Questions and Answers About the Lactational Amenorrhea Method

1.   Can LAM be an effective method of family planning?

Yes. LAM is very effective if the woman's monthly bleeding has not returned, she is fully or nearly fully breastfeeding, and her baby is less than 6 months old.

2.   When should a mother start giving her baby other foods besides breast milk?

Ideally, when the baby is 6 months old. Along with other foods, breast milk should be a major part of the child's diet through the child's second year or longer.

3.   Can women use LAM if they work away from home?

Yes. Women who are able to keep their infants with them at work or nearby and are able to breastfeed frequently can rely on LAM as long as they meet all 3 criteria for LAM. Women who are separated from their infants can use LAM if breastfeeds are less than 4 hours apart. Women can also express their breast milk at least every 4 hours, but pregnancy rates may be slightly higher for women who are separated from their infants. The one study that assessed use of LAM among working women estimated a pregnancy rate of 5 per 100 women during the first 6 months after childbirth, compared with about 2 per 100 women as LAM is commonly used.

4.   What if a woman learns that she has HIV while she is using LAM? Can she continue breastfeeding and using LAM?

If a woman is newly infected with HIV, the risk of transmission through breastfeeding is much higher than if she was infected earlier, because there is more HIV in her body. The breastfeeding recommendation is the same as for other HIV-infected women, however. If replacement feeding is acceptable, feasible, affordable, sustainable, and safe, she should be counseled that, with such replacement feeding, her baby will have no risk of HIV infection through breastfeeding. If replacement feeding cannot meet these 5 criteria, she should breastfeed exclusively during the first 6 months. Thus, she can continue relying on LAM. If she chooses to stop breastfeeding, she should stop completely over a period of about 2 days to 3 weeks. After 6 months, breast milk alone is no longer enough nutritionally for the baby, and she should switch from LAM to another contraceptive method (see also The Lactational Amenorrhea Method for Women With HIV).

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