Research Article| Volume 50, ISSUE 1, P35-53, July 1994

Progestogen-only contraceptives during lactation: I. Infant growth

      This paper is only available as a PDF. To read, Please Download here.


      Growth, development and health of infants whose mothers used progestogen-only contraceptives during lactation were examined in a prospective, non-randomized study carried out in seven centres in five countries (Egypt, Thailand, Kenya, Chile and Hungary). The results on growth are reported here. Breastfeeding women requesting effective contraception were admitted to the study at six weeks postpartum. Infants of acceptors of progestogen-only methods (pill, DMPA, NET-EN or NORPLANT® implants) and non-hormonal methods (IUD, barrier methods or sterilization) formed the study groups. The follow-up was at monthly intervals until the end of the first postpartum year. Participating in the study were 2466 mother-infant pairs. The mean duration of exclusive breastfeeding varied from 68 to 159 days, but did not differ significantly between study groups within centres. In anthropometric measures (weight, arm circumference and triceps skinfold), the mean rates of change varied over time as expected, and across the centres. However, there were very few statistically significant differences in these rates of change between groups within centres. Since a large number of statistical comparisons were made, and there was no consistency either across centres, over time, or in the direction of the differences, we conclude that in this study, the progestogen-only contraceptives used during lactation did not adversely affect infant growth.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Contraception
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • World Health Organization
        Breast-feeding and fertility regulation: current knowledge and programme policy implications.
        Bull World Health Organ. 1983; 61: 371-382
        • Berman ML
        • Hanson K
        • Hellman IL
        Effect of breast-feeding on postpartum menstruation, ovulation, and pregnancy in Alaskan Eskimos.
        Am J Obstet Gynecol. 1972; 114: 524-534
        • Kennedy KI
        • Rivera R
        • McNeilly AS
        Consensus statement on the use of breastfeeding as a family planning method.
        Contraception. 1989; 39: 477-496
        • Perez A
        • Labbok MH
        • Queenan JT
        Clinical study of the lactational amenorrhoea method for family planning.
        Lancet. 1992; 339: 968-970
        • Kennedy KI
        • Visness CM
        Contraceptive efficacy of lactational amenorrhoea.
        Lancet. 1992; 339: 227-229
        • International Planned Parenthood Federation
        VIIth edition. Acceptability and use continuation of the contraceptive methods—a multicentre study [A study report]. International Planned Parenthood Federation, London, U.K1993
      1. World Health Organization. Contraceptive Method Mix. Guidelines for Policy and Service Delivery. Geneva, Switzerland: World Health Organization, in press.

        • World Health Organization
        The effect of female sex hormones on fetal development and infant health.
        in: Report of a WHO Scientific Group. VIIth edition. World Health Organization Technical Report Series 657. 1981 (Geneva, Switzerland:)
        • Strauss LT
        • Speckhard M
        • Rochat RW
        • Senanayake P
        Oral contraception during lactation: a global survey of physician practice.
        Int J Gynaecol Obstet. 1981; 19: 169-175
        • Pebley AR
        • Goldberg HI
        • Menken J
        Contraceptive use during lactation in developing countries.
        Stud Fam Plann. 1985; 16: 40-51
        • World Health Organization Task Force on Oral Contraceptives
        Effects of hormonal contraceptives on milk volume and infant growth.
        Contraception. 1984; 30: 505-522
        • World Health Organization Task Force on Oral Contraceptives
        An investigation on the influence of steroidal contraceptives on milk lipid and fatty acids in Hungary and Thailand.
        Contraception. 1986; 33: 159-178
        • World Health Organization Task Force on Oral Contraception
        Effects of hormonal contraceptives on breast milk composition and infant growth.
        Stud Fam Plann. 1988; 19: 361-369
        • Nilsson S
        • Mellbin T
        • Hofvander Y
        • Sundelin C
        • Valentin J
        • Nygren K
        Longterm follow-up of children breast-fed by mothers using oral contraceptives.
        Contraception. 1986; 34: 443-457
        • Croxatto H
        • Diaz S
        • Peralta O
        • et al.
        Fertility regulation in nursing women: IV. Long-term influence of a low-dose combined oral contraceptive initiated at day 30 postpartum upon lactation and infant growth.
        Contraception. 1983; 27: 13-25
        • Laukaran VH
        The effects of contraceptive use on the initiation and duration of lactation.
        Int J Gynaecol Obstet. 1987; : 129-142
        • Heikkilä M
        • Luukkainen T
        Duration of breast-feeding and development of children after insertion of a levonorgestrel-releasing intrauterine contraceptive device.
        Contraception. 1982; 25: 279-292
        • Dahlberg K
        Some effects of depo-medroxyprogestorone acetate (DMPA): Observations in the nursing infant and in long-term user.
        Int J Gynaecol Obstet. 1982; 20: 43-48
        • Jimenez T
        • Ochoa M
        • Paz Soler M
        • Portales P
        Long-term follow-up of children breast-fed by mothers receiving depot-medroxyprogesterone acetate.
        Contraception. 1984; 30: 523-533
        • Koetsawang S
        • Boonayaprakob V
        • Suvanichati S
        • Paipeekul S
        Long-term study of growth and development of children breast-fed by mothers receiving Depo-Provera (medroxy-progesterone acetate) during lactation.
        in: Zatuchni GI Goldsmith A Shelton JD Sciarra JJ Long-acting Contraceptive Delivery Systems. Harper and Row, Philadelphia1984: 378-387
        • Diaz S
        • Herreros C
        • Juez G
        • et al.
        Fertility regulation in nursing women. VII: Influence of NORPLANT® levonorgestrel implants upon lactation and infant growth.
        Contraception. 1985; 32: 53-74
        • Shaaban M
        • Salem H
        • Abdullah K
        Influence of levonorgestrel contraceptive implants, NORPLANT®, initiated early postpartum upon lactation and infant growth.
        Contraception. 1985; 32: 623-635
        • Affandi B
        • Karmadibrata S
        • Prihartano J
        • Lubis F
        • Samil R
        Effect of NORPLANT® on mothers and infants in the postpartum period.
        Adv Contracept. 1986; 2: 371-380
        • Ramachandran CR
        Vernier Tape for circumferential measurements.
        J Trop Pediatr. 1986; 32: 30-34
        • McCann M
        • Moggia A
        • Higgins J
        • Potts M
        • Becker C
        The effects of a progestin- only oral contraceptive (levonorgestrel 0.03 mg) on breast-feeding.
        Contraception. 1989; 40: 635-648
        • Moggia AV
        • Harris GS
        • Dunson TR
        • et al.
        A comparative study of a progestin- only oral contraceptive versus non-hormonal methods in lactating women in Buenos Aires, Argentina.
        Contraception. 1991; 44: 31-43
        • World Health Organization Working Group
        Use and interpretation of anthropometrie indicators of nutritional status.
        Bull World Health Organ. 1986; 64: 929-941
        • Salmenperä L
        • Perheentupa J
        • Siimes MA
        Exclusively breast-fed healthy infants grow slower than reference infants.
        Pediatr Res. 1985; 19: 307-312
        • Dewey KG
        • Heinig M
        • Nommsen L
        • Peerson J
        • Lonnerdal B
        Growth of breast-fed and formula-fed infants from 0 to 18 months: the DARLING study.
        Pediatr. 1992; 89: 1035-1041
        • Boryslawski K
        Structure of monthly increments of length, weight and head circumference in the first year: a pure longitudinal study of 200 Wroclaw infants.
        Ann Hum Biol. 1988; 15: 205-212
        • Tanner JM
        • Whitehouse RH
        Revised standards for triceps and subscapular skinfolds in British children.
        Arch Dis Child. 1975; 50: 142-145
        • Malina R
        • Habicht J
        • Yarbrough C
        • Martorell R
        • Klein R
        Skinfold thicknesses at seven sites in rural Guatemalan Ladino children, birth through seven years of age.
        Hum Biol. 1974; 46: 453-469
        • Pardthaisong T
        • Yenchit C
        • Gray R
        The long-term growth and development of children exposed to Depo-Provera during pregnancy or lactation.
        Contraception. 1992; 45: 313-324