Undoubtedly, breastfeeding is associated with many maternal and child health benefits, including a delay in fertility return postpartum. These facts have been recognised for decades. According to the medical literature from Aristotle to the Renaissance, women who suckle are less likely to become pregnant.
But, by mid 20th century, this physiological the response was forgotten in scientific circles as the use of commercial infant formula displaced breastfeeding in industrialised settings, and family planning methods became more widely available.
However, recent scientific evidence, compiled both by social and biomedical sciences, demonstrating the population-level impact of breastfeeding on fertility and the biologic basis of lactational infertility, has reinitiated interest in breastfeeding and the mechanisms related to lactational infertility.
According to these studies, if we allow breastfeeding to deteriorate further, the increase in fertility in settings with limited family planning use would be significant, and very difficult to remedy.
Presently, breastfeeding is being revived and has become a norm when it comes to initial feeding for infants. However, the optimal patterns of breastfeeding that are also associated with fertility reduction are not as yet the norm in many industrialised settings.
For the World Health Organisation, WHO, the optimal breastfeeding for child health is defined as six months of exclusive breastfeeding followed by continued breastfeeding with age-appropriate complementary feeding for up to two years or longer.
According to the United Nations Children’s Fund, UNICEF report, in Nigeria, available statistics reveal that the average duration of exclusive breastfeeding is approximately three months and only 3 out of every 10 children under 6 months of age were exclusively breastfed (29 per cent).
Although, this is an improvement from 17 per cent in 2013 to 29 per cent in 2018 according to the National Demographic Health Survey, NDHS,2013; 2018, however, this still falls significantly below the target of 50 per cent set by the World Health Assembly to be achieved in 2025 and the SDG target for 2030.
The percentage of children who were breastfed within 1 hour of birth is 42 per cent remains less than 50 per cent. Breastfeeding rates in Nigeria reduces with age, 83 per cent of the children are breastfed up to one year while 28 per cent are breastfeeding till two years.
Furthermore, the proportion of children who are not breastfeeding increases with age, with these rates fall off over time and this still means that a majority of postpartum women will be introducing some form of contraception during breastfeeding.
However, experts say for optimal maternal and child health outcomes, there was a need for physicians to increase the knowledge and skills to support both optimal breastfeeding and appropriate family planning during breastfeeding.
Some studies of maternal nutritional recovery postpartum and of outcomes of subsequent pregnancies have shown that spacing of births is necessary for improved outcomes.
Although breastfeeding alone can result in child spacing in some cases, the individual woman is cautioned not to rely on breastfeeding alone if she wishes to achieve this goal.
Medical doctors say the introduction and use of family planning during breastfeeding are important health interventions.
Generally, contraceptive technology texts emphasise efficacy as the major criterion for method selection. Women’s choices while breastfeeding could be based on other health impacts of the method on her or her child, in addition to those directly associated with breastfeeding and contraceptive efficacy.
Experts believed that women breastfeeding need access to family planning information and services to help them choose a contraceptive method that allows them to sustain breastfeeding and make it safe for them and the breastfeeding child.
They also stated that providers must have correct information about the appropriate use of all contraceptive methods during lactation.
It has also been established that the family planning needs of breastfeeding women differ significantly from those of women who are not breastfeeding. Subsequently, women who are breastfeeding require advice about contraceptive methods that protect against pregnancy but also support breastfeeding.
For instance, contraceptive methods must be weighed carefully in terms of their potential effects on breast milk production and infant health as estrogen-containing methods, such as combined oral contraceptives, decrease milk volume and duration of lactation, and the breast milk of women who are using a hormonal contraceptive contains steroids that are absorbed by the infant.
Also, during the first six weeks of life, when the most intense extrauterine neurological development occurs, hormonal contraceptive methods are contraindicated for breastfeeding women.
However, family planning experts say there are other contraceptives that are appropriate during this period. These include barrier methods. IUDs have no adverse effects on breast milk production or on infant growth and development. In addition, the lactational amenorrhea method (LAM) is a birth spacing option for women who are fully breastfeeding.
After the sixth postpartum week, lactating women who wish to use hormonal methods should be advised to use progestin-only methods, which include the minipill, implants, Natural family planning, sterilisation, morning-after pill and injectables.