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Appendix I

Lactational Amenorrhea Method

The Bellagio Consensus provided the scientific basis for defining the conditions under which breastfeeding can be used safely and effectively for birth-spacing purposes, and programmatic guidelines were developed for use of lactational amenorrhea in family planning (1,2). These guidelines include the following three criteria, all of which must be met to ensure adequate protection from an unplanned pregnancy: 1) amenorrhea; 2) fully or nearly fully breastfeeding, and 3) <6 months postpartum.

The main indications for breastfeeding are to provide an ideal food for the infant and protect against disease. No medical conditions exist for which use of the lactational amenorrhea method for contraception is restricted. However, breastfeeding might not be recommended for women or infants with certain conditions.

Women with conditions that make pregnancy an unacceptable risk should be advised that the lactational amenorrhea method might not be appropriate for them because of its relatively higher typical-use failure rates. The lactational amenorrhea method does not protect against sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). If risk exists for STI/HIV (including during pregnancy or postpartum), the correct and consistent use of condoms is recommended, either alone or with another contraceptive method. Consistent and correct use of the male latex condom reduces the risk for STIs and HIV transmission.

HIV Infection

HIV can be transmitted from mother to infant through breastfeeding. Therefore, in the United States, where replacement feeding is affordable, feasible, acceptable, sustainable, and safe, breastfeeding for women with HIV is not recommended (3,4).

Other Medical Conditions

The American Academy of Pediatrics also recommends against breastfeeding for women with active untreated tuberculosis disease, who are positive for human T-cell lymphotropic virus types I or II, or who have herpes simplex lesions on a breast (infant can feed from the other breast). In addition, infants with classic galactosemia should not breastfeed (4).

Medication Used during Breastfeeding

To protect infant health, the American Academy of Pediatrics does not recommend breastfeeding for women receiving certain drugs, including diagnostic or therapeutic radioactive isotopes or exposure to radioactive materials, antimetabolites or chemotherapeutic agents, and current use of drugs of abuse (4).


  1. Kennedy KI, Rivera R, McNeilly AS. Consensus statement on the use of breastfeeding as a family planning method. Contraception 1989;39:477--96.
  2. Labbok M, Cooney K, Coly S. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea Method-LAM. Washington, DC: Institute for Reproductive Health; 1994.
  3. Perinatal HIV Guidelines Working Group. Public Health Service Task Force recommendations for use of antiretroviral drugs in pregnant HIV-infected women for maternal health and interventions to reduce perinatal HIV transmission in the United States. Rockville, MD: Public Health Service Task Force; 2009.
  4. Gartner LM, Morton J, Lawrence RA, et al. Breastfeeding and the use of human milk. Pediatrics 2005;115:496--506.

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