Breastfeeding, lactational, infecundity, contraception and the spacing of births: implications of the Bellagio consensus statement.

While the nutritional, immunological and anti-bacterial benefits of breast milk are incontestable, the contraceptive effect of breastfeeding is more apparent in the aggregate than at the level of the individual. Nevertheless, it has recently been recommended that lactating women not consider adopting contraception until the earliest of their first post-partum menstruation, the introduction of supplementary feeding or their child's reaching six months of age. This article employs microsimulation to quantify the implications of this recommendation for the spacing of births and, in particular, for the proportion of birth intervals that are unacceptably short. The findings are not encouraging. The implementation of this protocol would not produce better birth spacing than a simpler strategy of initiating contraception early in the post-partum period and, unless implemented perfectly, the outcomes would be considerably worse. Breastfeeding should be viewed not as a method of birth control but as the best form of infant nourishment. Efficient contraception is the best way to ensure that children in modernizing societies can reap the benefits of breastfeeding, without being endangered by being weaned too early because of a new pregnancy.