Consensus statement on the use of breastfeeding as a family planning method

doi:10.1016/0010-7824(89)90103-0

Contraception

Volume 39, Issue 5, May 1989, Pages 477-496

https://doi.org/10.1016/0010-7824(89)90103-0 Get rights and content

Abstract

An interdisciplinary international group of researchers in the area of lactational infertility gathered with the purpose of coming to a consensus about the conditions under which breastfeeding can be used as a safe and effective method of family planning. The consensus of the group was that the maximum birth spacing effect of breastfeeding is achieved when a mother “fully” or nearly fully breastfeeds and remains amenorrheic. When these two conditions are fulfilled, breastfeeding provides more than 98% protection from pregnancy in the first six months. Data are reviewed from thirteen prospective studies in both developed and developing countries supporting the consensus. The rationale for the consensus is given in detail. Recommendations are made based on what is currently known of the antifertility effects of breastfeeding. Research should continue to measure a broad spectrum of variables so that these guidelines can be refined as new information becomes available.

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Citation Excerpt :
Duration of breastfeeding and exclusive breastfeeding might be related to interpregnancy interval.35 If a woman remains amenorrheic, this state could increase intervals between pregnancies and reduce resource competition among siblings, although it is not clear if this method is reliable as contraception beyond 6 months.36 Despite existing recommendations, we did not find a consistent reduced risk of stillbirth for intervals greater than 24 months or an elevated risk of stillbirth for intervals of less than 6 months after a previous stillbirth across all models.
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Between July, 1997, and April, 2018, we identified 716 478 births from 338 223 women in 123 Demographic and Health Surveys from 58 LMICs, of which 9647 were stillbirths. Intervals of less than 6 months were associated with an increased risk of stillbirth in the between-mother models when considering the first interval (risk difference [RD] 0·0096, 95% CI 0·008–0·011). This association was slightly attenuated when considering only the second interval (RD 0·0054, 95% CI 0·0010 to 0·0099) and substantially attenuated when considering only the third interval (0·0007, −0·037 to 0·039). Within-mother modelling showed a null association with intervals of 24–59 months when considering the first and second (RD 0·007, 95% CI −0·001 to 0·016) and first and third (0·040, −0·422 to 0·501) intervals.
Although interpregnancy intervals of less than 12 months were associated with increased risk of stillbirth, these effects were attenuated when considering second and third intervals, suggesting the association in the first interval might not be causal. Future studies should use generalisable cohorts with longitudinal data, and report estimates stratified by birth order.
Canadian Institutes of Health Research.

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Consensus statement on the use of breastfeeding as a family planning method

Abstract

Journal of Steroid Biochemistry

Contraception

Fertility and Sterility

British Medical Journal

American Journal of Clinical Nutrition

Human Nutrition: Clinical Nutrition

Acta Paediatrica Scandinavia

Child-spacing effects on infant and early child mortality

Population Index

The potential impact of changes in fertility on infant, child and maternal mortality

Studies in Family Planning

Healthier mothers and children through family planning

Population Reports, series J, No. 27

The importance of family planning in reducing maternal mortality

Studies in Family Planning

Breastfeeding, birthspacing and child survival

Nature

Fertility, biology and behavior: An analysis of the proximate determinants

Variations in natural fertility: the effect of lactation and other determinants

Population Studies

The contraceptive role of breastfeeding

Population Studies

Breast Feeding

Scientific American

The proximal determinants of natural marital fertility

Center for Population Studies Working Paper No. 89

When a conception fails to become a pregnancy

Return of fertility in lactating and non-lactating women

Journal of Biosocial Science

The effect of a breastfeeding education program on lactational amenorrhea

A study of returning fertility after childbirth and during lactation by measurement of urinary oestrogen and pregnanediol excretion and by cervical mucus production

Journal of Biosocial Science

$Population Reports$ , series J, No. 27

$Center for Population Studies Working Paper$ No. 89