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DISCUSSION


From this study, it has been discovered that these rural women breast-feed for upwards of 12 months and this duration of breast- feeding is therefore a substantial interval of avoiding pregnancy since most family incomes are low, child nutrition inadequate and there is no application of any modern family planning technique. Breast-feeding which suppresses ovulation is therefore the major means of child spacing among the rural women. The result also shows that supplementals are not given until about the 10' month and this does not reduce the frequency of suckling episode. Though not investigated, it is believed that the fertility rate among the child bearing women in the rural communities is high.
However, significant difference also existed in time durations for first postpartum ovulation and menses to occur between the breast-feeding mothers and the controls. Breast-feeding frequency was related to the time when fertility returned in nursing mothers. It is therefore responsible for the prolonged an ovulation observed in the rural women. The difference in conception rate between the controls and the breast-feeding women is not a matter of interest for the investigator and very natural because since for the controls who were not breast-feeding cyclic menses appeared much sooner and there was no restriction to coitus among the group.

Breast-feeding is a universal and an acceptable method of child nutrition among nursing mothers in most of Nigeria's rural settlements and the health workers at the Health Centres emphasize that "breast is best" to all mothers during the ante-, pre-, and post- natal clinics. Perhaps, local beliefs about breast-feeding account for long durations of breast-feeding practices among the rural women. For instance, breast-feeding mothers do not have intercourse because it is said that if otherwise the breast-fed child dies and no mother or couple would want to lose their child through such an 'unwholesome' practice. It is believed that lactational infertility occurs in two phases, -a period of complete infertility which occurs during lactational ammenorrhoea when ovulation is suppressed, followed by a variable period of lowered fecundity after the resumption of ovulation and menstrual cycles (8), perhaps combinations of these two phases play additive roles to account for the prolonged anovulatory cycle among the breast-feeding mothers in the population studied. Furthermore, full and on-demand breast-feeding as practised by ruralities may playa role in lengthening the anovulation while the introduction of supplementary foods is often associated with a more rapid return of ovulation (9). This lactation induced ammonorrhoea inhibits an average of about four potential births during reproductive span of women in developing countries (8). It therefore conforms that breast-feeding is a natural means of controlling fertility (10). Experts have shown that breast milk is a potent guardian of infant health because the maternal antibodies found in the human milk protcct the baby from diseases such as gastroenteritis, diarrhoea, etc, (8).


Furthermore, the enteromamrnary circulation ensures that appropriate immunoglobulins are secreted into the breast milk within hours of exposure of mothers gut-associated lymphoid tissue to a potential pathogen (11). Mild substitutes are known to lack this immunological protection and may even exacerbate the situation by being bacteriologically contaminated during preparation and often incorrectly formulated (8). Weaning food in the rural communities consists of carbohydrate with little or no protein and do not serve as breast substitute unlike the cases of western infant formula. The key to short and long term success of lactation as a contraceptive method is therefore the frequency with which afferent neural inputs generated by the babies stimulation of the nipples reach the hypothalamus (12,13) due to the frequent breast-feeding and common occurrence among rural women. Not only do these neural inputs regulate, but the elevated prolactin levels stimulate the long-term synthesis and secretion of milk in the breast while the suckling induced discharge of oxytocin alveoli are not repeatedly emptied through frequent suckling, milk production will be inhibited through a feedback mechanism and lactogenesis will cease (14) and ovulation may occur and if coitus takes place, pregnancy might result. This explains in part, what happens in the non- breast-feeding controls.
The knowledge about the likelihood of ovulation based on infant feeding habit among rural dwellers will be a great asset to family planning providers whenever such services are to be extended to such rural areas. This is important in order to avoid double protection with other family planning methods while they are naturally infertile during the breast-feeding periods. Furthermore, in most rural areas where access to family planning is non-existent or difficult, a comprehensive method should be adopted. For instance breast-feeding should be exclusively encouraged for upwards of 12 months because of increasing awareness among rural women that infant formulas are inferior to breast milk.
The community health workers at the Health Centres should as a matter of urgency be made to inculcate family planning as the first element of primary health care and this can go a long way in improving maternal and child health. The success story of expanded programme on immunization and oral rehydration therapy in the rural communities has drastically reduced infant mortality and morbidity hence the need for more children or frequent birth is no longer necessary. It is therefore suggested that strategies for postpartum contraception should be devised and introduced in order to further maximise the benefits arising from breast-feeding infecundity .
In Nigeria, the Better Life for Rural Women programme and the National Council of Women Societies have been making some impacts in this direction and more education has been responsible in instilling in the rural

women the need to space births, long period of breast-feeding (12-18 months) late supplementals (10-12 months), etc. Breast-feeding indeed has acted as natures contraceptive and birth control method among the rural communities studied.



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