Total country population (2000): 5.3 million

Project population and area: 1 million in conjunction with MCH centers throughout Jordan

Project Duration:1998 to 2004

• Download a complete copy of World LINKAGES/Jordan
• Download LINKAGES LAM Project, Jordan 1998-2004 Final Report
• Download counseling cards developed by LINKAGES and its country program partners
• Download Cost and Effectiveness Analysis of LINKAGES' LAM Promotion Program in Jordan

Background
At current fertility levels, Jordanian women will have an average of 3.6 children, compared to 5.6 children in 1990. Contraceptive prevalence increased from 27 percent in 1990 to 38.7 percent in 1998. There continues, however, to be a gap between wanted and actual fertility. Ninety-five percent of Jordanian mothers initiate breastfeeding, but most do not practice optimal breastfeeding. In 1997, only 20 percent breastfed exclusively during the first two months, almost a fifty- percent drop from 1990. In a national survey conducted in 1997, two percent of married women interviewed said that they used prolonged breastfeeding to delay the next pregnancy.

Program Design and Implementation
The Lactational Amenorrhea Method (LAM), which is based on the natural infertility resulting from certain patterns of breastfeeding, is a culturally acceptable method of family planning in Jordan. LAM supports both optimal infant feeding and child spacing. In 1995 the Ministry of Health and USAID requested assistance from the Institute for Reproductive Health (IRH) in designing a project to address the need for improved breastfeeding practices and an increase in family planning prevalence. In June 1997 the USAID Mission asked LINKAGES to review the 16-month pilot Lactational Amenorrhea Method (LAM) project and to develop a strategy for completing the process of integrating LAM into Jordan's health care facilities. The outcome was the design of the MOH/LINKAGES LAM Project.

The key objective of the program was to increase quality offering and acceptance of LAM as a transition to the use of other modern contraceptive methods. To do so, the program (1) strengthened staff capacity to integrate LAM and improved skills in breastfeeding counseling and lactation management into the MOH service delivery system; (2) met informational needs of mothers and families by developing educational materials and media messages; (3) informed senior health officials, health professionals, and other stakeholders of LAM's impact on breastfeeding practices, infant health, and child spacing; (4) strengthened management information systems to capture new LAM acceptors and the postpartum month when they switch to another method; and (5) established a National Breastfeeding Center within the Maternal and Child Health Directorate.

Integration of LAM into Jordan 's service delivery system required nationwide in-service training. By the end of the project, 861 health professionals had been trained in lactation management and LAM. LINKAGES provided technical assistance for training needs assessment, course design, curriculum development, and the training of trainers. The project also introduced mother-to-mother support groups for breastfeeding as a community outreach component and developed educational materials and media spots.

Results
Data collected monthly in the MOH maternal and child health clinics showed that the LAM user rate (measuring the proportion of all women of reproductive age who report using LAM as a means of child spacing) increased from 0.1 percent in 1999 to 13.3 percent in 2003. National Demographic and Health Surveys found that exclusive breastfeeding among infants less than 6 months old increased from 11.9% in 1999 to 26.7% in 2002. During this period, the MOH and LINKAGES were actively promoting breastfeeding nationwide.