207649 Programmatic challenges and lessons learned: Integrating Lactational Amenorrhea Method into maternal newborn health programs as a strategy for improving healthy spacing of pregnancies for postpartum women

Tuesday, November 10, 2009: 11:00 AM

Robin Anthony Kouyaté, PhD , Access-Fp, Academy for Educational Development, Baltimore, MD
Catharine McKaig, DrPH , Access-Fp, Jhpiego, Johns Hopkins University, Baltimore, MD
Background: Lactational Amenorrhea Method (LAM), a 98% effective modern family planning method based on breastfeeding, has been underutilized. The integration of LAM into maternal newborn health (MNH) programs has been identified as one promising approach for revitalizing LAM and improving healthy spacing of pregnancies through an emphasis on the transition to other modern methods, based on:

• mutual health benefits for women and newborns through the reinforcement of exclusive breastfeeding

• the opportunity to reach postpartum women who may not otherwise use family planning services

• evidence that LAM can serve a gateway to other modern method use

Intervention: The ACCESS-FP Program has systematically integrated LAM into MNH programs in Nigeria, Afghanistan, and Bangladesh. Intervention efforts have centered on refining LAM and transition messages for the MNH context, determining the appropriate timing for incorporation into existing counseling schedules, and creating a supportive environment for LAM and transition. Community interventions were complemented by MNH provider training on LAM and contraceptive choices for breastfeeding and non-breastfeeding postpartum women.

Programmatic lessons learned: Assessments of the impact of integration on MNH programs, LAM use and the transition to other methods indicate:

• With tailored training and strategic message integration, MNH CHWs can counsel effectively on LAM and the transition, while maintaining the quality of MNH counseling.

• For programmatic purposes, harmonizing the LAM and child survival breastfeeding messages has facilitated LAM counseling for CHWs and providers.

• Even with successful implementation of LAM, specific messages and strategies are critical for ensuring the timely transition to other modern methods.

Learning Objectives:
1. list at least three key programmatic considerations for integrating Lactational Amenorrhea Method (LAM) into existing maternal newborn health community-based programs 2. describe at least three key strategies for facilitating the transition 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. 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.