1. Session I, Slide 11 Lactational Amenorrhea Method (LAM) Session I: Characteristics of LAM

2. Session I, Slide 22 LAM Objectives Participants will: Describe the three criteria for LAM in a manner that clients can understand. Explain basic mechanism of action and effectiveness of LAM. Identify appropriate timing to start other methods of contraception for breastfeeding mothers (for “transition” from LAM). Identify advantages and limitations of LAM Demonstrate how to counsel LAM-related topics (three criteria, transition from LAM to another method, optimal breastfeeding practices).

3. Session I, Slide 3 LAM: Key Points for Providers and Clients A temporary contraceptive method based on breastfeeding. “Lactational”—related to breastfeeding. “Amenorrhoea”— not having menstrual bleeding. Using LAM means choosing to breastfeed in a way that prevents pregnancy. It works by stopping ovulation. A “gateway” to other modern methods of contraception. LAM means breastfeeding often, day and night, and giving baby little or no other food. Fully or nearly fully breastfeeding (with little or no other food or drink) gives best protection from pregnancy and is best for the baby’s health. Effective for 6 months after giving birth If periods have not returned. Very effective when used correctly. (less than 1 pregnancy per 100 women using LAM in the first 6 months after childbirth). But as commonly used it is less effective (2 pregnancies per 100 women ) in the first 6 months of use. LAM

4. Session I, Slide 4 LAM: Key Points for Providers and Clients Breast milk is the best food for babies Healthiest way to feed most babies for first 6 months. Breast milk contains the exact nutrients the baby needs and helps protect the baby from infections. Breastfeeding benefits the mother’s health too. Breastfeeding should be started within 1 hour after birth, and babies should be given no other food or drink until they are 6 months old. Breast milk can be a major part of diet for 2 years or more. No protection against STIs or HIV/AIDS. For STI/HIV/AIDS protection, also use condoms. Breastfeeding can pass HIV from mother to baby, but is still recommended in most cases. LAM

5. Session I, Slide 55 LAM: Mechanism of Action Baby’s suckling stimulates the nipple Nipple stimulation triggers signals to mother’s brain Signals disrupt hormone production Disruption of hormones suppresses ovulation No egg, no pregnancy

6. Session I, Slide 6 Three LAM Criteria LAM If breastfeeding now, can use LAM if:  Baby is less than 6 months old AND  The baby is fully or nearly fully breastfeeding and is fed often day and night AND  Menstrual periods have not come back But please ask woman if she: Has AIDS? Or infected with HIV, the AIDS virus, so that she can receive counseling and treatment

7. Session I, Slide 7 How to Use LAM LAM Start giving baby other foods when he/she is 6 months old, but continue to breastfeed Can start LAM as soon as baby is born Breastfeed often day and night. Daytime feeding no more than 4 hours apart. Night-time feeding no more than 6 hours apart. Start another method at the right time, BEFORE the LAM criteria no longer apply What to do after LAM:

8. Session I, Slide 88 Effectiveness of LAM In this progression of effectiveness, where would you place LAM? Male Sterilization Female Sterilization IUDs Progestin-Only Injectables Combined Oral Contraceptives Male Condoms Standard Days Method Female Condoms Spermicides Less effective More effective Less effective More effective LAM

9. Session I, Slide 99 Effectiveness Source: CCP and WHO, 2007 (updated 20011). Oral contraceptives Percentage of women pregnant in first year of use, but note LAM only used for 6 months Rate during typical use Rate during perfect use Female condom Female sterilization Implants DMPA Spermicides Standard Days Method Male condom LAM 010 15 2025 5 30 IUD (TCu-380A)

10. Session I, Slide 1010 LAM: Characteristics Advantages Safe, natural and no side effects Requires no supplies or procedures Health benefits for mother and baby Can be used immediately after childbirth A temporary method Facilitates modern contraceptive use by previous non-users Is provided and controlled by the woman Supports and builds on global infant-feeding recommendation to exclusively breastfeed for six months Limitations No STI/HIV protection Is only a temporary method Not a good method for women who have to be away from their babies for long periods of time. Source: Hatcher, 2007; WHO, 2009; CCP and WHO, 2007 (updated 2008).