1. Learning for Adapting Lactational Amenorrhea Method (LAM)
for Family Planning in the Philippines
Molly Chen, RTI International
Presenting on behalf of USAID LuzonHealth Project

2. Monitoring & Evaluation, Research, Learning, and Adapting
Our MERLA approach takes M&E to a whole new level. It integrates M&E with operations research and USAID Learning Lab’s CLA guidance, thereby ensuring we obtain continuous learning from our efforts and use the learning for adaptive management, course correction, and policy decisions.

3. Monitoring & Evaluation, Research, Learning, and Adapting
Our unique MEL approach, MERLA, is the intentional application of results-focused monitoring, evaluation, and research… …to inform continuous learning and adaptive management… …for improving program effectiveness and policy decision making
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4. USAID Philippines LuzonHealth Project
LuzonHealth is a five-year ( ) health service strengthening project of USAID/Philippines implemented in partnership with RTI International. The project supports the Department of Health-led scale-up of high-impact services and client-centered information to reduce maternal and infant deaths, improve child health and nutrition, and meet the demand for modern family planning services.

5. Lactational Amenorrhoea Method (LAM) for family planning in the Philippines
LAM is 98% effective at preventing pregnancy when all criteria are met
The mother is exclusively or nearly exclusively breastfeeding
The mother is amenorrheic
The baby is six months old or younger
Lactational Amenorrhea Method (LAM) for family planning is at least 98% effective at preventing pregnancy when all criteria are met; (1) the mother is exclusively or nearly exclusively breastfeeding, (2) the mother is amenorrheic (not menstruating), and (3) the baby is six months old or younger.
LAM is a common and accepted form of family planning in the Philippines.  

6. The challenge
After examining M&E data in our data reflection sessions, we realized that while a lot of mothers reported exclusively breastfeeding and assumed they were protected from undesired pregnancies through LAM, the reality was that there appeared to be more pregnancies than expected.

7. The solution (?)
To gain more concrete evidence, we designed a better recording tool in collaboration with our LGU partners for tracking the shift in family planning methods. We then implemented an operations research study to find out how many women actually shifted from LAM to another modern family planning method.

8. Operations research Insert a photo of data collection
The project conducted a prospective evaluation in Legazpi City to inform the enhancement of guidelines aimed at increasing LAM compliance and encouraging a second form of contraceptive once LAM protection expires

9. Operations research
Information was tracked over a nine-month period among 521 postpartum women 
LAM compliance
reasons for non-compliance
family planning referral
uptake of secondary modern family planning methods
LAM compliance, reasons for non-compliance, family planning referral and uptake of secondary modern family planning methods were tracked over a nine-month period among 521 postpartum women.  

10. Percent of women protected from pregnancy
The study found that at three months postpartum, 75% of women either met LAM criteria or had shifted to a non-LAM modern family planning method. By month six, 87% of women no longer met LAM criteria and of these, only 31% had shifted to an alternative modern family planning method.

11. Percent of women protected from pregnancy
This means that at six-month postpartum, 57% of the women in this evaluation were not protected against pregnancy through any modern family planning method.

12. Moving from learning to adapting
Our findings show that outreach education on LAM compliance and focus on shifting to non-LAM mFP methods is needed in Legazpi City.
We are now highlighting these learnings through collaborative engagement with USAID and the regional government to understand how these learnings can be used to influence programmatic and policy decisions to ensure a shift from LAM to other modern family planning methods.

13. Moving from learning to adapting
Increase client knowledge and understanding of LAM as a temporary mFP method
Increase client knowledge/understanding of LAM as a temporary mFP method
Focus on encouraging a proactive shift among postpartum women to mFP methods. There should be an emphasis on self-identification of LAM criteria, empowering women to know when they are not protected through LAM with knowledge of how to obtain mFP methods if they wish to time, space or limit pregnancy.

14. Moving from learning to adapting
Improve communication around LAM from health service providers during prenatal and postpartum family planning counseling.
Along with training, health service providers should be provided with appropriate visual job aids to better explain the LAM mechanism of action, based on the temporary physiologic infertility resulting from EBF. Training should highlight the required feeding intervals to sustain EBF and delay ovulation.
Improve communication around LAM from health service providers during prenatal and postpartum family planning counseling.

15. Moving from learning to adapting
Improve current family planning referral mechanism and service delivery
Family planning services are currently only available at the City Main Health Center. As a result of this assessment, the Legazpi City Government plans to issue a policy expanding accessibility and availability of mFP services to satellite health centers with birthing clinics. This will be achieved by training staff on Postpartum Family Planning and Postpartum IUD; and training Midwives at BHSs to provide temporary mFP methods.
Improve current family planning referral mechanism and service delivery.

16. Moving from learning to adapting
Evaluate the effectiveness of the EBF/LAM/FP recording form in increasing knowledge and awareness.
Evaluate the effectiveness of the EBF/LAM/FP recording form in increasing knowledge and awareness
USAID LuzonHealth Project will provide technical assistance for future research on the effectiveness of the recording tool, in increasing knowledge on LAM among community health volunteers and among postpartum women, and in improving monitoring, prior to recommending it for use in other areas in the country.
To build upon these findings the LuzonHealth project plans to evaluate the use of the LAM recording tool as an education resource among both mothers and healthcare providers in two additional municipalities.

17. This work was supported by the U. S
This work was supported by the U.S. Agency for International Development. We thank our colleagues from USAID’s LuzonHealth Project who provided insight and expertise that greatly assisted this work. We would also like to show our gratitude to the Breastfeeding Support Group members for diligently collecting the data presented here. We are also immensely grateful to the women in Legazpi City for participating in this work.

18. For more information:
Ellen Bautista Senior Health Technical Advisor
Rebecca Flueckiger Research Specialist, MERLA