title: Transition from the Lactational Amenorrhea Method to other modern family planning methods in rural Bangladesh: barrier analysis and implications for behavior change communication program intervention design.
abstract: The timely transition from Lactational Amenorrhea Method (LAM)(2) to another modern family planning method contributes to healthy spacing of pregnancies by increasing the adoption of family planning during the first year postpartum. Yet, literature suggests challenges in completing a timely LAM transition. To guide program implementation in Bangladesh, this study identified factors influencing women's transition decisions. Eighty postpartum women, comprising 40 who transitioned from LAM(3) and 40 who did not,(4) participated. Half of each group participated in in-depth interviews to explore the decision-making process. All participants responded to a "Barrier Analysis" questionnaire to identify differences in eight behavioral determinants. More than half of transitioners switched to another modern method before or within the same month that LAM ended. Of the 18 transitioners who delayed,(5) 15 waited for menses to return. For non-transitioners, key barriers included waiting for menses to return, misconceptions on return to fertility, and perceived lack of familial support. The LAM transition can help women prevent unintended pregnancy during the first year postpartum. Increased emphasis on counseling women about the risk of pregnancy, and misconceptions about personal fertility patterns are critical for facilitating the transition. Strategies should also include interventions that train health workers and improve social support.
authors.affiliation: Academy for Educational Development, 1825 Connecticut Ave., NW, Washington, DC 20009, USA. Electronic address: kouyate03@msn.com.
authors.forename: Robin Anthony
authors.initials: RA
authors.lastname: Kouyaté
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA.
authors.forename: Salahuddin
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Jhpiego, 1615 Thames Street, Baltimore, MD 21231-3492, USA.
authors.forename: Jaime
authors.initials: J
authors.lastname: Haver
authors.affiliation: Jhpiego, 1615 Thames Street, Baltimore, MD 21231-3492, USA.
authors.forename: Catharine
authors.initials: C
authors.lastname: McKaig
authors.affiliation: Shimantik, 581 Shewrapara, Mirpur, Dhaka 1216, Bangladesh.
authors.forename: Nargis
authors.initials: N
authors.lastname: Akter
authors.affiliation: Jhpiego, 1615 Thames Street, Baltimore, MD 21231-3492, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Nash-Mercado
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Baqui
mesh_terms: D000328:Adult; D000568:Amenorrhea / Q000523:psychology*; D001459:Bangladesh; D001942:Breast Feeding / Q000523:psychology*; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D015438:Health Behavior; D058015:Health Communication; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D007774:Lactation; D012252:Natural Family Planning Methods / Q000379:methods* / Q000523:psychology*; D049590:Postpartum Period; D012424:Rural Population; D055815:Young Adult
keywords: Barrier analysis; Contraception; Lactational Amenorrhea Method; Postpartum family planning; Qualitative Research Methods; South Asia