Document Type : Research Article

Authors

1 Medical and Health Services, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria

2 Clinical Nursing Services, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife. Osun State, Nigeria

Abstract

Background: Women experience variations in postpartum amenorrhea, the length of which depends on the type of breastfeeding and women’s physiology. We conducted the present Study to assess the perception and pattern of resumption of menstruation, and identify the determinants of resumption of menstruation and proportion at risk of unplanned pregnancy among exclusive breastfeeding women.
Methods: Study employed sequential explanatory mixed method research design and was conducted between September and November, 2019. We collected the quantitative data using a semi-structured questionnaire from 497 exclusive breastfeeding women selected through a two-stage sampling technique in Southwest Nigeria. In addition, Focus Group Discussion guide was utilized to conduct qualitative study. The quantitative data were analyzed with SPSS version 22 using appropriate statistic, and the level of significance was p Results: Our result revealed that 43.4% of women whose postpartum period begins in less than eight weeks were amenorrheic, 65.6% of women whose postpartum period occurs between the 8th and 16th week were also amenorrheic, 85.8% of women whose postpartum period begins between 17th and 24th week remained amenorrheic. 76% of the women studied relied on Lactational Amenorrhea for contraception. Age (P=0.001, OR=0.24, CI=0.10-0.50), parity (P=0.04, OR=0.55, CI=0.31-0.79), and postpartum length (P=0.002, OR=0.23, CI=0.18-0.75) remained significant determinants of the return of menstruation.
Conclusion: A significant proportion of women studied perceived themselves to be at no risk of unplanned pregnancy which may ultimately influence timely postpartum contraceptive uptake. Advocacy should therefore focus on addressing effective contraception among this group of women

Keywords

1. Labbok MH. Postpartum sexuality and the lactational amenorrhea method for Contraception. Clin Obstet Gynecol. 2015; 58(4):915-927(13). doi:10.1097/GRF.0000000000000154. PubMed PMID: 26457855. ## 2. World Health Organization, WHO. 10 facts on breastfeeding. 2017. https://www. who.int/features/factfiles/breastfeeding/en. ## 3. Hailes J. About the menstrual cycle. Health A-Z. 2019.available from: https://jeanhailes.org.au/health-a-z/periods/about-the-menstrual-cycle. ## 4. Van der Wijden C, Manion C. Lactational amenorrhoea method for family planning. 2015. Cochrane Database of Systematic Reviews2015(10) CD001329. doi: 10.1002/14651858.CD001329.pub2. ## 5. Girum T, Wasie A. Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. Contracept Reprod Med. 2018(3)9. doi: 10.1186/s40834-018-0064-y. PubMed PMID: 30062044; PubMed Central PMCID: PMC6055351. ## 6. Van Lith LM, Yahner M, Bakamjian L. Women’s growing desire to limit births in Sub-saharan Africa: meeting the challenge.Glob Health Sci Pract.2013;1(1):97-107. doi: 10.9745/GHSP-D-12-00036. PubMed PMID: 25276520; PubMed Central PMCID: PMC4168554. ## 7. Lamina MA. Prevalence and determinants of unintended pregnancy among women in South-western Nigeria. Ghana Med J. 2015; 49(3): 187–194. PubMed PMID: 6693195; PubMed Central PMCID: PMC4676590. ## 8. Polis CB, Zabin LS. Missed conception or misconceptions: Perceived infertility among unmarried young adults in the United States. Perspectives on sexual reproductive health. 2012; 44(1):30-38. doi:10.1363/4403012. ## 9. Asekun-Olarinmoye EO, Adebimpe WO, Bamidele JO, Odu OO, Asekun-Olarinmoye IO, Ojofeitimi EO. Barriers to use of modern contraceptives among women in an inner city area of Osogbo metropolis, Osun state, Nigeria. Int J Womens Health. 2013;5:647-55. doi: 10.2147/IJWH.S47604. PubMed PMID: 24143124; PubMed Central PMCID: PMC3797631. ## 10. Calvert C, Baisley K, Doyle AM, Maganja K, Changalucha J, Watson-Jones D, et al. Risk factors for unplanned pregnancy among young women in Tanzania. J Fam Plann Reprod Health Care. 2013; 39(4): e2. doi: 10.1136/jfprhc-2012-100389. PubMed PMID: 23902713; PubMed Central PMCID: PMC3786620. ## 11. La leche league International. Fertility. 2020. Available at:https://www.llli.org/breastfeeding-info/fertility. ## 12. RamaRao S, Ishaku S, Liambila W, Mane B. Enhancing contraceptive choice for postpartum women in sub-Saharan Africa with the progesterone vaginal ring: a review of the evidence. Dovepress. 2015; 6:117-123.doi: 10.2147/OAJC.S55033. ## 13. Bonyata K. Breastfeeding and fertility. KellyMom. 2018. available from: https://kellymom.com/ages/older-infant/fertility. ## 14. Kuti O, Adeyemi AB, Owolabi AT. Breast-feeding pattern and onset of menstruation among Yoruba mothers of South-west Nigeria. Eur J Contracept Reprod Health Care. 2007;12(4):335-9. doi: 10.1080/13625180701536383. PubMed PMID:17853160. ## 15. Van der Wijden C, Manion C. Lactational amenorrhoea method for family planning. Cochrane Database Syst Rev. 2015 Oct 12;2015(10):CD001329. doi: 10.1002/14651858.CD001329.pub2. PubMed PMID: 26457821; PubMed Central PMCID: PMC6823189. ## 16. Monjok E, Smesny A, Ekabua JE, Esien E J. Contraceptive practices in Nigeria: Literature review and recommendation for future policy decision. Journal of contraception. 2010;9-22. doi:10.2147/OAJC.S9281. ## 17. Martinez-Galiano JM, Hernandez-Martinez A, Gomez-Salgado J. Relationship between parity and the problems that appear in the postpartum period. Sci Rep. 2019; 9: 11763. doi: 10.1038/s41598-019-47881-3. PubMed PMID: 31409871; PubMed Central PMCID: PMC6692385. ## 18. Teresa Kulie, Andrew Slattengren, Jackie Redmer, Helen Counts, Anne Eglash, Sarina Schrager. Obesity and women’s health: An evidence-based review. J Am Board Fam Med. 2011;24(1):75-85. doi: 10.3122/jabfm.2011.01.100076. PubMed PMID: 21209347. ## 19. Lipsky LM, Strawderman MS, Olson CM. Maternal weight change between 1 and 2 years postpartum: The importance of 1 year weight retention. Obesity (Silver Spring). 2012 Jul;20(7):1496-502. doi: 10.1038/oby.2012.41. PubMed PMID: 22334257; PubMed Central PMCID: PMC4862000. ## 20. Eleje GU, Ugwu EO, Dinwoke VO,Enyinna PK, Enebe JT, Okafor II ,et al. Predictors of puerperal menstruation. POS ONE.2020. doi:10.1371/journal.pone.0235888. ## 21. Jackson N, Glacier A. Return of ovulation and menses in postpartum non-lactating women: A systematic review. Obstet Gynecol. 2011;117(3):657-62. doi: 10.1097/AOG.0b013e31820ce18c. PubMed PMID: 21343770. ## 22. Adeyemi AB, Ijadunola KT, Orji EO, Kuti O, Alabi MM. The unmet need for contraception among Nigerian women in the first year post-partum. Eur J Contracept Reprod Health Care. 2005; 10(4): 229-234. doi: 10.1080/13625180500279763. PubMed PMID: 16448949. ##