# Presentation: 515028

## Birth control and breastfeeding  What is the evidence? 

- Eve Espey, MD MPH

## Mark Twain

- Get your facts straight,
- Then you can distort ‘em any way you want

## Objectives

- Understand evidence related to the impact of hormonal contraception on breastfeeding
- Describe expert opinion about choices of hormonal contraceptives for breastfeeding women
- Be aware of future directions for research

## Case

- 18 y/o G1P1 s/p NSVD yesterday is ready for discharge.  You note on the chart that she is breastfeeding.  You have counseled her about birth control pills.
- What should you prescribe?

## Answer

-                             An IUD

## Birth control and breastfeeding

- Public health issue of global importance
- 100 million postpartum women/yr decide:
- What method
- When to start it

## Oral contraceptive use worldwide

- 1980	53.4 million
- 1988	62.9 million
- 2000	84.0 million

**Notes:**
Over the last 40 years, there has been a dramatic increase in contraception usage worldwide from 15% in the 1960s to 54% in 2000.  Much of the increase in developing countries derives from foreign aid and international family planning programs

##  2 Good Things

- Postpartum contraception
- Birth interval < 24 months rarely desired
- Maternal/infant mortality

- Breastfeeding
- Complete nutrition
- Safe food source
- Immunological defense
- Saves money
- Reduces risk of breast and ovarian cancer

**Notes:**
Postpartum contraception Improves health by lengthening birth intervals.  Women are more likely to report pregnancies as unintended if they occur in an interval of 24 months or less.
Preventing these unintended pregnancies helps avoid financial, psychological and health costs.  

On a global scale: if children are spaced 3-5 years apart:
The mother is 2.5 x more likely to survive childbirth
The baby is 1.5 x more likely to survive the 1st week of life
           and 2.5 x more likely to survive to age 5

Maternal complications like:  third trimester bleeding and anemia

## Slide 9

## Global strategy on infant and young child nutrition

- Revitalization of the global commitment to appropriate infant and young child nutrition, and in particular to breastfeeding
-        WHO, 4/02

**Notes:**
Importance of a world-wide commitment to supporting breastfeeding through education, Baby Friendly Initiatives and curtailment of marketing of formula.  At its lowest in the US, BF initiation was only around 21% in the early 1970s

## US commitment to breastfeeding

- American Academy of Pediatrics
- Breastfeeding is the ideal method of feeding and nurturing infants
- Healthy People 2010
- Increase rates of breastfeeding initiation and continuation

**Notes:**
Policy statement in 2001, reviewing the known benefits of breastfeeding and establishing that BF is the ideal method of feeding and nurturing infants, that it:  
decreases the incidence and/or severity of diarrhea, lower respiratory infection, otitis media, bacteremia, bacterial meningitis, botulism, urinary tract infection, and necrotizing enterocolitis. There are a number of studies that show a possible protective effect of human milk feeding against sudden infant death syndrome, insulin-dependent diabetes mellitus, Crohn ́s disease, ulcerative colitis, lymphoma, allergic diseases, and other chronic digestive diseases. Breastfeeding has also been related to possible enhancement of cognitive development. 

## Breastfeeding statistics

|  | Initiation | 6 months | 1 year |
| --- | --- | --- | --- |
| 2010 goal | 75% | 50% | 25% |
| US | 64% | 29% | 16% |
| NM | 78% | ?? | ?? |

**Notes:**
60% continue at least 9 weeks
Data for New Mexico is from the PRAMS database – reason to suspect that our rates are likely falling short of the goals for 6 months and a year.  We are exceeding the Healthy People 2010 goal for initiation of breastfeeding however.

## Family planning in New Mexico

- 44% pregnancies unintended in 2000
- 50% no method
- Fifth highest teenage pregnancy rate
- 						PRAMS, 2001