| Abstract: | Breastfeeding has long been a means of fertility regulation in traditional communities but only recently have attempts been made to characterize and quantify this attribute. Breastfeeding encompasses behavioral, geographical, and cultural factors, which account for the differences in the prevalence and practice of breastfeeding in different communities. Ovarian activity is suppressed in the breastfeeding mother. Initially the suppression is complete and the woman is amenorrheic. This is followed by anovulatory menstrual cycles or ovulatory cycles that manifest luteal phase deficiency or normal ovulatory cycles. The duration of ovarian follicular suppression is variable and recent work suggests that lactation suppresses ovarian activity by disturbing the pulsatile pattern of luteinizing hormone (LH) secretion. During lactational amenorrhea, prolactin levels are high, LH levels are low to normal. Follicle stimulating hormone concentrations are normal by four weeks postpartum, and estrogen and progesterone levels are low. The degree of ovarian suppression is enhanced by increased frequency of suckling, longer duration of feeds, and more frequent night-time feeds. Introduction of supplementary feeds inhibits ovarian suppression. These and other factors account for variations in the length of lactational amenorrhea in an individual and between populations. The Bellagio Consensus Statement affirms that the risk of pregnancy in a fully breastfeeding, amenorrheic woman in the first six months of lactation is less than 2%. After the sixth month it is increasingly likely that ovulation will precede the first menstruation. The Bellagio Consensus has given scientific validity to birth-spacing in developing countries and the lactational amenorrhea method (LAM) as a means of contraception. If breastfeeding ceases to be full, menstruation resumes, or the baby is more than six months old, alternative methods of contraception should be used. Breastfeeding should feature more prominently in fertility regulation programs and counseling, especially in developing countries. |
