Number or percent of maternal and child health services clients who received counseling about LAM

 

The number or percent of women attending maternal and child health (MCH) services (i.e., antenatal care, labor and delivery, postpartum visit, and/or infant and child health/immunization visits) during a specified time period, who received counseling about the lactational amenorrhea method (LAM) as a postpartum family planning (FP) method.

For women delivering at a facility, counseling should be conducted prior to discharge.  It should consist of an evaluation for LAM use, instruction on the method including information that LAM is 98 percent effective in preventing pregnancy when used correctly, and the need for immediate transition to another modern method when any of the LAM criteria are no longer being met.  The three criteria for correct LAM use are:

  1. The mother’s period has not returned.
  2. The infant is fully or nearly fully breastfed and is fed often, day and night.
  3. The infant is less than six months old.

For more background on LAM counseling, see the K4Health LAM Toolkit.

This indicator is calculated as:

(Number of women attending MCH services who received LAM counseling / Total number of women who attended MCH services during a specified time period) x 100

For closely related indicators in this database, see the Percent of women receiving postpartum/ postabortion family planning counseling under Safe Motherhood; the Percent of eligible women who use the lactational amenorrhea method as their method of FP under Breastfeeding; and the Percent of women who received family planning information for pregnancy spacing during a postpartum/postabortion visit, by type of visit under Healthy Timing and Spacing of Pregnancy.


Data can be used from facility records, health information systems (HIS), client interviews, and specialized surveys. The data can be disaggregated by the type of MCH services (e.g., antenatal, labor and delivery, or postpartum), the type of facility or program (public, private, non-governmental, community-based), and where data are available by other relevant factors, such as women’s age, parity, and urban/rural location.


Facility records; HIS; client interviews; specialized surveys


This indicator provides information on the level of access women have to information and counseling on LAM and can be used to compare and track trends in the integration of LAM counseling with MCH services. Because LAM is 98 percent effective when used correctly, encourages the best breastfeeding patterns with health benefits for both mother and baby, and is a good option before transitioning to another postpartum contraceptive method, it is often promoted by health providers, particularly in low resource settings. FP use during the first year postpartum has the potential to significantly reduce the number of unplanned pregnancies leading to fewer closely spaced pregnancy intervals and decreases in maternal and child morbidity and mortality. The integration of LAM counseling, as well as other FP methods, with MCH programs and services provides opportunities to streamline and improve care at the most favorable and critical times for maximizing women’s reproductive health and the health of their children. Multiple contacts with MCH services during the antenatal and the postpartum periods have been shown to increase women’s use of FP methods by six months postpartum and decrease unmet need for FP (USAID, ACCESS-FP, Frontiers, 2008). The benefits associated with combining FP and MCH services are directly related to achieving Millennium Development Goals #4 reduce child mortality and #5 improve maternal health.


 

This indicator does not  capture the quality of the LAM counseling services, if LAM was accepted as a FP method, or whether the facility makes referrals or follows up with women on the adoption, correct use, or continuation of LAM. Where the indicator is primarily based on self-report, clients may not remember or know for certain whether they received counseling on LAM, especially if there is a long time lag between receiving services and the interview.


breastfeeding (BF), family planning, newborn (NB), safe motherhood (SM)

 

K4Health LAM Toolkit: http://www.k4health.org/toolkits/lam

JHPIEGO/ ACCESS-FP, 2009, LAM Counseling Checklist for MNCH Service Providers, Baltimore MD: K4Health, Johns Hopkins Bloomberg School of Public Health.  https://www.k4health.org/toolkits/lam/lam-counseling-checklist-mnch-service-providers

USAID/ ACCESS-FP/ Frontiers, 2008, Strengthening Postnatal Care Services Including Postpartum Family Planning in Kenya, New York: The Population Council. http://pdf.usaid.gov/pdf_docs/Pnadn570.pdf

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