It is generally agreed that contraception after childbirth improves the health of mothers and children by lengthening
birth intervals. Every year, it is estimated over 100 million women make decision about beginning or resuming contraception
after childbirth. The timing of contraception initiation is important since the return of menstruation and ovulation
can be unpredictable in breastfeeding women. This review discusses the relationship between breastfeeding, sexuality
and contraception during the postpartum period.
Evidence shows that many couples resume sexual intercourse before the sixth postpartum week. Yet information on the
relationship between sexuality and breastfeeding is limited and conflicting. While some studies reported positive effects
of breastfeeding on sexuality, many studies showed a delay in the resumption of sexual activities among breastfeeding
compared with bottle-feeding women. Since many women become sexually active earlier than 6 weeks post-partum, they
should use a method of contraception before the sixth week, especially if they are not breastfeeding.
Evidence confirms the recommendations of Bellagio Consensus Conference in 1988 on Lactational Amenorrhea Method
(LAM) that fully breastfeeding women who remain amenorrheic have a very small risk of becoming pregnant in the first 6
months after delivery (less than 2%). As soon as the baby is 6 months old or as soon as supplementary feeding is started
or menses is resumed, LAM no longer provides effective contraception, and other family planning methods should be introduced
if pregnancy is not desired. Despite its demonstrated efficacy, many women, however, decide not to use LAM
due to concerns of its efficacy and uptake of this method is low in many countries.
Given the demonstrated efficacy of LAM as a contraceptive in the postpartum period, the method should be more strongly
promoted for its effective use in developing countries, in particular where access to or the acceptability of other forms of
contraception may be limited.