African Journal of Basic & Applied Sciences 4 (2): 30-37, 2012 ISSN 2079-2034 © IDOSI Publications, 2012 DOI: 10.5829/idosi.ajbas.2012.4.2.2720 Corresponding Author: Laxmi Kant Dwivedi, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India. 30 Relationship Between Breastfeeding and Postpartum Amenorrhea among Indian Women: An Epidemiological Appraisal Laxmi Kant Dwivedi and Priyanka Dixit 1 2 School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India 1 International Institute for Population Sciences, Mumbai, India 2 Abstract: There has been renewed interest about what the optimal duration of postpartum amenorrhea (PPA) so that women should know in advance to use contraceptives and prevent unwanted births. The main objective of the present study (using National Family Health Survey (NFHS)-3 data) is to ascertain the duration of breast-feeding which will yield optimal contraceptive effect, that is, after how many months of breast-feeding; its effect on PPA has appeared/disappeared in the Indian setting. After adjusting the important confounding factors, no significant effect of breast-feeding was found up to the 10 month in extending the return of th ovulation after delivery. Further, we have tried to determine after how many months of breast-feeding the role in extending PPA has disappeared. After retaining the important covariates at their average level and then changing the duration of breast-feeding from 6-10 months to 11-14 months, the gain in the duration of amenorrhea was around 1.3 months. Again, by changing the duration of breast-feeding from 11-14 months to more than 15 months, the gain in extending the duration was significant and was around 1.6 months. Key words: Postpartum amenorrhea Ovulation Postpartum anovulation NFHS-3 India INTRODUCTION surveys. It is expected that reporting of the PPA period It has long been established clinically as well as postpartum anovulation because women can easily empirically (based on demographic data) that breast- observe menstruation. Therefore, in demographic feeding postpones the return of ovulation after birth; it literature PPA period is used as a proxy for the duration of lengthens the period of postpartum anovulation, during postpartum anovulation. which a woman cannot conceive. It also extends the Some women may not have sound knowledge about return of menstruation after birth-postpartum amenorrhea duration of postpartum bleeding (known as lochia) and (PPA). find it difficult in differentiating it from resumption of However, the occurrence of ovulation precedes menstruation. Chances are high to gather inaccurate menstruation by around nine days [1] and generally, it information in case of late postpartum bleeding in a cross- happens within the first six months after delivery. At sectional survey. Moreover, the probability of getting times, first postpartum menstruation precedes ovulation; accurate information from illiterate women will be further these are called anovulatory menstruations and are more lowered. However, its accurate reporting is very much likely to be occur after six months of delivery. Moreover, expected by demographers and epidemiologists who use the duration of amenorrhea could be extended and it postpartum resumption of menstruation as a proxy for highly depends upon the nature of breast-feeding. So, the breast-feeding intensity and the return to fecundity. relationship between duration of postpartum anovulation Previous investigations of PPA in developing and amenorrhea are not perfectly related [2]. countries suggest that the distribution of amenorrhea is In demographic literature the PPA period is defined bimodal composed of a “normal” duration subgroup and as the time interval between a birth and resumption of the a short duration subgroup that resumes menses within next menstruation and this definition is generally used in 3 or 4 months [3-4]. It is this short-duration subgroup collecting large scale data in demographic and health that has puzzled demographers/epidemiologists. Some would be better than reporting of the duration of