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

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.