It is a well known fact that breastfeeding suppresses a woman's fertility in the early months after delivery. However, many women do not feel comfortable relying on breastfeeding as a form of birth control because they have been told it is unreliable, or perhaps because they know someone who became pregnant while breastfeeding.

The Lactational Amenorrhea Method (LAM) was created to allow women to safely rely on breastfeeding as a family planning method. Based on scientific research, the method uses three measures of a woman's fertility: 1) the return of her menstrual period, 2) her patterns of breastfeeding, and 3) the time postpartum.

Who can use LAM?
A woman can use LAM if:
1. Her menstrual period has not returned since delivery (Bleeding or spotting during the first 56 days is not considered menstrual bleeding.)
AND
2. She is breastfeeding her baby on demand, both day and night and not feeding other foods or liquids regularly (Occasional tastes of foods or other liquids are permitted, but they should never replace a feeding at the breast.)
AND
3. Her baby is less than six months old.

When all three of these conditions exist, she has less than a two percent chance of becoming pregnant. However, the woman is encouraged to begin using a complementary family planning method when any of the three conditions changes, or whenever she chooses.

When is LAM no longer effective?
A woman who chooses to rely on LAM should be advised that the method is short-term (up to six months) and is no longer effective when any one of the three criteria changes.
The LAM user should be counselled to use another contraceptive method for continued protection when:
1. Her menstrual periods return.
Menstrual bleeding is the most important indicator of fertility. After the initial 56 days postpartum, two consecutive days of bleeding/spotting or the woman's perception that her period has returned, whichever of the two comes first, should be considered an indication that fertility is returning. A woman can ovulate before her period returns, however, studies indicate this rarely occurs when the woman is breastfeeding intensively and less than six months postpartum.
OR
2. She begins feeding her baby other liquids or foods regularly, or her baby sleeps through the night.
Ovulation is suppressed in the breastfeeding woman as the baby suckles at the breast. When the baby begins taking other foods or liquids she/he generally suckles at the breast less, thus reducing the fertility-suppressing effect of breastfeeding. This is also true when the baby begins sleeping through the night--long intervals between breastfeeds (more than four hours during the day and six hours at night) should be avoided.
OR
3. Her baby is older than six months.
At about six months, the baby should begin eating other foods, as their nutritional needs change at this time. Usually the baby will breastfeed less when this happens, thus, LAM becomes less effective.
Any one of these changes will reduce LAM's high efficacy. At this time, the LAM user should be counselled about complementary family planning methods that do not interfere with breastfeeding.