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  • Title: Attenuation of nursing-related ovarian suppression and high fertility in well-nourished, intensively breast-feeding Amele women of lowland Papua New Guinea.
    Author: Worthman CM, Jenkins CL, Stallings JF, Lai D.
    Journal: J Biosoc Sci; 1993 Oct; 25(4):425-43. PubMed ID: 8227092.
    Abstract:
    Intense, sustained nursing lengthens inter-birth intervals and is causally linked with low natural fertility. However, in traditional settings, the effects of such nursing on fertility are difficult to disentangle from those of nutrition. Results from a prospective, direct observational study of reproductive function in well-nourished Amele women who nurse intensively and persistently but who also have high fertility are here presented. Endocrine measures show that ovarian activity resumes by median 11.0 months postpartum. Median duration of postpartum amenorrhoea is 11.3 months, time to next conception is 19.0 months, and the inter-birth interval is 28.0 months. Average life time fertility is 6.8. High fertility in Amele women is due both to refractoriness of reproductive function to suckling stimuli, and to maintenance of equivalent age-specific fertility rates across the reproductive life span. Evidence is presented, from a study of 52 breast-feeding women with an infant under 5 years of age from 12 Amele villages in lowland Papua New Guinea, that women with good nutritional status experienced less variation in ovarian suppression than reported elsewhere among less well-nourished populations. Direct observations of nursing behavior were recorded during 660 hours. The average number of observations per child, which were conducted at different developmental stages, was 1.9. 1549 nursing events were recorded. 38 women had serum samples drawn to determine prolactin levels. Saliva samples were collected from 51 women for measurement of gonadal steroids. Women reported menstrual patterns in the preceding month. Measures were also taken of weight, skinfolds of the triceps and subscapular area, and mid-upper-arm circumference. Birth interval, completed fertility, and age at introduction of solid foods and denial of breast were obtained from ongoing demographic surveillance on nutrition in 1982-84 and 1982-83. Laboratory methods were described for serum prolactin and progesterone analysis. The results showed skewed results for the hormonal and some nursing variables, which were transformed by logarithmic functions. All Amele mothers practice indulgent demand feeding schedules. Supplementary foods are introduced at the median age of 7.4 methods. Early supplementation is liquids or semiliquids, followed by mashed starchy staples, and finally a standard diet. Cessation of breast feeding occurs at a subsequent pregnancy of the advanced age of the child (5 years). The median age of cessation was 36.3 months. The breast feeding pattern during the first 18 months was 1.5-3 times per hour for 1-3 minutes. Infant age was not linearly related to nursing frequency declines or feeding intervals. Nursing frequency was unrelated to morbidity. Prolactin declined strongly when bout frequency and interval were stable. Multiple regression findings were that duration of postpartum amenorrhea was explained by mother's parity and age, feeding interval, and time postpartum. Time of supplementary feeding was unrelated to duration of amenorrhea, nursing frequency, or feeding duration. 16% of interval variance was explained by length of postpartum amenorrhea, which was correlated with length of subsequent birth interval. 45% of the variance in prolactin was explained by triceps skinfolds and bout length.
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