Lactational Amenorrhea Method of Contraception

Abstract: The lactational amenorrhea method is not halachically considered a form of active contraception at all and thus it presents no halachic concerns. In fact, Jewish Law encourages breastfeeding for at least two years, without concern for the potential reduction in fecundity during that time.

Discussion: The lactational amenorrhea method is endorsed by the World Health Organization as a valuable method of family planning worldwide due to its efficacy, lack of side effects, and low cost [1], [2]. This method of contraception takes advantage of the anovulation caused by breastfeeding. Research demonstrates (see sources below) that, for up to six months postpartum, women who breastfeed exclusively or almost exclusively, and who have not resumed menses, have less than a 1% chance of becoming pregnant [3]. This method has been proven effective in multiple clinical trials worldwide, including in developed countries. In addition, both mother and infant receive the health benefits associated with breastfeeding [4].

All three conditions - exclusive breastfeeding, no menses, and infant age under six months - must be met for the method to work [5], [6]. Exclusive breastfeeding assumes frequent nursing, with intervals of no longer than four hours during the day and no longer than six hours at night. This type of breastfeeding delays the onset of menses and decreases the chances of ovulating prior to the first menses. The more one deviates from this pattern by feeding on schedule (rather than demand), and by reducing suckling time with the use of pacifiers or return to work [7], the less likely it is to be effective [2]. By learning how to check cervical secretions with a certified health educator (see Fertility Awareness Method), a woman can increase the chances of this method working [8].

Implications for Patient Care: As there are no halachic problems in the use of LAM, instructing patients in its proper use can help assure child spacing in couples that cannot or do not wish to use other methods of contraception. Patients should be instructed in all the components of LAM so they do not just assume that any breastfeeding is contraceptive.

Medical References

[1] The World Health Organization Multinational, Study of Breast-feeding and Lactational Amenorrhea. I. Description of infant feeding patterns and of the return of menses. World Health Organization Task Force on Methods for the Natural Regulation of Fertility. Fertil Steril 1998 Sep;70(3):448-60.

[2] The World Health Organization Multinational Study of Breast-feeding and Lactational Amenorrhea. II. Factors associated with the length of amenorrhea. World Health Organization Task Force on Methods for the Natural Regulation of Fertility. Fertil Steril 1998 Sep;70(3):461-71.

[3] Van der Wijden C, Kleijnen J, Van den Berk T. Lactational amenorrhea for family planning. Cochrane Database Syst Rev 2003;(4):CD001329.

[4] Gartner LM, Morton, J, Lawrence, RA, Naylor AJ, O'Hare D, Schanler, RJ, Eidelman A I. Breastfeeding and the use of human milk. Pediatrics 2005 Feb;115(2):496-506.

[5] Labbok M, Cooney K, Coly S. Guidelines: Breastfeeding, Family Planning, and the Lactational Amenorrhea Method-LAM. Washington, DC: Institute for Reproductive Health, 1994.

[6] Labbok MH, Hight-Laukaran V, Peterson AE, Fletcher V, von Hertzen H, Van Look PF. 1997. Multicenter study of the lactational amenorrhea method (LAM): I. Efficacy, duration, and implications for clinical application. Contraception 1997 Jun;55(6):327-36.

[7] Valdés V, Labbok MH, Pugin E, Perez A.The efficacy of the lactational amenorrhea method (LAM) among working women. Contraception. 2000 Nov;62(5):217-9.

[8] Gross BA. Breast-feeding and natural family planning. Int J Fertil 1988;33 Suppl:24-31.

Suggested Further Reading

Kennedy KI, Visness CM. Contraceptive efficacy of lactational amenorrheoea. Lancet 1992;339:227-29.

Labbok MH, Perez A, Valdes V, Sevilla F, Wade K, Laukaran VH, Cooney KA, Coly S, Sanders C, Queenan JT. The lactational amenorrhea method (LAM): a postpartum introductory family planning method with policy and program implications. Adv Contracept 1994;Jun 10(2):93-109.
Perez A, Labbok MH, Queenan J. Clinical studies of lactational amenorrhoea method for family planning. Lancet 1992; 339:968–970.

Short RV, Lexis PR., Renfree MB, Shaw G. Contraceptive effects of extended lactational amenorrheoea: beyond the Bellagio Consensus. Lancet 1991 Mar 23;337(8743):715-7.

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