method (LAM) and the transition to other modern methods into maternal, newborn, and child health (MNCH) country programs in Africa, Asia and the Caribbean. I serve as one of the coordinators of an interagency LAM Working Group that provides leadership for repositioning LAM as a gateway method and for the integration of LAM into MNCH programs. I have conducted research using similar qualitative methods for my doctoral research - Exploring the Narrative Processes Middle Adolescent Girls Use When Constructing Their Stories. (2008). Unpublished doctoral dissertation, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. Selected publications and presentations: • Technical preparer for - ACCESS-FP & USAID. (2008.) The Lactational Amenorrhea Method (LAM): A postpartum choice for women who breastfeed. Program brief by ACCESS-FP and USAID. • Anthony Kouyaté, R. and Nash-Mercado, A. (2007, June). The Lactational Amenorrhea Method and the Transition to Other Modern Methods. Technical Update for JHPIEGO, Baltimore, MD. • Nash-Mercado, A., Blanchard, H. and Anthony Kouyaté, R. (2007, June). LAM: Lactation Amenorrhea Method and Transitioning to Other Modern Methods. Presented at the annual Child Survival and Health Mini-University, Baltimore, MD. • Jennings, V., Anthony Kouyaté, R., and Hind, D. (September 2007). Counseling on Lactational Amenorrhea Method and the Transition to Other Modern Methods. Skills lab presented at the Scaling-up FP/MNCH Best Practices in Asia and the Near East Technical Meeting, Bangkok, Thailand. • Arevalo, M & Anthony Kouyaté, R. (2008, April). Revitalizing the Lactational Amenorrhea Method; presented at CORE Group Spring Meeting, Atlanta, Georgia.
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.

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