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Home » DHS-7 Questionnaire Review - Archived » Family Planning and Reproductive Health » REVISION: Lactational Amenorrhea Method (LAM)
REVISION: Lactational Amenorrhea Method (LAM) [message #1725] Wed, 02 April 2014 09:33 Go to next message
Messages: 4
Registered: April 2014
Location: United States
Suggested revision: Add a probe to LAM in question 301.

Rationale: LAM is the only method with not probe. Some users may know recognize the name, yet
may be familiar with the method itself. Not having a probe probably results in underestimating LAM use.

Specific change: we suggest inserting the following probe
"If a woman's menstrual period has not returned in the first 6 months after her baby is born, she can
avoid pregnancy by breastfeeding frequently, day and night."

Institute for Reproductive Health, Georgetown University
Using evidence to expand family planning choices, advance gender equality, and involve communities.

[Updated on: Wed, 02 April 2014 09:34]

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Re: REVISION: Lactational Amenorrhea Method (LAM) [message #1810 is a reply to message #1725] Thu, 03 April 2014 15:10 Go to previous messageGo to next message
jkavle is currently offline  jkavle
Messages: 1
Registered: April 2014
Location: Washington DC
Dear DHS Colleagues:

On behalf of the Maternal Infant and Young Child Nutrition and Family Planning (MIYCN-FP) Working Group, we endorse the following changes for the DHS on LAM. This group includes technical organizations, including PATH, Jhpiego, and JSI. We have attached a document which outlines suggestions for measuring LAM for surveys (such as DHS). Please see attached document. We also outline our rationale and changes below, as well as how the interviewer can confirm whether a mother is using LAM
LAM Indicators for Survey Use
Background: Ensuring quality data from household and other surveys, i.e. Demographic Health Surveys (DHS), requires standardization of survey items with possible responses that adequately differentiate between various states under study.

It is critical that the description of LAM is clearly understood, properly translated and described in a standardized manner by survey staff. Trained survey interviewers should probe if women say they are using LAM but cannot explain the three LAM criteria to clearly differentiate LAM from breastfeeding practices, or amenorrhea alone. Given that many women equate breastfeeding with LAM, it is important to distinguish the difference between the two practices to avoid confusion during survey data collection. This guidance should be included in the survey tool as well. Therefore, LAM should be automatically included in all DHS surveys and countries may choose to "opt-out," if programs do not offer LAM.

Surveys are usually cross-sectional and address a specific point in time. Questions about LAM use and transition to another method will be cross-sectional and/or retrospective (See Appendix 1 for example questions). LAM indicators that can be measured via surveys are included in Table 2.

For DHS, we propose the following changes to the Model Women's Questionnaire. To ensure that women can differentiate LAM from breastfeeding according to the three LAM criteria, we suggest adding a probe for LAM in Question 301 (09) of the contraceptive table. Specifically, for the question "Have you ever heard of Lactational Amenorrhea Method?"
We suggest the addition of the following probe: "If a woman's menstrual period has not returned in the first 6 months after her baby is born, she can avoid pregnancy by giving her baby breastmilk and no other liquids, food or water, on demand, day and night."

We also suggest that the following qualifying statement regarding LAM be changed (2):
The LAM method should be delted in countries that do not have a LAM program. In these countries, LAM should also be delted as a coding category in Qs 304, 314, 316, 322 and Column 1 of the calendar. The description of LAM should not be provided in Question 301.

Should be replaced with: LAM should be included in the coding category for all the following questions: Qs. 304, 314, 316, 322 and Column 1 of the calendar.

For all questions such as Q 304 (Which method are you using?), 314, 313, 315, 315A, 321, 322,the interviewer should confirm that if a woman states she has ever used or currently uses LAM (depending on country, there may be a local term for LAM) and that she can explain the 3 criteria for LAM use (operational definitions).

When the interviewer asks about and probes for LAM, the DHS interviewer can review previous responses to confirm if the woman states her menses has returned through question 238 (When did your last menstrual period start?) and whether she has a child under age of 6 months (question 217 how old was (NAME) at his/her last birthday). Current breastfeeding practices can be ascertained through "Section 4 Pregnancy and Postnatal Care", for example, Question 459 (Are you still breastfeeding (NAME)? Interviewers should ask if the mother is only giving breastmilk to her baby, if the baby is less than 6 months of age), as well as confirmation on menses return, Question 447 (Has your menstrual period returned since the birth of (NAME)?)

With best regards,
Justine Kavle

Justine Kavle, PhD, MPH, CPH
Senior Program Officer, Nutrition
PATH and MCHIP Project
455 Massachusetts Ave. NW, Suite 1000 | Washington, DC 20001
Direct (at PATH DC): 202.540.4345
Re: REVISION: Lactational Amenorrhea Method (LAM) [message #1871 is a reply to message #1810] Fri, 04 April 2014 14:27 Go to previous message
agnes guyon
Messages: 3
Registered: April 2014
Location: USA
I strongly agree that LAM should be added in DHS as a modern family planning method.
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