Lactational Amenorrhea Method (LAM)
Madagascar, Bolivia, Jordan

LAM is a modern contraceptive method based on the natural infertility resulting from full or nearly full breastfeeding in the absence of menses up to six months postpartum. LAM, under typical use, is more than 98 percent effective and contributes to the first six months of birth spacing. Safe and affordable, LAM is also the most effective short-term modern method of contraception accessible to all women right after delivery. Despite these benefits, LAM is often misunderstood and undervalued by family planning and maternal and child health program planners and service providers. Consequently, many women are not presented with LAM as a family planning option.

AED's LINKAGES project used the LAM rate as a proxy for the expanded offering of the lactational amenorrhea method. This rate reflects the proportion of eligible women who give birth in a given period of time who consciously and deliberately accept LAM as a modern contraceptive method. Eligible women are those with infants less than six months.

Baseline results of the LAM rate in Madagascar and Bolivia were similar. In Madagascar the LAM rate increased dramatically, from 2 percent to 24 percent, which is statistically significant. Although the LAM rate more than doubled in Bolivia, this increase was not significant.

In Jordan the focus was on phased-in LAM training of all public, clinic-based maternal and child health service providers. Service statistics were analyzed to determine the LAM user rate. Because this rate reflects LAM use among all women of reproductive age using family planning services, it underestimates use among eligible women. When infant age is not available, the LAM user rate serves as a proxy for LAM use. In Jordan the LAM user rate among women who received services at the government's health centers increased dramatically over time, from 0.1 percent in 1999 to 13.3 percent in 2003. Due to the tendency of the LAM user rate to underestimate actual trends, this increase is more dramatic than it appears.

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