Why is contraceptive use inversely associated with lactational amenorrhoea? Qualitative and quantitative insights from Bangladesh |
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Authors: | Sarah Salway |
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Institution: | (1) London School of Hygiene and Tropical Medicine, London, UK;(2) Centre for Population Studies, 49-51 Bedford Square, WC1B 3DP London, UK |
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Abstract: | Over the past 15–20 years observations in many parts of the world have revealed a negative association between the natural
protection afforded by lactational amenorrhoea and contraceptive uptake. This paper uses qualitative and quantitative data
to explore the possible explanations for this nagative association in two Bangladeshi populations, one urban and one rural.
The findings suggest that a subconscious substitution of contraceptive protection for natural protection against pregnancy
is the most likely explanation. It appears that shorter durations of exclusive breastfeeding have led to earlier resumption
of menses which in turn prompts the use of contraception. However, other mechanisms appear to play a subsidiary role, at least
in the rural population. Moreover, changes in breastfeeding cannot be viewed as totally independent of the promotion of modern
family planning. Evidence suggests that family planning staff are poorly equipped to support breastfeeding, and may often
encourage the early introduction of supplements. There is a need to consider ways of promoting exclusive breastfeeding as
well as ensuring ready access to contraception when fecundity resumes postpartum. Only such an integrated approach is likely
to ensure that both negative effects on child health and unwanted pregnancies are avoided. |
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