Knowledge and use of lactational amenorrhea as a family planning method among adolescent mothers in Uganda: a secondary analysis of Demographic and Health Surveys between 2006 and 2016

ABSTRACT Objective To assess the level of knowledge and use of lactational amenorrhea method (LAM) among adolescents in Uganda between 2006 and 2016 using nationally representative data from Demographic and Health Surveys (DHS). Design Cross-sectional design involving analysis of three DHS (2006, 2011, and 2016) in Uganda. Setting The data was collected in Uganda. The DHS are nationally representative surveys on a wide range of indicators including contraception knowledge and use. Participants A total of 8,250 adolescents (15-19 years) and 7,110 young women (20-24 years) were included. Primary outcome measure Use of LAM among adolescents and young women with a livebirth within six months before each survey. Results In 2016, less than 1% of eligible adolescents correctly used LAM and 56% were passively benefitting from LAM. The median duration of postpartum amenorrhea (PPA) among adolescents in 2016 was 6.9 months, declining from 8.3 months in 2006. Compared to adolescents, eligible young women had higher knowledge of LAM and higher medianPPA duration in 2016. The percentage of eligible adolescents who met the LAM criteria irrespective of whether they reported LAM use (protected by LAM) decreased from 76% in 2006 to 57% in 2016. More than 50% of eligible adolescents were aware of LAM in 2016, increasing from 6% in 2006, potentially in part due to change in survey question. Conclusion Despite increasing awareness of LAM, reported and correct use of LAM was low among adolescents who could benefit from this method in Uganda, and declining over time. Support for adolescents to harness the benefits of correct LAM use should be increased. Additional research is needed to better understand the dynamics of LAM use in adolescents, including the transition to use of other modern contraceptive methods. Strengths and limitations of this study ➢ Lactational amenorrhea method has the potential to promote healthy timing and spacing of pregnancies and to reduce repeat adolescent births, yet, its use among Ugandan adolescents has not been examined. ➢ This study provides useful insights into the behavior of adolescents mothers which can be targeted to improve their reproductive knowledge and wellbeing. ➢ The study used data from three standardised nationally representative surveys, thus findings are generalizable and comparable over time and across age groups. ➢ Assessment of knowledge of LAM was affected by a change in the phrasing of the question in 2016, thus providing limited comparability with previous surveys. ➢ The measurement of LAM use was based on self-report.