p181-189 - CEU Guidance

Journal of Family Planning and Reproductive Health Care 2004: 30(3) Background It is estimated that 69% of women initiate breastfeeding in the UK.1 The number breastfeeding then falls and by 6 months postpartum only 21% of women continue.1 Exclusive breastfeeding for 6 months or more is promoted worldwide to achieve optimal infant and maternal health.2 In the UK it is difficult to ascertain the number of women who are exclusively breastfeeding and only around 1 in 10 women breastfeeding at 6 months are providing breast milk only. Clinicians and women may have concerns about the effects of hormonal contraception on breastfeeding, breast milk, infant growth and development, and maternal health. The World Health Organization (WHO) provides recommendations on contraception for women who are breastfeeding.3,4 These WHO documents were developed to facilitate safe and effective contraceptive use in developing countries, where access to alternative sources of infant feeding is limited and anything which may inhibit or reduce the success of breastfeeding may have serious consequences for infant survival. The WHO Selected Practice Recommendations for Contraceptive Use (WHOSPR)4 has been adapted for use in the UK.5,6 However, the adapted recommendations provide incomplete advice regarding breastfeeding women and some are at odds with accepted UK practice. This evidence-based guidance summarises contraceptive options and effects of hormonal contraception on breast milk and infant growth (what women need to know). The Clinical Effectiveness Unit (CEU) provides recommendations and good practice points on which contraceptive methods can be used by breastfeeding women and when to start these methods (when to start methods).