Percent of eligible women who use the lactational amenorrhea method as their method of family planning
The percent of women giving birth in a reference period who report using the lactational amenorrhea method (LAM) as their method of family planning (FP) within the first six months postpartum. This indicator counts women who self-report that they are using the method and does not require that they meet all three criteria for correct (or perfect) use listed below (WHO/JHU-CCP, 2011):
- The mother’s period has not returned
- The infant is fully or nearly fully breastfed and is fed often, day and night
- The infant is less than six months old
This indicator is calculated as:
(Number of women who report using LAM as their FP method / Total number of women with infants < 6 months) x 100
The LAM Interagency Working Group has recommended further indicators specific to women’s use of LAM. The “Number of confirmed LAM users” measures correct LAM use based on the above criteria and the “Number of passive LAM users” captures the women who meet the criteria but do not report using LAM.
A related indicator in this database is “Number or percent of maternal health services clients who received counseling about LAM” under Family Planning and Maternal and Child Health. For more background on this and related indicators, see IRH (2011).
Data on the number of women with infants less than 6 months old, and of those, the number who report that they are using LAM as a FP method. It is important that survey questions on LAM are clearly understood, properly translated, and described in a standardized manner by survey staff. Where the data are available, this indicator also can be disaggregated by the mother’s age, parity, education, income quintiles, and urban/rural residence.
Population-based surveys employing representative samples (e.g., Demographic Health Survey and UNICEF Multiple Indicator Cluster Surveys); FP service statistics (if data are systematically obtained on the age of the youngest child)
This indicator measures women’s use of LAM as a FP method during the first six months postpartum and can be used to examine current prevalence and follow trends in use. LAM protects a woman from pregnancy by disrupting ovulation through about six months postpartum as long as she is fully breastfeeding and menses have not returned. Because LAM is 98 percent effective when used correctly, encourages the best breastfeeding patterns with health benefits for both mother and baby, and is a good option before transitioning to another contraceptive method, it is often promoted by health providers, particularly in low resource settings. The benefits associated with LAM use are directly related to achieving Millennium Development Goals #4 reduce child mortality and #5 improve maternal health. Optimally, when any of the three criteria for correct LAM use is no longer met, another FP method needs to be introduced quickly. Evaluators can capture this follow-up method in both the FP registry as well as in subsequent population-based surveys.
This indicator is primarily based on self-report without verification that the respondent actually fulfills the three LAM criteria. A measure of correct use will include questions that confirm that the respondent knows the three criteria, that she meets these criteria, and that she is deliberately using LAM as her method of FP.
breastfeeding (BF), healthy timing and spacing of pregnancies (HTSP), family planning
WHO and Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (JHU-CCP), 2011, Family Planning: A Global Handbook for Providers, Baltimore, MD: Johns Hopkins University. http://www.globalhandbook.org/
Institute for Reproductive Health (IRH), 2011, Measurement of LAM through Programs, Surveys and Research: Recommendations from the MIYCN/FP Integration Working Group, Washington DC: IRH at Georgetown University.