It has been an eye opener for me to see the range of responses on this
thread.  Many of them reveal confusion about the definition and criteria for
LAM, as well as misunderstandings about what is a failure of the method, and
what is an expected outcome given the situation described.

For LAM to have an effectiveness rate comparable to pharmaceutical or
barrier methods of contraception, none of which are 100%, THREE things must
be true.
1- Baby must be fully breastfed, and it is an advantage if there are no
intervals over 6 hours between any feeds.
2- Mother must be amenorrheic, defined as NO VAGINAL BLEEDING POST PARTUM
AFTER THE INITIAL LOCHIA HAS STOPPED (not shouting, just enunciating very
clearly)
3- Baby must be under 6 months old

After numerous off-list posts on this to me, I have still only encountered
one woman who became pregnant when all of these criteria were met.

The instant any one of these conditions is not true, the LAM will have lower
effectiveness than before.  Vaginal bleeding is readily recognizable as long
as the woman is not visually impaired.  Age of baby is also possible for
most women to keep track of.  Whether baby is fully BF or not seems to me to
be an easy yes/no question too.
What's the problem?  The problem is that a lot of people  out there seem to
think they know what LAM is, when they don't.  If you aren't sure, then
please consult a reference work or refer to someone who is, rather than
giving yourself or another person inaccurate information.
Back in the olden days when I did contraceptive counseling, I liked
'Contraceptive Technology' by Hatcher, Hatcher et al, updated every other
year, published by Irvington.  I don't know whether they are still producing
the series but if they are it is definitely worth a look.
Rachel Myr
Kristiansand, Norway

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