It is a well known fact that breastfeeding
suppresses a woman's fertility in the early
months after delivery. However, many women do
not feel comfortable relying on breastfeeding
as a form of birth control because they have
been told it is unreliable, or perhaps because
they know someone who became pregnant while
The Lactational Amenorrhea Method (LAM) was
created to allow women to safely rely on breastfeeding
as a family planning method. Based on scientific
research, the method uses three measures of
a woman's fertility: 1) the return of her menstrual
period, 2) her patterns of breastfeeding, and
3) the time postpartum.
Who can use LAM?
A woman can use LAM if:
1. Her menstrual period has not returned since
delivery (Bleeding or spotting during the first
56 days is not considered menstrual bleeding.)
2. She is breastfeeding her baby on demand,
both day and night and not feeding other foods
or liquids regularly (Occasional tastes of foods
or other liquids are permitted, but they should
never replace a feeding at the breast.)
3. Her baby is less than six months old.
When all three of these conditions exist, she
has less than a two percent chance of becoming
pregnant. However, the woman is encouraged to
begin using a complementary family planning
method when any of the three conditions changes,
or whenever she chooses.
When is LAM no longer
A woman who chooses to rely on LAM should be
advised that the method is short-term (up to
six months) and is no longer effective when
any one of the three criteria changes.
The LAM user should be counselled to use another
contraceptive method for continued protection
1. Her menstrual periods
Menstrual bleeding is the most important indicator
of fertility. After the initial 56 days postpartum,
two consecutive days of bleeding/spotting or
the woman's perception that her period has returned,
whichever of the two comes first, should be
considered an indication that fertility is returning.
A woman can ovulate before her period returns,
however, studies indicate this rarely occurs
when the woman is breastfeeding intensively
and less than six months postpartum.
2. She begins feeding
her baby other liquids or foods regularly, or
her baby sleeps through the night.
Ovulation is suppressed in the breastfeeding
woman as the baby suckles at the breast. When
the baby begins taking other foods or liquids
she/he generally suckles at the breast less,
thus reducing the fertility-suppressing effect
of breastfeeding. This is also true when the
baby begins sleeping through the night--long
intervals between breastfeeds (more than four
hours during the day and six hours at night)
should be avoided.
3. Her baby is older
than six months.
At about six months, the baby should begin eating
other foods, as their nutritional needs change
at this time. Usually the baby will breastfeed
less when this happens, thus, LAM becomes less
Any one of these changes will reduce LAM's high
efficacy. At this time, the LAM user should
be counselled about complementary family planning
methods that do not interfere with breastfeeding.