When counseling women about the effects of lactation on fertility I feel
very strongly that we should follow the internationally recognized
guidelines for LAM, which are based on large studies of women in many
countries.
Please do not confuse 'lactational amenorrhea' with the lactational
amenorrhea method of family planning.  The first merely describes a feature
of lactation in virtually all women, though the period varies widely.
The LAM has statistically much higher effectiveness in the first 6 months
postpartum.  It works as long as the mother is lactating and providing all
baby's calories around the clock (and some say, meeting all baby's suckling
needs, as in no pacifiers either), and has not had a period, AND the baby is
under six months old.  Once ANY of those conditions changes, the woman
should not rely on LAM alone if she is intent on avoiding a pregnancy at
that time.

All of us know that some women don't resume menses until total weaning, and
others resume shortly after giving birth despite exclusive and frequent
breastfeeding.

Women need to know how effective LAM is under the circumstances described
above, and the pregnancy rate for women using LAM in this way is 2%.  I am
not sure whether that is 2% per woman-year or per woman-half year, since if
they are following the guidelines they will not be relying on it for more
than 6 months maximum.

Fertility is altered when breastfeeding; some women will not conceive
despite regular periods, while breastfeeding.  Others will.  Knowing what
happened to one individual is not as relevant for the woman learning about
LAM, as learning the FACTS about the method so she can make an informed
choice.

http://www.who.int/reproductive-health/hrp/progress/55/news55_2.en.html
This is a document about LAM, very detailed, and worth reading.

Rachel Myr
Kristiansand, Norway

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