Measuring use of the lactational amenorrhea method through the Demographic and Health Surveys: data quality and implications

Our study purpose is to assess data quality of self-reported current use of the Lactational Amenorrhea Method (LAM) in the Demographic and Health Surveys (DHS). LAM, an important contraceptive method during the postpartum period, is a modern contraceptive with an effectiveness rate of 98% for the six month postpartum period when used correctly. Our study’s specific objectives are: 1) to examine accuracy of self-reported LAM use compared to the constructed correct practice variable, and 2) to explore differentials in accuracy measures by characteristics at the individual-level and survey-level by analyzing data from 73 DHS conducted in 45 countries since 1998. Findings reveal that on average only 26% of reported LAM users met criteria of correct LAM practice across the surveys, indicating potentially unacceptably low user effectiveness at the population level. We discuss implications for future DHS data collection efforts, and implications for family planning and maternal and child health programming.