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"Nutrition and Population"

The ACC/SCN held a symposium on "Nutrition and Population" at its annual session, hosted this year by UNFPA in New York, on 25-26 February 1991. The SCN, with representatives of all concerned UN agencies and with participation of bilateral donors, approved a statement on the issues including the following.

"Breastfeeding provides one link between nutrition and family planning with mutually beneficial effects at the level of the individual mother and child. Exclusive breastfeeding for 4-6 months is advised. Lactational amenorrhoea, prolonged by breastfeeding, is of great benefit through increasing birth intervals. There is an opportunity at this time for counselling on modern family planning methods, in particular those deemed most appropriate for lactating women.

"At an individual level, the health and nutritional status of the mother (particularly the adolescent mother) is a fundamental concern, in term of her nutritional resources, reproductive and productive roles and family planning needs. Increasing the length of birth intervals will reduce the likelihood of cumulative reproductive stress in the mother and improve her ability to adequately care for her child. The individual child too will benefit from birth spacing and maternal health through more adequate feeding and care practices.

"These are major reasons why family planning and nutrition services and information should be integrated. Programmatic considerations as to how to bring this about, in terms of policy formulation, programme planning, training and the support of community level initiatives present several challenges.

These include the following:

- appropriate training of health and family planning workers; the motivation to support and counsel women should emerge from common goals;

- reconciling programmatic priorities of agencies that differ in their support for the concept and practice of integrated breastfeeding and family planning strategies;

- recognition of constraints on exclusive breastfeeding due to competing demands on women's time, misinformation and other factors, hence the need for appropriate programmatic support to enable women to practise breastfeeding;

- resource mobilisation to provide relevant information, education and communications to promote the practice of breastfeeding and the adoption of contraceptives, including research on beliefs and obstacles to family planning and infant feeding."

From: "If Queen Victoria had known about LAM"

An editorial with this title in the Lancet (Vol 337, pp 703-4. March 23 1991) starts by explaining the important role of breastfeeding in child spacing, and notes that what Queen Victoria, who had 9 children ". . . failed to grasp was that, by putting every one of her babies to a wet-nurse the day it was born, she was destroying the role of breastfeeding in the spacing of pregnancies". Recent research clarifies why: "'. . . In examining the proximate determinants of natural fertility, Bongaarts found that lactation-induced amenorrhoea was the single most important variable determining fertility". This has led to recommendations on family planning. "A consensus meeting sponsored by the World Health Organization, Rockefeller Foundation, and US Agency for International Development in Bellagio, Italy, on the contraceptive effect of lactation [concluded] that if a woman feeds her child on demand for up to 6 months after delivery and has not menstruated, then she has only a 2% chance of conceiving - a "failure" rate similar to that of most modern methods of reversible contraception".

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