The Influence between Breastfeeding Conditions with Breastfeeding

Mothers Characteristics toward the Usage of Lactation Amenorrhoea

Method (LAM) as Contraception

Husna Sari¹, Erlina Hayati¹, Kristin Natalia Napitupulu¹, G. F. Gustina Siregar¹,

Nanda Pratama Tampubolon¹

Department Of Midwifery, Deli Husada Delitua Health Institute

Keywords: Influence, Breastfeeding Conditions, Characteristic, Lactation Amenorrhoea{Method, Contraception

Abstract: The low coverage of exclusive breastfeeding for 6 months caused the national target of exclusive

breastfeeding to be 40% unachieved. Whereas exclusive breastfeeding can reduce infant mortality in

Indonesia and it can also be used as natural contraception. This research type was an analytic study with

case control design. The study was conducted from August to December 2018. The population of this study

were all breastfeeding mothers who have babies aged 6-12 month. The study sample amounted 44

breastfeeding mothers, consist of 22 cases and 22 controls whereas the case group was giving exclusive

breastfeeding to baby but they did not experience lactation amenorrhoea and the control group was giving

exclusive breastfeeding to the baby, they experienced lactation amenorrhoea. Primary data collection

methods obtained through direct interviews on research subjects. The research instrument was standardized

questionnaire. Data analysis used univariate analysis, bivariate with chi-square test and multivariate analysis

with multiple simple logistic regression test. The analysis results indicated dominant variable influencing

the usage of LAM as contraceptive for breastfeeding mothers was occupational variable because it has (p =

0.015; OR = 10.962 95% CI 1.529-75.283), it means that breastfeeding mothers who work have 11 times

greater risk who did not use LAM as contraceptive compared to mothers who do not work.

1 INTRODUCTION

Lately, women in Indonesia, especially young

mothers, are actively promoting exclusive

breastfeeding. However, the facts show that

exclusive breastfeeding is still not optimal. Coverage

of exclusive breastfeeding for 6 months is still low

which caused the national target of exclusive

breastfeeding to be 40% was not achieved. The

United Nations Children’s Fund (UNICEF) states

that 30,000 babies’ deaths in Indonesia and 10

million babies’ deaths in the world each year can be

prevented through exclusive breastfeeding. Kamlesh

Tiwari, et al (2018) found that there were no

breastfeeding mothers conceived within the first six

months of giving birth to their babies and it was only

4% of mothers had evidence of pregnancy especially

after 10 months after giving birth.

Some experts conclude that mothers who have

knowledge or get counseling about LAM have more

desire to use LAM as contraceptive, and working

mothers can influence exclusive breastfeeding to

their babies, as well as education and income which

become significant predictor variables with LAM as

contraceptive method (Teklehay manot Huluf

Abraha, et al., 2018; Aparna Sridhar and Jennifer

Salcedo, 2017; Rubeena Zaka, et al., 2018; Edibe

Pirincci1, et al., 2016; Chelsea M. Cooper, et al.,

2018; Shawn Malarcher, et al., 2016; Alla al

Hadaby, et al., 2018; Amira A. El-Houfey, et al.,

2017; Sevgi Ozsoy, et al., 2017).

The above data illustrates that the problem of

using LAM as contraceptive needs to get good

attention, considering the usage of LAM as a

contraceptive is influenced by exclusive

breastfeeding. In order to get more precise picture, it

is needed an analysis of the breastfeeding conditions

effect with characteristics (knowledge, education,

occupation, parity, and social economy) for

breastfeeding mothers toward LAM usage as

contraception.

Sari, H., Hayati, E., Napitupulu, K., Siregar, G. and Tampubolon, N.

The Inﬂuence between Breastfeeding Conditions with Breastfeeding Mothers Characteristics toward the Usage of Lactation Amenorrhoea Method (LAM) as Contraception.

DOI: 10.5220/0009472202470254

In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 247-254

ISBN: 978-989-758-460-2

247

2 METHODOLOGY

This research type is an analytic study with case

control design. This research was conducted from

August to December 2018. The research population

were all breastfeeding mothers who have babies

aged 6-12 months at Kasih Ibu Maternity Clinic

Kasih Dusun VII Street Deli Tua Sub-district Deli

Serdang Regency. The sample consisted of 44

breastfeeding mothers that consisting of 22 cases

and 22 controls namely the case group were

breastfeeding mothers who gave exclusive

breastfeeding to their babies but they did not

experience lactational amenorrhoea.

The research sampling technique was purvosive.

Primary data collection methods obtained through

the distribution of questionnaires directly on the

research subject. The research instruments were

standardized questionnaires. Data analysis used

univariate, bivariate analysis with chi-square test and

multivariate analysis with multiple logistic

regression tests. The research roadmap is as follows:

Figure 1: Research Roadmap

Figure 2. Research on the Effect of Breastfeeding

Conditions and Characteristics of Breastfeeding Mothers

on LAM usage as Contraception.

3 RESULTS

Based on the table below, it can be explained that:

a. Conditions for breastfeeding women who used

the lactation amenorrhoea method should pay

attention to breastfeeding, namely breastfeeding

immediately after giving birth, breastfeeding

without schedule, breastfeeding without bottles

or nipples, did not take supplements, and still

gave breastmilk to babies. If one of the criteria

was not met then the condition of breastfeeding

was not good.

0. Good

1. Not Good

The majority of breastfeeding cases were not

good as many as 18 cases (81.8%) and in control

group the majority of breastfeeding conditions

were good as much as 13 (59.1%). Statistical test

results obtained p value = 0.013 means that there

was an influence of the breastfeeding condition

on LAM usage as a contraceptive

forbreastfeeding mothers. From the analysis

results, it also obtained value (OR = 6.5 with

95% CI 1,640-25,759), it means that

breastfeeding condition which was not good has

a risk of 6.5 times greater risk of breastfeeding

mothers did not use LAM as contraception

compared with the breastfeeding conditions was

good.

b. Knowledge

Mother's knowledge questionnaire consisted of 8

questions. The scoring is done based on

provisions, the correct answer is given score of 1

and the wrong answer is given score of 0. So that

the highest total score was 8. The highest

possible score is 8 and the lowest possible score

was 0.

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

248

0. The level is good if the score obtained>

50% of the total score (5-8)

1. The level is not good if the score is

obtained <50% of the total score (0-4)

The cases majority ofbreastfeeding

mothers’ knowledge were poor (14.6%) and in

the control group the majority of breastfeeding

mothers’ knowledge were 13 (59.1%). Statistical

test results obtained p value = 0.227 meaning that

there was not knowledge effect on LAM usage as

contraception in breastfeeding mothers. From the

analysis results also obtained value (OR = 2.5

with 95% CI 0.750-8.522) means that exposure

(knowledge) is a protective effect or reduces the

risk of LAM usage as contraceptive in

breastfeeding mothers.

c. Education, the highest formal school level ever

taken and completed by respondents which

obtained a graduation mark that is categorized

into 3 groups:

0 = Low (elementary - junior high)

1 = High (High School - College)

In the case of education group, the majority of

breastfeeding low mothers were 16 (72.7%) and

in the control group, the majority of

breastfeeding mothers had high education

(14.6%). Statistical test results obtained p value

= 0.034 meaning that there was an influence of

education on the LAM usage as contraceptive in

breastfeeding mothers. From the analysis it was

also obtained the value (OR = 4.7 with 95% CI

1,299-16,761) meaning that mothers with low

education have 4.7 times greater risk did not use

LAM as contraception compared to mothers

who have higher education.

d. Occupation is an activity carried out by the

mother outside the home with the aim to find

basic necessities of life. The duration of mother

works is known from she leaves home.

Categorized as:

0 = did not work outside the home

1 = workoutside the home

The cases majority of breastfeeding mothers

who worked as many as 17 (77.3%) and in the

control group the majority of breastfeeding

mothers did not work as many as 14 (63.6%).

Statistical test results obtained p value = 0.015

meaning that there wasoccupation effect on the

LAM usage as contraceptive in breastfeeding

mothers. From the analysis also obtained value

(OR = 5.9 with 95% CI 1,586-22,328) meaning

that mothers who work outside the home have

5.9 times greater risk did not useLAM as a

contraceptive compared to mothers who did not

work outside the home.

e. Parity is the children number who have been

born by respondent both born alive and stillborn.

Parity is categorized:

0 = primipara (woman who gave birth to a

child, who is big enough to live in the

outside world).

1 = multipara (women who have given birth to

child more than once).

The parity case group of multiparous majority

breastfeeding mothers as many as 15 (68.2%)

and in the control group parity of breastfeeding

mothers majority were 12 (54.5%). Statistical

test results obtained p value = 0.223 meaning

that there is no effect of parity on LAM usage

as contraceptive for breastfeeding mothers.

From the analysis results also obtained value

(OR = 2.6 with 95% CI 0.753-8.784) means

that exposure (parity) was a protective effect or

reduces the risk of LAM usage as contraceptive

for breastfeeding mothers.

f. Sosoo - economic is the income amount from

basic and additional work which is obtained by

respondents and the head of the family in

average of one month. Classified into two,

namely the value of City Minimum Wage

(CMW) of Tanjungbalai City and below the

CWN value. The criteria for income are as

follows:

0 = Income above CMW > Rp. 1.835.000

1 = Income below the CMW < Rp. 1.835.000

The majority of socio-economic case

groups of breastfeeding mothers were Rp. >

1,835,000 as many as 16 (72, 7%) and majority

of socioeconomic control group of

breastfeeding mothers wereRp. > 1,835,000 as

many as 13 (59.1%). Statistical test results

obtained p value = 0.068 means that there was

not socioeconomic influence on the LAM

usage as breastfeeding mothers’ contraceptive.

From the analysis results also obtained value

(OR = 3.8 with 95% CI 1,086-13,661) means

that mothers who have income Rp. <1,835,000

have 3.8 times greater risk did not useLAM as

contraceptive compared to mothers who have

income Rp> 1,835,000.

The Inﬂuence between Breastfeeding Conditions with Breastfeeding Mothers Characteristics toward the Usage of Lactation Amenorrhoea

Method (LAM) as Contraception

249

Table 1: Effect of breastfeeding conditions with

breastfeeding mothers characteristics on MAL usage as

contraception

Multivariate analysis was performed to analyze

the effect of independent variables (conditions of

breastfeeding, knowledge, education, employment,

parity and socioeconomic), with the dependent

variable (Lactation Amenorrhoea Method).

Multivariate analysis used multiple logistic

regression analysis. Before conducting multivariate

analysis, the selection of variables which will

become candidates for the multivariate model is

done first. Variables that become multivariate

candidates are independent variables with p values

<0.25 in bivariate analysis.

Table. 2: Selections of Model Candidates for Multivariate

Modelling Phase

No Variable

p value

1. Breastfeeding Condition

0,013

2. Education

0,227

Knowledge

0,034

Occupation

0,015

Parity

0,223

Sosialekonomi

0,068

Based on the results of multivariate analysis with

multiple logistic regression test shows that in the

modeling analysis, all variables of the conditions of

breastfeeding, education, occupation and

socioeconomic are significant to the use of the

Lactational Amenorrhoea Method as contraceptive

for breastfeeding mothers with a value of p <0.05.

Thus, the most dominant variable influencing the

use of the Lactation Amenorrhoea Method as

contraception in breasfeeding mothers is the

occupational variable (p = 0.015; OR = 10.962 95%

CI 1.529-75.283) meaning that breastfeeding

mothers who work have a 11 times greater risk of

not using the LactationalAmenorrhoea Method as a

contraceptive compared to mothers who do not

work.

Table 3: Analysis Results of Multiple Logistic Regression

Test

Independent

Variable

B Sig Exp(B) 95% CI

Breastfeeding

Condition

2.136 0.019 8.466

1.421-

50.453

Education 1.664 0.056 5.280

0.959 -

29.083

Occupation 2.394 0.015 10.962

1.596 -

75.283

Socio

Economic

1.859 0.040 6.420

1.092 -

37.756

This study showed that there was an influence of

breastfeeding conditions toward the LAM usage as

contraceptive for breastfeeding mothers. The

analysis also obtained value (OR = 6.5 with 95% CI

1,640-25,759) meaning that breastfeeding mothers

with not good conditions have 6.5 times greater risk

did not use LAM contraceptive compared to good

conditions. The study results are in line with

Kamlesh Tiwari, et al research (2018) that is

foundthere was not breastfeeding mothers be

expecting within the first six months after they gave

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

250

birth to their babies and it was only 4% of mothers

had evidence of pregnancy especially after 10

months after giving birth.

The data is presented in the table below:

Table 4: The Effect of Breastfeeding Conditions on the

Use of the LAM as Contraception for Breastfeeding

Mothers

Breastfeeding

Conditions

valv

(95%

CI)

Cases Control

N % n %

Not good

good

81,8

18,2

40,9

59,1

0,01

6,5(1,

640-

25,75

Total 22 100 22 100

The statistical test results obtained p value =

0.387, it was concluded that there was no knowledge

influencetoward the LAM usage as contraceptive for

breastfeeding mothers. The analysis results also

obtained value (OR = 2.5 with 95% CI 0.750-8.522)

means that exposure (knowledge has a protective

effect or reduces the LAM risk as contraception for

breastfeeding mothers. The study results are in line

with Kasmiandriani's study (2014) showed that 113

respondents who had good knowledge (62%),

sufficient knowledge (9.7%) and lack knowledge

(84%). The total respondents with positive attitude

and applied LAM contraception only 19 respondents

(16.8%) and the rest (82.3%) did not applied LAM

contraception.

This study is also in line with Chelsea M.

Cooper, et al research (2018) stated the relationship

perception between breastfeeding, LAM, menstrual

return, and recognition of timely food / mother’s

way to recognize the relationship between

breastfeeding and birth spacing, but there were gaps

in understanding and LAM usage. The mothers

expressed their belief that women are protected from

pregnancy while they are breastfeeding, regardless

of the frequency or breastfeeding duration.

Prolonged breastfeeding (within a few months) is

associated with delayed menstruation. However,

women also discuss that some women return

menstruation even when they are still breastfeeding.

Some women say they have heard that breastfeeding

helps birth spacing, but they don't trust this method

because other women breastfeed and don't see

menstruation but are still pregnant.

Some constraints related to the low application

of exclusive breastfeeding and the low number of

mothers who use the Lactation Amenorrhea Method

(LAM) as contraceptive during breastfeeding

include the lack of confidence in the mother that

breast milk is sufficient for her baby, the mother

back to work after they finished the maternity leave

which causes the use of bottled or formula milk in a

manner early so shift the breastmilk position.

Besides that, the incessant promotion of formula

milk, both through health workers and mass media

also had an effect.

The LAM effectiveness is very high around 98%

if it is used correctly and meets the requirements of

being used during the first 6 months after giving

birth and exclusively breastfeeding (without

providing additional food). The effectiveness of this

method is also very dependent on the frequency and

intensity of breastfeeding.

This study showed there was an effect of

education on the LAM usage as breastfeeding

contraceptive. The analysis also obtained value (OR

= 4.7 with 95% CI 1,299-16,761) meaning that

breastfeeding mothers with low education have 4.7

times greater chance did not useLAM as

contraceptive compared to higher education. It is

strengthened by Nursalam theory(2003), that

education can influence one's behavior in motivating

oneself to actively participate in development. The

different levels of education for mothers in this

study affect the mothers desire to use LAM

contraception.

Occupation is the most dominant variable that

influences the LAM usage because it has (p = 0.015;

OR = 10.962 95% CI 1.529-75.283) meaning that

breastfeeding mothers who work have 11 times

greater risk did not use lactation amenorrhoea

method as contraception compared to mothers who

does not work.

This study is in line with Amira A. El-Houfey, et

al research (2017) stated that there were many

factors that affect exclusive breastfeeding such as,

lack of knowledge, lactation problems, poor families

and social support, social norms, shame, occupation

and child care and health services. Data showed that

61.1% of US mothers who have children under the

age of three years old are employed. It is known that

mothers who are not employed are more than twice

as likely to breastfeed for six months as mothers

who work full time.

The study results are in line with Kasmiandriani

research (2014) showed that 113 respondents who

have good knowledge (62%), sufficient knowledge

(9.7%) and lack of knowledge (84%). All

respondents with positive attitude and applied LAM

contraception, there were only 19 respondents

The Inﬂuence between Breastfeeding Conditions with Breastfeeding Mothers Characteristics toward the Usage of Lactation Amenorrhoea

Method (LAM) as Contraception

251

(16.8%) and the rest (82.3%) did not apply LAM

contraception.

According to Lawrence Green's theory cited in

Notoatmodjo (2015), which underlies the emergence

of breastfeeding mothers' behavior in conducting

LAM as contraceptive namely predisposing factors,

which are manifested in knowledge, attitudes,

beliefs, confidence, values, and so on, enabling

factors, which are manifested in physical

environment, the availability or unavailability of

health facilities, and the reinforcing factors

manifested in the attitudes and behavior of health

workers or other officers, who are group reference of

community behavior.

Quynh-NhiThi Le, et al research (2018) states

LAM is based on the frequency of breastfeeding,

including nighttime breastfeeding. Women who

leave their babies and work outside home, difficulty

in maintaining this frequency usually increases their

failure rate.

The study results are in line with the Tesfayi

research (2008) only dividing mothers into two,

namely working mothers and mothers who did not

work. It was found that mothers who did not work

had risk of 0.98 times longer to return menstruation

than mothers who worked.

The study results indicated that there was no

influence of parity toward LAM usage as

breastfeeding mothers’ contraceptive. The analysis

results also obtained value (OR = 2.6 with 95% CI

0.753-8.784) meaning that exposure (parity) is a

protective effect or reduces the risk of using LAM

contraception in breastfeeding mothers. The study

results are in line with Sevgi Ozsoy, et alresearch

(2017) states that one-third of mothers are

primiparous and 66.5% of mothers have

breastfeeding experience. From the study results

38.9% of mothers said that they received knowledge

about the effects of breastfeeding contraception and

68.9% of mothers received this knowledge from

nurse. There were 17% of mothers received this

knowledge reported that breastfeeding was

contraception and 1.8% of mothers reported that it

was sometimes as contraceptive. Around 41.3% of

mothers thought that they would be able to used

breast milk as contraception method.

In this study it was stated that there was no

influence of income toward LAM usage as

contraceptive for breastfeeding mothers. The

analysis results also obtained value (OR = 3.8 with

95% CI 1.086-13.666) means that exposure

(income) is a protective effect or reduces the risk of

LAM usage as contraceptive for breastfeeding

mothers.

This study is in line with Amira A. El-Houfey, et

al research (2017) which states the factors associated

with positive or negative effects on the level of

exclusive breastfeeding: internationally there are

many factors associated with poor people to provide

exclusive breastfeeding and it must be considered

when it is investigated the reasons for lower levels

than recommended and the duration of breastfeeding

were identified at most.

Tespayi study was based on DHS (Demographic

and Health Surveys) data for women with

amenorrhoea in the first 12 months after their birth

in Dominic, it resulted smaller HR of 1.10 (1.03-

1.17 95% CI) held by the rich social economic

status.

The cross tabulation result between mother's

work and income shows that 67.55% of low-income

mothers are housewives (not working), so they will

have more time for their babies. Mothers with low

socioeconomic status tend to have less access to

meet food needs for their babies. So they will

provide breastmilk with more frequencies and longer

durations to meet those needs. Increasing the

frequency and duration of breastfeeding will result a

longer duration of lactational amenorrhoea.

Based on study results, the most dominant

variable influencing the LAM usage as

contraceptive for breastfeeding mothers is the

occupational variable because it has (p = 0.015; OR

= 10.962 95% CI 1.529-75.283) meaning that

breastfeeding mothers who work have 11 times

greater risk do not useLAM as contraceptive

compared to mothers who do not work .

4 DISCUSSION

It can be concluded that the effect of breastfeeding

conditions with the characteristics of breastfeeding

mothers toward the LAM usage as contraception is

as follows:

a. Variables that have been proven to influence the

lactation amenorrhoea method as contraception

in breastfeeding mothers are the conditions of

breastfeeding, education, employment and

socioeconomic.

b. Variables that have not been proven to influence

the lactation amenorrhoea method as

contraception in breastfeeding mothers are

knowledge and parity.

c. Multivariate results indicate that occupation is

the most dominant variable that influences the

LAM usage at Kasih Ibu Maternity Clinik Kasih

Street Hamlet.VII Deli Tua Sub District because

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

252

having (p = 0.015; OR = 10.962 95% CI 1.529-

75.283) means that breastfeeding mothers who

work have 11 times greater risk do not use

LAM as contraceptive compared to mothers

who do not work.

ACKNOWLEDGEMENTS

This research was supported by Health Institute of

Deli Husada Deli Tua, Health Institute of Medistra

Lubuk Pakam, Sembiring General Hospital

Foundation, and Medistra Foundation, Indonesia.

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Penerapan Kontrasepsi Metode Amenorea Laktasi

(MAL) Pada Ibu Di Wilayah Kerja Puskesmas Citta

Dan Puskesmas Pacongkang Kabupaten Soppeng

Tahun 2014. Makasar: Universitas Hasanuddin.

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

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