Do LAM Users Transition to Other Modern Methods

1
Do LAM Users Transition to Other Modern Methods?

• Postpartum Contraception Study in Jordan

2
Preliminary Results

• Presented at
• PVO/NGO Flexible Fund
• Partners Meeting
• Annette Bongiovanni
• LINKAGES Project
• Academy for Educational Development
• March 21, 2005

3
Background

• LAM is a modern family planning method based on
  natural infertility resulting from certain
  patterns of breastfeeding
• LAM is 98.5 effective at preventing pregnancy
  during the first six months postpartum
• Family planning providers often do not support
  LAM because
• Concerned about a missed opportunity for
  promotion of non-temporary methods such as pill
  and IUD
• FP providers point of entry 6 months
  postpartum
• Confuse LAM with breastfeeding

4
Problem Statement

• Modern method hiatus during the postpartum period
• Evidence indicates even the best contraceptors
  are reluctant to use modern methods during the
  postpartum period
• Wasted government resources
• Many governments subsidize modern methods
  offering dual protection to women who are already
  protected by LAM
• Non-users and traditional users are poorly
  protected from pregnancy
• Non-users of modern methods more likely to be
  comfortable with LAM which affords them a
  critical birth spacing interval to avert maternal
  and neonatal mortality
• LAM make serve as a bridge to modern method use

5
Purpose of Study

• Determine LAM users rate of transition to other
  modern methods
• Assess CPR at 12 months postpartum by type of
  contraception used in first 6 months
• Assess unintended pregnancy rates by 12 months
  postpartum
• Develop profile of LAM users and LAM users who
  transition

6
Methods

• Data collection mid-March through August 2004
• Clinic exit interviews at 11 MOH clinics offering
  MCH services in Jordan
• Women age 15-49 married prior to 2002 seeking
  care for non-twin index child 13-24 months of age
• 3,183 women interviewed (222 LAM users)

7
Terms for LAM

• LAM (Lactational Amenorrhea Method) term used in
  flipcharts, brochures and posters, but not during
  counseling
• BAM (coined Breastfeeding and Amenorrhea Method)
  A method using breastfeeding to delay
  menstruation in order to plan the family as
  expressed during counseling

8
Definition of LAM Use

• Reports use of LAM, BAM or breastfeeding during
  first 6 months postpartum, and
• When asked What criteria need to be met for LAM
  to be effective, spontaneously gives all 3
  responses
• Amenorrhea (period has not returned)
• Breastfeeding (exclusive or nearly full)
• Baby is lt6 months old

9
Use of Family Planning in the first 6 months
postpartum
N 3,183
10
Types of Family Planning Used at 12 months
N 3,183
11
Family Planning UseComparing use in the first 6
months to use at 12 months postpartum
N 3,183
12
Family Planning Use at 12 months by type of use
in first 6 months
n 222
n 829
n199
n511
n350
n488
n100
n434
Use at 12 months
13
Family Planning at 12 Months
LAM Users
Breastfeeders
Non-Users
Pill Users
14
Use of Modern Method at 12 Months Controlling for
Ever Use of Modern Method in 24 Months Preceding
Index Pregnancy
N1969
N1164
15
Percent of Women Pregnant by 12 months by type
of FP in the first 6 months
N3133
16
ConclusionsHow does LAM relate to modern method
use at 12 months?

• LAM users had higher use of other modern methods
  than non-users, or those who used breastfeeding,
  abstinence or withdrawal
• This pattern continued when parity, educational
  level, wealth, desire for additional children,
  previous use of another method and breastfeeding
  were controlled

17
ConclusionsDoes LAM use increase modern method
use among previous non-users?

• LAM use appears to increase use of modern methods
  among previous non-users
• Thus, for women who do not want to use a modern
  method in the 1st six months, LAM appears to
  bring women into the family planning system

18
ConclusionsHow does LAM relate to pregnancies by
12 months?

• LAM users were less likely to get pregnant than
  non-users (p lt .05)
• Odds Ratios were not different between the other
  groups and LAM users with the exception of IUD
  users who were less likely to get pregnant
• LAM user not any more likely to get pregnant than
  a pill user.

19
Discussion

• Proper identification of LAM users is essential
  to understanding their outcomes
• LAM is not synonymous with breastfeeding
• LAM users can be reached through MCH clinics (vs.
  family planning clinics)
• Promoting LAM does not necessarily lead to a
  missed opportunity for contraception

20
Appendices

• LAM Study Preliminary Results

21
Unadjusted Odds Ratios for Use of Family
Planning at 12 months postpartum (LAM Users vs.
Other Postpartum Women)
CI 12.2-28.8
CI 2.79-5.71
18.789
CI 1.67-3.67
CI . 33-.61
CI .16-.34
CI .02-.17
CI .17-.37
22
Binary Logistic Regression Variables

• Wealth index
• Breastfeeding/No breastfeeding at 12 months
• Living children
• Educational level
• Use of modern method in 24 months prior to the
  pregnancy with the index child
• Wants/Does not want another child
• Used/Did not use LAM in first 6 months

23
Percent of Respondents in Lowest Wealth
Tercileby type of FP in the first 6 months
N3133
24
Breastfeeding Practices for Index Child by
type of FP in the first 6 months
N3166
25
Percent of Women with Only 1 Living Child by
type of FP in the first 6 months
N3183
26
Percent of Women with lt Secondary Education by
type of FP in the first 6 months
N3183
27
of Women Using a Modern Method in the 24
Months preceding the index pregnancy by type of
FP in the first 6 months
N3183
28
Percent of Respondents who Desire Another Child
by type of FP in the first 6 months
N3144
29
Adjusted Odds Ratios for Use of Family Planning
at 12 Months (LAM Users vs. Other Postpartum
Women)

CI 14.13-37.12
23.139
30
Percent of Women Pregnant by 12 months by type
of FP in the first 6 months
N3133
31
Unadjusted Odds Ratios for Rate of Pregnancy by
12 Months by type of FP at 12 months postpartum
(LAM Users vs. Other Postpartum Women)
CI 1 .76-3.5
CI .71-2.37
CI .71-1.96
CI .55-1.24
CI .49-1.21
CI .39-1.03
CI .09-.31