1 Birabwa C, et al. BMJ Open 2022;12:e054609. doi:10.1136/bmjopen-2021-054609 Open access Knowledge and use of lactational amenorrhoea as a family planning method among adolescent mothers in Uganda: a secondary analysis of Demographic and Health Surveys between 2006 and 2016 Catherine Birabwa , 1,2 Pamela Bakkabulindi, 1,3 Solomon T Wafula, 1 Peter Waiswa, 1,4 Lenka Benova 2 To cite: Birabwa C, Bakkabulindi P, Wafula ST, et al. Knowledge and use of lactational amenorrhoea as a family planning method among adolescent mothers in Uganda: a secondary analysis of Demographic and Health Surveys between 2006 and 2016. BMJ Open 2022;12:e054609. doi:10.1136/ bmjopen-2021-054609 ► Prepublication history for this paper is available online. To view these files, please visit the journal online (http://dx.doi. org/10.1136/bmjopen-2021- 054609). CB and PB contributed equally. Received 21 June 2021 Accepted 02 February 2022 For numbered affiliations see end of article. Correspondence to Catherine Birabwa; cathybirabwa3@gmail.com Original research © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. ABSTRACT Objective To assess the level of knowledge and use of the lactational amenorrhoea 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 collection took place in Uganda. The DHS are nationally representative surveys on a wide range of indicators including contraception knowledge and use. Participants A total of 1948 (2006), 2026 (2011) and 4276 (2016) adolescents (15–19 years) and 1662 (2006), 1666 (2011) and 3782 (2016) young women (20–24 years) were included. Primary outcome measure Use of LAM among adolescents and young women with a live birth within 6 months before each survey. Results In 2016, less than 1.0% (95% CI: 0.2% to 3.5%) of eligible adolescents correctly used LAM, and 56.3% (95% CI: 48.8% to 63.6%) were passively benefitting from LAM. The median duration of postpartum amenorrhoea (PPA) among adolescents in 2016 was 6.9 months, declining from 8.3 months in 2006. Compared with adolescents (56.7%), eligible young women had higher knowledge of LAM (64.1%) and higher median PPA duration (8.0 months) in 2016. The percentage of eligible adolescents who met the LAM criteria irrespective of whether they reported LAM use (were protected by LAM) decreased from 76.4% (95% CI: 66.5% to 84.0%) in 2006 to 57.2% (95% CI: 49.5% to 64.6%) in 2016. More than 50.0% (95% CI: 49.2% to 63.8%) of eligible adolescents were aware of LAM in 2016, increasing from 6.0% (95% CI: 2.5% to 13.8) in 2006. 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. INTRODUCTION Reducing adolescent pregnancy rates is an important public health issue in sub-Saharan Africa (SSA), where high fertility and unmet need for family planning (FP) persist. Esti- mates show that 21 million adolescents aged 15–19 years in developing countries become pregnant every year. 1 2 Of these, 2.5 million are younger adolescents 12–15 years and at least 10 million are unintended pregnan- cies. 1 2 The prevalence of adolescent first births in SSA is estimated at 50%. 1 As of 2019 about 218 million women in low-income and Strengths and limitations of this study ► The study used data from three standardised nation- ally representative surveys in Uganda, thus findings are generalisable and comparable over time and across age groups. ► The study used various indicators to assess the knowledge and use of lactational amenorrhoea method (LAM) among the population and separately among females able to use LAM at the time of the survey. ► Assessment of knowledge of LAM was affected by a change in the phrasing of the question in 2016, thus limiting comparability with previous surveys. ► The measurement of LAM use was based on self- report which may result in underestimation or over- estimation due to differences in understanding of LAM. ► The surveys did not collect information about rea- sons for non-use of LAM or about follow-on contra- ceptive methods.