LAM User Rate

Definition
Proportion of women of reproductive age who give birth in a given period of time who consciously and deliberately accept LAM as a modern contraceptive method. This is self-reported use of a family planning method.

This can be calculated using the following equation:

Data Requirements
In order to correctly calculate the LAM user rate, data are needed on the total number of women of reproductive age, and of those, the number who choose to use LAM as a method of family planning.

Data Source(s)
Population-based surveys employing representative samples (e.g., DHS); available family planning service statistics data. A sample survey is attached that includes questions needed to calculate the LAM user rate. The denominator within this data set is women in the family planning registry, which represents all women of reproductive age, who choose to use a method of family planning where family planning use data is collected.

Purpose and Issues
The lactational amenorrhea method (LAM) is a modern, temporary family planning method that promotes pregnancy prevention, improved breastfeeding, child spacing, child survival and women's health. LAM is defined by these criteria:

1. The woman's menstrual periods have not resumed, and
2. the infant is fully or nearly fully* breastfed, and
3. the infant is less than 6 months old.

Programmatic considerations may determine that the appropriate breastfeeding message for LAM, according to MOH regulations and for consistency with other program messages, is to exclusively breastfeed. Clinicians, however, must be aware of the criteria that an infant is fully or nearly fully breastfed.

Another family planning method must be introduced in a timely manner to ensure birth spacing when any one of these three criteria is no longer met. This follow-up method would be captured in both the family planning registry as well as in subsequent population-based surveys.

One shortcoming of this indicator is that it is often based on self-report, without verification that the respondent actually fulfills the three criteria listed above. A more precise measure would include questions that confirm that the respondent knows the three criteria and that she meets the three criteria.

Furthermore, the LAM user rate is calculated when the age of the infant cannot be collected. This results in an underestimate of actual LAM rate among eligible (infant less than 6 months) women. When the LAM user rate is interpreted compared to other family planning method use rates, the LAM user rate is compared with the use of methods that can be used throughout the reproductive cycle, and is not confined to a 6-month period.

Rate Calculation
The attached LAM user rate calculator allows you to insert your population-based survey or clinic data. The LAM user rate will be automatically calculated.

*Full or nearly full breastfeeding is defined as breastfeeding that significantly impacts fertility through the maintenance of amenorrhea. Full breastfeeding is defined as exclusive (no other liquid or solid is given to the infant) or almost exclusive (vitamins, mineral water, juice, or ritualistic feeds are given infrequently in addition to breastfeeds). In nearly full breastfeeding, the vast majority of feeds given to infants are breastfeeds.