1. Lactational Amenorrhea Method and Infant Feeding Options

2. Lactational Amenorrhea Method Temporary contraceptive option Used by postpartum women who: –are less than six months postpartum –are fully or nearly fully breastfeeding –have no menses Safe, convenient, effective Source: Hatcher, 2007.

3. Characteristics of LAM: Advantages Universally available At least 98% effective, no side effects Begins immediately postpartum Health benefits for mother and child No direct cost for family planning or feeding the baby No commodities/supplies required Bridge to other contraceptives

4. Characteristics of LAM: Disadvantages Breastfeeding pattern may be difficult to maintain No STI or HIV protection Risk of HIV transmission to baby Duration of method limited Only useful for breastfeeding women

5. Recommended Breastfeeding Behaviors A mother should breastfeed: Soon after delivery Without supplementation up to six months Frequently, upon request, not on schedule Without long intervals between feeds both day and night Without pacifiers or bottles

6. LAM Use by Women with HIV Advise that children can become infected –risk of acquisition through breast milk ~16% Exclusive breastfeeding during first 6 months may reduce risk of acquisition by infant (compared to mixed feeding) Exclusive use of formula or other substitutes eliminates risk of transmission through breast milk (often not possible) Source: WHO, 2004, updated 2008; Nduati, 2000; De Cock, 2000; WHO, 2006.

7. Infant Infection Risks if Mother with HIV Receives No Treatment Fewer babies are infected if mothers and babies are treated. 4 babies will be infected with HIV through pregnancy and delivery 3 more babies will be infected with HIV through breastfeeding 13 babies will be HIV-free If 20 women with HIV have babies: Source: WHO, 2004.

8. Factors That Increase Transmission of HIV to Infant during Breastfeeding High maternal viral load Duration of breastfeeding Mixed feeding Breast abscesses, nipple fissures, mastitis Poor maternal nutrition status Infant oral sores Source: WHO, 2004.

9. Infant Feeding Options for Women with HIV Up to six months: Exclusive breastfeeding OR Replacement feeding –expressed, heat-treated breast milk –commercial infant formula –breastfeeding by an HIV-negative wet nurse –breast-milk banks Source: WHO, 2006.

10. Infant Feeding Options for Women with HIV Beyond six months: Switch to replacement feeding if acceptable, feasible, affordable, sustainable, safe (AFASS) If not AFASS, continue breastfeeding along with complementary foods All breastfeeding should stop if adequate and safe diet without breast milk can be provided Source: WHO, 2006. If a child is known to have HIV, the mother should be strongly encouraged to continue breastfeeding.

11. Summary of Contraceptive Choices Use two methods concurrently (condoms plus another contraceptive method) Use one method and understand its limitations (prevent pregnancy versus prevent transmission) –effective pregnancy prevention but no STI/HIV protection –condoms protect from STIs/HIV but typically less effective preventing pregnancy than some other methods Use no method and abstain from sexual intercourse