Breast milk remains the most important food for new born babies. It contains various nutrients and protective components for the baby’s optimal growth. Breastfeeding therefore offers numerous benefits to the baby: It reduces infections and mortality in children, improves mental and motor development, and protects against obesity, metabolic diseases, and premature deaths later in the life course.
Breastfeeding has also been known to give various benefits to the mother as It results in faster recovery after delivery, reduced blood loss following delivery, reduced maternal stress, faster loss of excess weight, protection against conception and reduced risk of breast and ovarian cancer [1-3]. It is no wonder that the World Health Organization (WHO) recommends exclusive breastfeeding in the first six months of life and sustained breastfeeding with complementary feeding for up to two years or beyond for optimal growth, development and survival of children .
Despite the well-known benefits of breastfeeding, misinformation and misperceptions regarding these benefits may be detrimental to both the health of the baby and the mother. One benefit of breastfeeding that seems to be widely misunderstood is that of using breastfeeding as a family planning (FP) method. Lactational amenorrhoea method (LAM) has long been accepted as a viable method of family planning . Lactational amenorrhea refers to temporary post-natal infertility when a woman is breastfeeding. A consensus conference in Bellagio in 1988 proposed guidelines under which LAM can be acceptable as a family planning method. For LAM to be acceptable, a mother has to fully or nearly fully breastfeed and must remain amenorrheic (not menstruating), during the first six months after birth. When these two conditions are fulfilled, breastfeeding provides over 98% protection from pregnancy in the first six months after birth .
The gospel of LAM has been widely spread in communities all over Kenya, but it seems that the conditions under which LAM is effective as an FP method are not adequately explained or understood. LAM has seemingly been strongly embraced as a method of family planning, probably because it is a natural method with no side effects that people often associate with other family planning methods e.g. “FP lowers sexual urge”, “FP reduces breast milk production,” easy access and no cost. What is really surprising, according to recent research by the African Population and Health Research Center (APHRC) in collaboration with the Unit of Human Nutrition and Dietetics, Ministry of Health are the misperceptions regarding this method and the consequences of these misperceptions with regards to breastfeeding and health of the child.
Through a public engagement study funded by the Wellcome Trust, APHRC together with the Unit of Human Nutrition and Dietetics, Ministry of Health conducted qualitative studies across six counties in Kenya including Nairobi, Kwale, Vihiga, Kiambu, Machakos and Kajiado. These studies involved in-depth interviews (IDIs), key informant interviews (KIIs), focus group discussions (FGDs) and community dialogues (CDs) with mothers, fathers, health care workers, community health workers (CHWs), community leaders and traditional birth attendants (TBAs) and other community representatives regarding their knowledge, attitudes and practices on breastfeeding and other infant feeding practices. Narratives from these studies clearly portray the misperceptions regarding use of LAM. As illustrated below, there is belief that any breastfeeding (whether exclusive or not, and whether in the first six months or not) is protective against conception.
While some women may be lucky to delay conception for the desired duration, many women conceive while breastfeeding and end up disappointed by unplanned pregnancy.
The consequence of the unplanned pregnancies is that they shorten the duration of breastfeeding. Mothers get pregnant within a short time following delivery and “the day that you realize you are pregnant you stop breastfeeding” (FGD, CHWs, Kajiado). While breastfeeding could continue for some months even when the mother gets pregnant to safeguard the health of the child, there are widespread myths across the country associated with breastfeeding while pregnant. Many people believe that breastfeeding while pregnant drastically affects the breastfeeding child: the child may become sick with diseases like diarrhoea or marasmus, may be deformed or may actually die. Many mothers have to therefore stop breastfeeding immediately when they discover they are pregnant, a fact illustrated in the following excerpts:
The misperceptions regarding LAM may be a major contributing factor to the high levels of unmet need for family planning (25%) among currently married women and also the high prevalence of unintended pregnancies (43%) among women of reproductive age (15-49 years) reported in Kenya . Consequently, unintended pregnancies leading to high parity coupled by the myths surrounding breastfeeding while pregnant may contribute to the high levels of malnutrition among children in Kenya with stunting levels of 35% among children aged less than five years . There is immediate need to address the misperceptions surrounding LAM and the myths surrounding breastfeeding for optimal breastfeeding practices, growth and development of children in Kenya.
1. Lanigan, J. and A. Singhal, Early nutrition and long-term health: a practical approach. Proc Nutr Soc, 2009: p. 1-8.
2. Victora, C.G., et al., Maternal and child undernutrition: consequences for adult health and human capital. Lancet, 2008. 371(9609): p. 340-357.
3. Grantham-McGregor, S., et al., Developmental potential in the first 5 years for children in developing countries. Lancet, 2007. 369(9555): p. 60-70.
4. WHO, Global strategy for infant and young child feeding, 2003, WHO Geneva.
5. Perez, A., M.H. Labbok, and J.T. Queenan, Clinical study of the lactational amenorrhoea method for family planning. Lancet, 1992. 339(8799): p. 968-70.
6. Kennedy, K.I., R. Rivera, and A.S. McNeilly, Consensus statement on the use of breastfeeding as a family planning method. Contraception, 1989. 39(5): p. 477-496.
7. Kenya National Bureau of Statistics (KNBS) and ICF Macro, Kenya Demographic and Health Survey 2008-09. 2009: Calverton, Maryland: KNBS and ICF Macro.