259916 Impact of promotion of Lactational Amenorrhea Method within a community based maternal, neonatal and child health program in rural Bangladesh

Monday, October 29, 2012 : 1:00 PM - 1:15 PM

Salahuddin Ahmed , Mchip, Jhpiego, Sylhet, Bangladesh
Jaime Mungia, MPH , Jhpiego, Baltimore, MD
Saifuddin Ahmed, MBBS, PhD , Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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.

Learning Areas:
Planning of health education strategies, interventions, and programs
Program planning

Learning Objectives:
Participants will be able to- 1) identify potential programming opportunities to link family planning (FP) services within a community based maternal, neonatal and child health program (MNCH). 2) describe a model of integrated FP-MNCH program in low resources setting. 3) assess community practice of exclusive breastfeeding and use of lactational amenorrhea method (LAM) for pregnancy spacing during first six months postpartum. 4) describes approaches for supporting client transition from LAM to a modern family planning method

Keywords: Family Planning, Contraceptives

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am coinvestigator of the study, have more than 10 years experience on public health research on MNCH/FP
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.