Examining the use of lactational amenorrhea as a contraceptive strategy in Niger

Background: The lactational amenorrhea method (LAM) can be a valuable family planning tool, particularly in low-income countries such as Niger, where women may have limited access to alternative contraceptive methods. The prevalence of LAM and its effective use in Niger have not been well documented. Improved understanding of these estimates may be useful for informing future intervention efforts. Methods: We utilized cross-sectional data from the 2006 Niger Demographic Health Survey. Our sample included all sexually active, non-pregnant, breastfeeding women using some form of contraception (N=673, unweighted). We generated weighted frequencies to describe the prevalence of LAM and its effective use and used logistic regression models to describe women who chose LAM for contraception. Results: Among sexually active, non-pregnant women who were breastfeeding, 52% reported LAM as their primary method of contraception. Only 21% used this approach correctly. Women who reported using LAM were more likely to live in a rural area, have no education and have delivered their most recent baby at home. They were also less likely to have spoken with a health worker or with their husband/partner about family planning in the past year. Conclusions: A majority of breastfeeding women in Niger report using LAM for contraception; however, few use it correctly. Results reinforce the need to address this knowledge gap and suggest that LAM users may have less access to health care and be less empowered within their marriages or partnerships. In light of Niger's high fertility rate, findings may inform international efforts to improve family planning.