Breastfeeding, Fertility and the Life-Cycle

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Breastfeeding, Fertility and the Life-Cycle

• Miriam Labbok, MD, MPH, FABM
• Senior Advisor,
• Infant and Young Child Feeding and Care
• UNICEF NYHQ

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Areas to be Discussed

• What is a Life-cycle approach to Health?
• How does Delaying the First Birth and Increasing
  Birth Intervals contribute to Nutrition?
• How does Breastfeeding contribute to Birth
  Spacing?
• How does this effect us today, and what should be
  considered in terms of policy and programmes?
• References
• Labbok MH. Effects of Breastfeeding on the
  Mother. Ped Clin of North America, 2001 Feb
  48(1)143-5
• Optimal Birthspacing Saves Lives
  http//www.rhcatalyst.org/site/DocServer/Catalyst_
  OBSI_Overview_Final.pdf?docID341

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Intergenerational Life-cycle Approach Programme
Entry Points
Adolescent and School Programmes DELAY OF FIRST
BIRTH
ANC IRON/NUTRITION SAFE DELIVERY FEEDING SPACING
Mother
Birth
EPI, FP, All contacts AT LEAST 3 YRS.
SPACING WITH EXCLUSIVE BREASTFEEDING, CONTINUED
BREASTFEEDINGAND FREQUENT QUALITY CFs
Child
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Intergenerational Life-cycle Approach
Prolonging periods of the lifecycle to allow for
improved outcomes
Paternal Path
Puberty
Pregnancy
Complications/ Abortion
Maternal Path
Childs Path
Birth
Delay First Union Breastfeed Use Contraception
Unable to prolong, extra intervention necessary

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Breastfeeding is the Heartbeat of
Intergenerational Health
Breastfeeding supports
Nutrition
Survival Oral Rehydration
Birth Spacing and Fertility
Growth and Development
Womens Health, Survival, and Reproductive
Readiness
Immunization
Reduced Cancers and Chronic Diseases
Logo, Breastfeeding Division, IRH
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What is the importance of Maternal Nutrition?
Increased death from bleeding if already anemic
Poor nutritional status
Decreased stores for fetus and for breastfeeding
Increased risk of SGA/LBW
Small stature at age of Reproduction
Reduced Growth and Productivity
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2. How does Delaying the First Birth and
Increasing Birth Intervals contribute to
Nutrition?
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Length of the Birth Interval is Correlated with
Small Size and Low Weight at Birth, controlled
for many variables(Also, Mothers Age and
Nutritional Status, are associated with SGA/LBW)
It is good to be born three years after your sib!
Safest
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Length of the Birth Interval is Correlated with
Stunting and Underweight, controlled for many
variables
It is good to be the youngest child for as long
as possible!
Safest
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Why the New Policy is At least Three Years Birth
Spacing or Three to Five Saves Lives
months
Current Norm
Proposed Norm
Data from analyses of Shea Rutstein, Agustín
Conde-Agudelo, and Fuentes-Afflick and Hessol
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Where can we intervene for Maternal Nutrition?
Maintain her body
Develop Stores
Food Nutrients
Work
Breastfeeding
Fetal/placental growth
DELAY!!
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Golden Bow Initiative (UNICEF and WABA)

• Breastfeeding is the Gold Standard for Resolution
  of Pregnancy and for Infant Feeding
• One Loop indicates the Child
• One Loop indicates the Mother
• The Knot Father, Family, and Community, without
  whose support, breastfeeding will not succeed.
• One streamer for Continued Breastfeeding with
  Frequent and Quality Complementary Feeding
• Second Streamer for the 3-5 Years of Birth Spacing

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How does infant feeding contribute to Birth
Spacing?

• Survival
• Fertility Delay
• Método de Lactancia y Amenorrea (MELA / LAM)

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Timing of subsequent pregnancy by month
postpartum and by breastfeeding status
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Median duration of breastfeeding and
lactational amenorrhea in selected countries
DHS, 1980s
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LAM / MELA
YES
It is time to begin use of a new method to ensure
the optimal 3-5 years spacing needed for best
maternal and child health and nutrition outcomes
Have menses returned?
NO
YES
Have you begun regular supplementary feeding?
NO
YES
Is the baby more than 6 months old?
Begin frequent high quality complementary feedings
NO
YOU MEET CRITERIA TO RELY ON LAM / MELA
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Results of Studies on LAM Efficacy by 6 (or 9)
Month Life Table

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Return of Menses among Exclusively Breastfeeding
Women Approximate Cumulative Percent by
Six-Month Life Table
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Average Number of Feeds per Day by Month
Postpartum




plt0.05
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Why does LAM have improved efficacy over
lactational amenorrhea?

• Slightly, but significantly, shorter intervals
• Slightly, but significantly, more feeding
  episodes per day
• Greater attention to night feeds
• Dedication to breastfeeding patterns for
  fertility impact
• Conclusion Women who choose LAM will practice
  closer to optimal breastfeeding behaviors

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Healthy Spacing for Maternal Nutrition and Child
Survival
Excl. BF
No BF No Preg
Pregnant
BF with Comp.
30 mo.
Birth
6 Months
36 mo.
45 mo. Next Birth
Time
Derived from INCAP studies
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Additional Births If There Were No
Breastfeeding...
Globally, if breastfeeding disappeared, the birth
rate would increase immediately and
significantly
Becker et al, 1999
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3. How does this effect us today, and what should
be considered in terms of policy and programmes?
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Risk of Pre-Menopausal Breast Cancer Among Women
Who Breastfed
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?Breastfeeding and Reduced Osteoporosis?

• YES Melton et al, Influence of breastfeeding and
  other reproductive factors on bone mass later in
  life. Osteoporos Int 1993 Mar3(2)76-83
• YES Kreiger N, Kelsey JL, Holford TR, O'Connor
  T. An epidemiologic study of hip fracture in
  postmenopausal women. Am J Epidemiol 1982
  Jul116(1)141-8
• NONE Ramalho AC, Lazaretti-Castro M, Hauache O,
  Vieira JG, Takata E, Cafalli F, Tavares F Sao
  Paulo Med J 2001 Mar119(2)48-53 Osteoporotic
  fractures of proximal femur clinical and
  epidemiological features in a population of the
  city of Sao Paulo.
• NONE Clark P, de la Pena F, Gomez Garcia F,
  Orozco JA, Tugwell P. Risk factors for
  osteoporotic hip fractures in Mexicans. Arch Med
  Res 1998 Autumn29(3)253-7

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HIV Breastfeeding and Maternal Mortality

• Nduati R, Richardson BA, John G, Mbori-Ngacha D,
  Mwatha A, Ndinya-Achola J,Bwayo J, Onyango FE,
  Kreiss J. Effect of breastfeeding on mortality
  among HIV-1 infected women a randomised trial
  Lancet. 2001
• Versus
• Coutsoudis A, Coovadia H, Pillay K, Kuhn L. Are
  HIV-infected women who breastfeed at increased
  risk of mortality? AIDS 2001 Mar 3015(5)653-5
• WHO Statement, 2003, no reason to change policy
  that states that pregnancy is not an additional
  risk

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For todays woman

• Delayed first birth and birth spacing allow
  mothers bodies to mature and achieve better
  nutritional status.
• Better maternal nutritional status at conception
  is associated with less SGA/LBW and reduced MMR
• Better maternal nutrient status supports best
  breastfeeding practices
• The longer the baby is the youngest, the longer
  it will be breastfed, the more time the mother
  will have for active feeding, the longer this
  child will remain the center of family care and
  benefit in terms of survival, growth and
  development.
• The best birth interval for both maternal and
  child outcomes is three to five years
• Considering all best choices results in best
  outcomes
• Recognize that our bodies evolved for survival,
  and if problems arise, they merit consideration
  from an evolutionary and intergenerational
  life-cycle perspective.

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Thank you!!!
Danke!!!
C??????!!!
Muchas Gracias!!!
Merci!!!