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Breastfeeding duration related to practised contraception in the Netherlands


Correspondence Jacobus P van Wouwe, M.D., Ph.D., Netherlands Organization for Applied Scientific Research TNO, P.O. Box 2215, 2301 CE Leiden, the Netherlands. Tel: +31-71-518-1758 | Fax: +31-71-518-1920 | E-mail:


Aim: The aim of this study was to gain insight into contraception practised and related to breastfeeding duration.

Methods: Mothers with infants up to 6 months received a questionnaire on infant feeding (breast or formula feeding) and contraception (hormonal or non-hormonal methods). Estimates of the time interval between resuming contraception and cessation of lactation was calculated by Chained Equations Multiple Imputation.

Results: Of all women (n = 2710), 30% choose condoms, 22% the combined oral contraceptive pill (OCP) and few other methods. Breastfeeding was started by 80%, and 18% continued up to 6 months. Of the breastfeeding mothers, 5% used hormonal contraception; 7% of women who used hormonal contraception practised breastfeeding. After adjustment for background variables, the use of OCP is strongly associated with formula feeding: after delivery to the third month postpartum, the crude OR being 17.5 (95% CI: 11.3–27.0), the adjusted OR 14.5 (9.3–22.5); between the third and sixth month postpartum, respectively, 13.1 (95% CI: 8.6–19.9) and 11.7 (7.6–17.9). Of all breastfeeding women, 20–27% resumed OCP at 25 weeks postpartum and 80% introduced formula feeding. The time lag between these events is 6 weeks. Hormonal contraception was resumed after formula introduction.

Conclusion: Mothers avoid hormonal contraception during lactation; they change to formula feeding 6 weeks before they resume the OCP. To effectively promote longer duration of breastfeeding, the BFHI needs to address contraception as practised.