Yes. LAM is effective if the woman’s monthly bleeding has not returned, she is fully or nearly fully breastfeeding, and her baby is less than 6 months old.
Ideally, when the baby is 6 months old. Along with other foods, breast milk should be a major part of the child’s diet through the child’s second year or longer.
Yes. Women who are able to keep their infants with them at work or nearby and are able to breastfeed frequently can rely on LAM as long as they meet all 3 criteria for LAM. Women who are separated from their infants can use LAM if breastfeeds are less than 4 hours apart. Women can also express their breast milk at least every 4 hours, but pregnancy rates may be slightly higher for women who are separated from their infants. The one study that assessed use of LAM among working women estimated a pregnancy rate of 5 per 100 women during the first 6 months after childbirth, compared with about 2 per 100 women as LAM is commonly used.
If a woman is newly infected with HIV, the risk of transmission through breastfeeding may be higher than if she was infected earlier, because there is more HIV in her body. The breastfeeding recommendation is the same as for other HIV-infected women, however. HIV-infected mothers and their infants should receive the appropriate antiretroviral therapy (ART), and mothers should exclusively breastfeed their infants for the first 6 months of life, and then introduce appropriate complementary foods and continue breastfeeding for the first 12 months of life. At 6 months—or earlier if her monthly bleeding has returned or she stops exclusive breastfeeding—she should begin to use another contraceptive method in place of LAM and continue to use condoms. (See also Chapter 24 – Maternal and Newborn Health, Preventing Mother-to-Child Transmission of HIV.)