ArticleProceedings of the National Academy of Sciences of the United States of America2021
Socioeconomic development predicts a weaker contraceptive effect of breastfeeding.
Article in Proceedings of the National Academy of Sciences of the United States of America, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
8 citing papers in PubMed, 13 citations in OpenAlex.
- Combined hormonal versus nonhormonal versus progestin-only contraceptives for postpartum contraception in lactating individuals.The Cochrane database of systematic reviews · 2026Article
- Modelling the age pattern of fertility: an individual-level approach.Royal Society open science · 2024Article
- Impact of energy availability and physical activity on variation in fertility across human populations.Journal of physiological anthropology · 2023Review
- Pregnancy risks and contraceptive use among postpartum mothers in Cameroon: implications for improving the coverage of postpartum family planning services.Reproductive health · 2023Article
- A milk-sharing economy allows placental mammals to overcome their metabolic limits.Proceedings of the National Academy of Sciences of the United States of America · 2022Article
- Focus on the Analysis of the Effect of Solving the Nursing Mode on the Time of the Production Time of the First Maternity and the Subjective Happiness of the Postpartum.Contrast media & molecular imaging · 2022Article
- Public health needs evolutionary thinking.Proceedings of the National Academy of Sciences of the United States of America · 2021Article
- Using sequence analysis to visualize exposure to pregnancy in the postpartum period.Demographic researchArticle
Corrections and comments
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Authors and funding
2 authors at 2 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The contraceptive effect of breastfeeding remains essential to controlling fertility in many developing regions of the world. The extent to which this negative effect of breastfeeding on ovarian activity is sensitive to ecological conditions, notably maternal energetic status, has remained controversial. We assess the relationship between breastfeeding duration and postpartum amenorrhea (the absence of menstruation following a birth) in 17 World Fertility Surveys and 284 Demographic Health Surveys conducted between 1975 and 2019 in 84 low- and middle-income countries. We then analyze the resumption of menses in women during unsupplemented lactation. We find that a sharp weakening of the breastfeeding-postpartum amenorrhea relationship has globally occurred over the time period analyzed. The slope of the breastfeeding-postpartum amenorrhea relationship is negatively associated with development: higher values of the Human Development Index, urbanization, access to electricity, easier access to water, and education are predictive of a weaker association between breastfeeding and postpartum amenorrhea. Low parity also predicts shorter postpartum amenorrhea. The association between exclusive breastfeeding and maintenance of amenorrhea in the early postpartum period is also found in rapid decline in Asia and in moderate decline in sub-Saharan Africa. These findings indicate that the effect of breastfeeding on ovarian function is partly mediated by external factors that likely include negative maternal energy balance and support the notion that prolonged breastfeeding significantly helps control fertility only under harsh environmental conditions.
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Registered trials
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