Transition from the Lactational Amenorrhea Method to other modern family planning methods in rural Bangladesh: Barrier analysis and implications for behavior change communication program intervention design |
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| Institution: | 1. Academy for Educational Development, 1825 Connecticut Ave., NW, Washington, DC 20009, USA;2. Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA;3. Jhpiego, 1615 Thames Street, Baltimore, MD 21231-3492, USA;4. Shimantik, 581 Shewrapara, Mirpur, Dhaka 1216, Bangladesh;1. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI;2. Program on Women’s Healthcare Effectiveness Research, University of Michigan, Ann Arbor, MI;3. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI;4. Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI;5. University of Michigan Medical School, Ann Arbor, MI;6. Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA;7. Department of Internal Medicine, University of Michigan, Ann Arbor, MI;1. MedStar Washington Hospital Center, Department of Women and Infant Services, Washington, DC;2. Georgetown University School of Medicine, Washington, DC;3. MedStar Health Research Institute, Washington, DC;4. Department of Pediatric Surgery, Children''s National Medical Center, Washington, DC;1. Reproductive Health Division, Center for Population Research, Mexican National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, CP 62100 Cuernavaca, Morelos, Mexico;2. Center for Population Research, Mexican National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, CP 62100 Cuernavaca, Morelos, Mexico;1. Institute of Geology, Chinese Academy of Geological Sciences, Beijing 100037, China;2. Shandong Institute of Geology Survey, Jinan 250000, Shandong, China;3. School of Earth Sciences and Resources, China University of Geosciences (Beijing), Beijing 100083, China;4. Dinosaur Research Center of Zhucheng, Zhucheng 262200, Shandong, China |
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| Abstract: | The timely transition from Lactational Amenorrhea Method (LAM)2 to another modern family planning method contributes to healthy spacing of pregnancies by increasing the adoption of family planning during the first year postpartum. Yet, literature suggests challenges in completing a timely LAM transition. To guide program implementation in Bangladesh, this study identified factors influencing women's transition decisions.Eighty postpartum women, comprising 40 who transitioned from LAM3 and 40 who did not,4 participated. Half of each group participated in in-depth interviews to explore the decision-making process. All participants responded to a “Barrier Analysis” questionnaire to identify differences in eight behavioral determinants.More than half of transitioners switched to another modern method before or within the same month that LAM ended. Of the 18 transitioners who delayed,5 15 waited for menses to return. For non-transitioners, key barriers included waiting for menses to return, misconceptions on return to fertility, and perceived lack of familial support. The LAM transition can help women prevent unintended pregnancy during the first year postpartum. Increased emphasis on counseling women about the risk of pregnancy, and misconceptions about personal fertility patterns are critical for facilitating the transition. Strategies should also include interventions that train health workers and improve social support. |
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| Keywords: | Contraception Postpartum family planning South Asia Lactational Amenorrhea Method Qualitative Research Methods Barrier analysis |
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