Impact of promotion of Lactational Amenorrhea Method within a community based maternal, neonatal and child health program in rural Bangladesh

Background: In Bangladesh, median duration of breastfeeding is 32.8 months but mean duration of exclusive breastfeeding is only 1.8 months. Lactational Amenorrhea Method (LAM) is not promoted by service providers. In the study area of Sylhet, Bangladesh, contraceptive prevalence rate (CPR) was 31% and unmet need for FP was 26%. Intervention: The Community Health Workers (CHW), one per 4000 population, conducted antenatal and postpartum counseling on maternal, neonatal and child health (MNCH) care in intervention and comparison areas; pregnancy spacing, LAM and transitional methods counseling were integrated in intervention area. Evaluation Design: Using a quasi-experimental design a cohort of 4504 pregnant women – 2247 in intervention and 2257 in comparison arms were followed longitudinally from pregnancy to 18 months postpartum at five time points. Result: Ever LAM use rate is 38% in intervention arm compare to none in comparison area. At three months postpartum the LAM use rate was 23% in the intervention group compared to zero in the comparison group and at six month 12% in intervention area. Contraceptive use rate at six months (37% vs. 18%; p<0.01), 12 months (42% vs. 27%; p<0.01) and 18 months (47% vs. 34%; p<0.01) postpartum were significantly higher in intervention arm with significant changes in the method mix over time. 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 18 months postpartum.