The ethiopian
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S.A. IGWEABSTRACT: A randomised prospective study of 150 breast-feeding and 100 non- breast-feeding postpartum women was conducted in some rural communities in Nigeria, to determine the relationship between breast-feeding and anovulation. Non-breast-feeding postpartum controls experienced early return of menses, ovulation and ultimate pregnancy whereas in the breast-feeding mothers, these parameters were delayed much longer (menses, ovulation and pregnancy more than 12 months). Breast-feeding is shown to be a method of family planning and child spacing among the ruralities covered in the study. In the rural areas of developing countries, where contraceptive use is either low or non-existent, active promotion of breast-feeding is needed to reinforce the traditional method of breast-feeding so as to retain its child spacing as well as maternal and child health benefits. [Ethiop. i. Health Dev. 1993;7(2):93-00] INTRODUCTIONThere are several rural communities and settlements in Nigeria and the rural disposition of each community or settlement depends on its remoteness from the urban or semi-urban settlements. Most of these rural communities lack standard hospitals. Some have Health Centres but these are usually managed by qualified nurses from other centres. Once in a while mobile doctor service is extended to the Health Centres. Such Health Centres located in most part of the country's rural settlements offer services ranging from maternal and child health, simple primary health care guide, personal hygiene and environmental sanitation to referrals. In each case,modem family planning techniques have not been practised by the ruralities and available information shows that they have depended solely on breast-feeding as their only method of child spacing and birth control. Nigeria is a developing country and there are no accurate statistical data on family planning practices among the population. With this background, breast-feeding has come to play an essential role in child health, child nutrition and child spacing where the standard of living of the rural communities is generally below western average. Breast-feeding has been known to be the best traditional way to feed infants among the rural communities. According to WHO expert committee, its multiple benefits for the health of the infant and the mother greatly outweighs bottle-feeding (1,2). Breast-feeding also delays the resumption of ovulation and thus induces a considerable length of infecundity beyond that resulting from normal postpartum ammenorrhoea (3, 4). The contraceptive effect of breast-feeding has been known for several generations, but it has been only in recent times that researchers have attempted to quantify its role regarding birth interval and relative importance compared with the other determinants of fertility.
______________________________ College of Medicine and Health Sciences
METHODSA randomised sampling of 1,000 adult female volunteers from 20 rural communities or settlements with an averaged age of 22-30 years was conducted. Each has little, if any formal education and all are full-time house wives. None had used any family planning techniques to this or other pregnancies before they were recruited for this study. Information about them were initially obtained from the records at the Health Centres and those with history of previous abortions were discharged as well as those not willing from partaking in the study. They were then divided into two groups. In the first, were breast-feeding others (150) and parturient, having had one or more children previously. All deliveries were normal. The group chosen intended to breast-feed as long as possible, that is about 12 months. The second group consists of mothers who had still birth at term or whose babies died after delivery (100), and were enlisted in the study to serve as postpartum comparative group. The objective of the study was carefully explained and interpreted to the volunteers as they had no formal education, and their full consent to participate was obtained. Each subject provided an early morning urine sample daily and pregnancy tests were conducted using pregnancy latex test (Agglutination inhibition slide test, B subunit specific, CBL), creatinine level was assayed using standard methods by Jaffe (7) while radio immunoassay for pregnanediole-3- RESULTS150 breast-feeding women and 100 non-breast-feeding controls were used. An received ante-, intra-, and post-partum care at the Health Centres. An the participants were residents in the same rural community being served by the Health Centre. The controls were marginally older (mean age 26.2) see Table 1. The mean time until the first postpartum coitus for the non-breast-feeding controls was 2.1 months. There was no coitus in the breast-feeding and lactating mothers because cultural norms prohibited intercourse during breast-feeding in the community. The median time to first menses was 1.5 months for the controls and 8.0 months for the breast-feeding women. The difference was highly significant (p < 0.001). An controls menstruated by postpartum day 51. Ovulation preceded menses in 20 of the l00 non-beast- feeders and ovulation did not precede menses in the breast-feeders. Table 1: Characteristics of the rural volunteer women
Table 2: Range of breast-feeding episodes at first ovulation among the rural women:
However, only 20% of breast-feeding mothers experienced their first postpartum bleeding in the first 6 months and all the controls ovulated during the study. The median times to first ovulation (2.1 months for controls and 11.0 months for the breast- feeding mothers), were significantly different between the two groups (p>0.001). By the 4' month postpartum, all the controls had ovulated at least once whereas only 7% of the breast-feeding mothers had done so. The earliest ovulation among the non-breast-feeding mothers occurred at postpartum day 30 while for those breast-feeding women it occurred at postpartum day 60. Thereafter, this percentage of the mothers ovulated and menstruated at regular intervals. Inspite of ovulation there was no pregnancy in the breast-feeding mothers because cultural belief prevented intercourse during breast-feeding. Furthermore, there was no supplements by the early ovulators. |