Emergency Contraception as a Back up of Lactational Amenorrhea Method(LAM)
Emergency Contraception as a Back up of Lactational Amenorrhea Method(LAM)
Prolonged breast-feeding is an encouraged tradition in Egypt. Breastfeeding is associated
 with variable degrees of amenorrhea and infertility but there is a risk of resumption of
 fertility and therefore, of conception during lactation. A consensus statement formalized the
 lactational amenorrhea method of contraception (LAM), which has subsequently been included in
 the family planning programs in some developing countries. It has proved to be effective with
 cumulative pregnancy rates ranging from only 0.9% to 1.2%. However, if any of the
 prerequisites of LAM expire at any time, the contraceptive efficacy will be much reduced.

 The expiry of LAM requirements can occur unexpectedly at a time the woman is not ready to
 visit a clinic to initiate another contraceptive. Pregnancy during breast-feeding may result
 in mistimed, unplanned and sometimes unwanted childbirth. A study done in Egypt has shown
 that one in 4 of pregnancies during lactation were unplanned Such pregnancies, in addition to
 their negative social impact may lead some women to seek induced abortion; a procedure which,
 in settings (like Egypt) where abortion is illegal (except on very restricted grounds), is
 often unsafe.

 Levonorgestrel 1.5 mg EC pills has been used for long time and proved to decrease the
 incidence of pregnancy by 75-85% in each act of unprotected sexual intercourse. Its safety
 has been documented. It can be used safely during lactation and has been classified by the
 WHO medical eligibility criteria for contraception as category-1 for lactating mother. Even
 if take early in pregnancy it is not abortifacient and does not by any mean affect the
 continuation of pregnancy or cause any side effects to the growing baby (WHO category 1).

 The present study tries to estimate the efficacy of in advance provision of 1.5
 Levonorgestrel EC pills (as a back-up of LAM) at the time of counseling of LAM when used in
 increasing the incidence of initiation of another long term method of contraception and
 probably decreasing the incidence of unintended pregnancy during breast-feeding in rural
 Egypt.

 The investigators are planning to include all women who deliver in the investigators service
 and intent to breast-feed and planning of birth spacing. Women who refused to participate or
 planned to use a method of contraception other than LAM and those with expected difficulty of
 subsequent communication were excluded from participation.

 All eligible participants will receive proper counseling for LAM by trained research nurse.

 Women who choose to use LAM will be advised to return to the investigators contraception
 outpatient clinic to have a long term method of contraception as soon as any of the
 requirements of LAM expires. All eligible participants who accept to participate in the study
 will be randomly assigned to one of two groups:Group 1 will only receive the above described
 care (control group). Group II (Intervention group) in which women will have the above proper
 counseling. Additionally, they will be advised to use the EC pills if one of the
 prerequisites of LAM expires and sexual relation with their husband had occurred before the
 initiation of another contraceptive. Each women assigned to the intervention group will be
 supplied with one packet containing two 0.75 mg Levonorgestrel emergency contraceptive (EC)
 pills and advised to swallow the two tablets as soon as possible after having sexual
 intercourse with their husband after the expiry of LAM. They will be informed that they
 should not use the method after more than 5 days of having intercourse. They will be also
 advised not to use EC pills more than once. All women who have used the EC pills need to
 visit the clinic within few days of use for contraception advise. All the above information
 will be additionally given to the patient in a small flyer.
Inclusion Criteria:

 -  All women who delivers in the obstetric intent to breast-feed.

 -  Eligible participants should have been planning of birth spacing

 Exclusion Criteria:

 -  Women refusal to participate in the study

 -  Women planned to use a method of contraception other than LAM

 -  Anticipation of difficulty of subsequent communication with the woman