LACTATIONAL AMENORRHOEA METHOD (LAM)

The lactational amenorrhoea method (LAM) is the use of breastfeeding as a contraceptive method. Lactational means breastfeeding and amenorrhoea means not having monthly bleeding. In this case, there is a delay in ovulation caused by the action of prolactin hormone from the effect of lactation or breastfeeding. An infant’s suckling of the nipple sends neural signals to the mother’s hypothalamus (part of the brain), which influences the anterior pituitary gland to secrete prolactin to stimulate the breast for milk production. This, in turn, inhibits the secretion of follicle stimulating hormone (FSH) and luteinizing hormone (LH), and as a result ovulation does not occur. While women are exclusively breastfeeding, prolactin continues to be secreted and pregnancy is unlikely. When prolactin levels decrease, the woman’s monthly bleeding may return, and if she continues to have unprotected sexual intercourse she may get pregnant. But the duration of suppression of ovulation is quite variable, depending on the breastfeeding status of the mother and the condition of the infant. To be fully effective the following three conditions must be met:

1 The woman’s menstrual period must not have returned.

2 The baby must be exclusively breastfed frequently, day and night. Exclusive breastfeeding means the infant receives no food or fluids other than breast milk.

3 The baby must be less than six months old. This is because from six months onwards the baby needs to begin receiving complementary foods while continuing to be breastfed. The reduction in the amount of suckling at the breast may affect the hormonal mechanism, resulting in ovulation and menstruation returning, indicating a return of the woman’s fertility. If any one of these three criteria changes, another contraceptive must be started immediately to prevent an unwanted pregnancy, and to ensure healthy birth spacing of at least three years.

Factors affecting LAM

Any factor that causes a decrease in suckling can result in the return of ovulation and decreased milk production. These factors include 

• Supplemental feeding of the infant,

• Reduction in the number of breastfeeds or long intervals between breastfeeds,

• Maternal stress and maternal/child illness. In these cases, the client should not rely on LAM

• Instructions to client on LAM

• Breastfeed exclusively for the first 6 months

• Breastfeed as often as the child demands

• Refrain from giving a pacifier (dummy)

• Allow long time on the breast each time (at least 15 minutes on each breast)

• Breastfeed both in the day (at least 8 times) and during the night (at least twice)

• Give no other food, drink or water before 6 months of age

• Use another method of contraception, if for any reason the milk begins to fail or

• breastfeeding is interrupted or irregular

• Return to the clinic if breastfeeding pattern changes or menstruation resumes. (Another method will be needed, counsel and provide accordingly)

• Note: This method can be effective for women whose infants are less than 6 months old, and who follow instructions strictly. After 6 months, effectiveness is not certain.

Advantages

• Effectively prevents pregnancy for at least six months.

• Encourages the best breastfeeding pattern

• Can be used immediately after birth

• Does not interfere with sexual intercourse

• No hormonal side-effects.

Disadvantages

• Not a suitable method if the mother is working outside the home.

• No protection against STIs including HIV.

• If the mother has HIV, there is a small chance she may pass it to her baby in breastmilk.

• Not effective after six months

Effectiveness of LAM

If the woman follows the method correctly — it is 98–99% effective 

COITUS INTERRUPTUS (WITHDRAWAL OR PULLING OUT) METHOD

Coitus interruptus or withdrawal is a traditional family planning method in which the man withdraws or pulls out his penis from his partner’s vagina and ejaculates outside, keeping his semen away from her genitalia.

Mechanism of action of withdrawal method

Coitus interruptus prevents fertilisation by stopping contact between spermatozoa in the sperm and the ovum or egg.

Advantages of withdrawal method

• It is important for you to teach this method as part of natural family planning methods. 

• It costs nothing and requires no devices or chemicals. It is available in any situation and can be used as a back-up method of contraception.

Disadvantages of withdrawal method

It has several disadvantages. 

• Interruption of the excitement of sexual intercourse may result in the incorrect or inconsistent use of this method, as well as decreasing sexual pleasure for both partners. 

• A high failure rate may be due to a lack of self-control, and semen containing sperm may leak into the vagina before the person ejaculates.

• There is a further possibility of premature ejaculation by the man. 

• In addition, the couple is not protected from STIs, including HIV.

• May be difficult for couples with sexual dysfunction such as premature or

• unpredictable ejaculation

•  Requires the co-operation of the couple

Effectiveness of withdrawal method

It is the least effective method because it depends on the man’s ability to withdraw before he ejaculates. However, it is about 73% effective if used correctly 

BARRIER CONTRACEPTIVE METHODS

Barrier contraceptive methods are another type of contraceptive method used for preventing pregnancy and certain sexually transmitted infections. Various male and female barrier methods of contraception have been in use for centuries, and they are one of the oldest methods in use. They are designed to prevent the passage of sperm into the uterus during the sexual act. The success of such methods depends on the quality of the barriers, and the motivation and willingness of the couple to use the method. The male condom is the only male barrier known, while a number of different female barriers exist, such as the diaphragm, female condom and cervical cap, all of which are widely available. Spermicides are often used in conjunction with barrier methods. They are chemical barriers which can also be used on their own.

Types of barriers

Barrier contraceptives are broadly classified into two main types: 

• Mechanical barriers and 

• Chemical barriers.

MECHANICAL BARRIERS

Mechanical barriers are devices that provide a physical barrier between the sperm and the egg. Examples of mechanical barriers include the male condom, female condom, diaphragm, cervical cap, and sponge. The condom is the only contraceptive method that helps prevent sexually transmitted infections (STIs).

Chemical barriers

Chemical barriers or spermicides are sperm-killing substances, available as foams, creams, gels, films or suppositories, which are often used in female contraception in conjunction with mechanical barriers and other devices. Spermicides are usually available without a prescription or medical examination.