Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-23T19:02:29.680Z Has data issue: false hasContentIssue false

Attenuation of nursing-related ovarian suppression and high fertility in well-nourished, intensively breast-feeding Amele women of lowland Papua New Guinea

Published online by Cambridge University Press:  31 July 2008

Carol M. Worthman
Affiliation:
Department of Anthropology, Emory University, Atlanta, USA
Carol L. Jenkins
Affiliation:
Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
Joy F. Stallings
Affiliation:
Department of Anthropology, Emory University, Atlanta, USA
Daina Lai
Affiliation:
Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea

Summary

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 an 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.

Type
Research Article
Copyright
Copyright © 1993, Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Allen, B. J. (1980) Report on a Reconnaissance Visit to Madang, April 1980. Office of Environment and Conservation, Port Moresby, PNG.Google Scholar
Allison, P. D. (1982) Discrete time methods for the analysis of event histories. In: Sociological Methodology, pp. 6198. Edited by Tuma, N.. Jossey-Bass, San Francisco.Google Scholar
Bentley, G. R. (1985) Hunter-gatherer energetics and fertility: a reassessment of the !Kung San. Hum. Ecol. 13, 79.CrossRefGoogle Scholar
Bongaarts, J. & Delgado, H. (1979) Effects of nutritional status on fertility in rural Guatemala. In: Natural Fertility. Edited by Leridon, H. & Menken, J.. Ordina, Liége.Google Scholar
Bongaarts, J. & Potter, R. G. (1983) Fertility, Biology and Behavior: An Analysis of the Proximate Determinants. Academic Press, New York.Google Scholar
Bowen-Jones, A., Thompson, C. & Drewett, R. F. (1982) Milk flow and suckling rates during breast-feeding. Dev. Med. Child Neurol. 24, 626.CrossRefGoogle Scholar
Bracher, M. (1992) Breastfeeding, lactational infecundity, contraception and the spacing of births: implications of the Bellagio Consensus statement. Hlth Transition Rev. 2, 19.Google ScholarPubMed
Consensus (1988) Consensus statement: breastfeeding as a family planning method. Lancet, ii, 1204.Google Scholar
Delgado, H., Lechtig, A., Martorell, R., Brineman, E. & Klein, E. (1978) Nutrition, lactation, and postpartum amenorrhea. Am. J. clin. Nutr. 31, 322.CrossRefGoogle ScholarPubMed
Delvoye, P., Delogne-Desnoeck, J. & Robyn, C. (1980) Hyperprolactinaemia during prolonged lactation: evidence for anovulatory cycles and inadequate corpus luteum. Clin. Endocr. 13, 243.CrossRefGoogle ScholarPubMed
Elias, M. J., Teas, T. J. & Bora, C. (1986) Nursing practices and lactation amenorrhoea. J. biosoc. Sci. 18, 1.CrossRefGoogle ScholarPubMed
Ford, K. & Huffman, S. (1988) Nutrition, infant feeding and post-partum amenorrhoea in rural Bangladesh. J. biosoc. Sci. 20, 461.CrossRefGoogle ScholarPubMed
Glasier, A., McNeilly, A. S. & Howie, P. W. (1986) The prolactin response to suckling. Clin. Endocr. 21, 109.CrossRefGoogle Scholar
Hennart, P., Hofvander, H., Vis, H. & Robyn, C. (1985) Comparative study of nursing mothers in Africa (Zaire) and in Europe: breastfeeding behaviour, nutritional status, lactational hyperprolactinemia and status of the menstrual cycle. Clin. Endocr. 22, 179.CrossRefGoogle ScholarPubMed
Heywood, P. F. (1983) Growth and nutrition in Papua New Guinea. J. Hum. Evolut. 12, 133.CrossRefGoogle Scholar
Howie, P. J. & McNeilly, A. S. (1982) Effect of breast-feeding patterns on human birth intervals. J. Reprod. Fert. 65, 545.CrossRefGoogle ScholarPubMed
Howie, P. J., McNeilly, A. S., Houston, M. J., Cook, A. & Boyle, H. (1981) Effect of supplementary food on suckling patterns and ovarian activity during lactation. Br. med. J. 283, 757.CrossRefGoogle ScholarPubMed
Howie, P. J., McNeilly, A. S., Houston, M. J., Cook, A. & Boyle, H. (1982) Fertility after childbirth: postpartum ovulation and menstruation in bottle and breast feeding mothers. Clin. Endocr. 17, 323.CrossRefGoogle ScholarPubMed
Huffman, S. L., Chowdhury, A., Allen, H. & Nahar, L. (1987a) Suckling patterns and postpartum amenorrhoea in Bangladesh. J. biosoc. Sci. 19, 171.CrossRefGoogle ScholarPubMed
Huffman, S. L., Chowdhury, A. K. M., Chakraborty, J. & Simpson, N. K. (1980) Breastfeeding patterns in rural Bangladesh. Am. J. clin. Nutr. 33, 144.CrossRefGoogle ScholarPubMed
Huffman, S. L., Ford, K., Allen, H. A. & Streble, P. (1987b) Nutrition and fertility in Bangladesh: breastfeeding and post partum amenorrhoea. Popul. Stud. 41, 447.CrossRefGoogle Scholar
Jenkins, C. L. (1989) The Amele and Dr Braun: a history of early experience with Western Medicine. In: A Continuing Trial of Treatment: Medical Pluralism in Papua New Guinea, pp. 181198. Edited by Frankel, S. & Lewes, G.. Kluwer, Boston.CrossRefGoogle Scholar
Jenkins, C. L. & Heywood, P. F. (1985) Ethnopediatrics and fertility among the Amele of lowland Papua New Guinea. In: Breastfeeding, Child Health, and Child Spacing: Cross-Cultural Perspectives. pp. 1134. Edited by Hull, V.. & Simpson, M.. Croom Helm, London.Google Scholar
Jenkins, C. L., Orr-Ewing, A. K. & Heywood, P. F. (1984) Cultural aspects of early childhood growth and nutrition among the Amele of lowland Papua New Guinea. Ecol. Food Nutr. 14, 261.CrossRefGoogle ScholarPubMed
Johnston, J. M. & Amico, J. A. (1986) A prospective longitudinal study of the release of oxytocin and prolactin in response to infant suckling in long term lactation. J. Clin. Endocr. Metab. 62, 653.CrossRefGoogle ScholarPubMed
Jones, R. E. (1988) A hazards model analysis of breastfeeding variables and maternal age on return to menses postpartum in rural Indonesian women. Hum. Biol. 60, 853.Google ScholarPubMed
Jones, R. E. (1989) Breast-feeding and post-partum amenorrhoea in Indonesia. J. biosoc. Sci. 21, 83.CrossRefGoogle ScholarPubMed
Jones, R. E. (1990) The effect of initiation of child supplementation on resumption of postpartum menstruation. J. biosoc. Sci. 22, 173.CrossRefGoogle Scholar
Konner, M. J. & Worthman, C. M. (1980) Nursing frequency, gonadal function, and birth spacing among !Kung hunter–gatherers. Sciences, 207, 788.CrossRefGoogle ScholarPubMed
Lewis, P. R., Brown, J. B., Renfree, M. B. & Short, R. V. (1991) The resumption of ovulation and menstruation in a well-nourished population of women breastfeeding for an extended period of time. Fert. Steril. 55, 529.CrossRefGoogle Scholar
Lögren, T. (1985) Time-resolved fluorometry and immunoassay. In: Alternative Immunoassays, pp. 203217. Edited by Collins, W. P.. Wiley, Chichester.Google Scholar
Lunn, P. G., Austin, S., Prentice, A. M. & Whitehead, R. G. (1980) Influence of maternal diet on plasma prolactin levels during lactation. Lancet, i, 623.CrossRefGoogle Scholar
Lunn, P. G., Austin, S., Prentice, A. M. & Whitehead, R. G. (1984) The effect of improved nutrition on plasma prolactin concentrations and postpartum infertility in lactating Gambian women. Am. J. clin. Nutr. 39, 227.Google ScholarPubMed
McNeilly, A. S. (1987) Prolactin and the control of gonadotrophin secretion. J. Endocr. 115, 1.CrossRefGoogle ScholarPubMed
McNeilly, A. S., Glasier, A., Jonassen, J. & Howie, P. W. (1982a) Evidence for direct inhibition of ovarian function by prolactin. J. Reprod. Fert. 65, 559.CrossRefGoogle ScholarPubMed
McNeilly, A. S., Howie, P. W., Houston, M. J., Cook, A. & Boyle, H. (1982b) Fertility after childbirth: adequacy of postpartum luteal phases. Clin. Endocr. 17, 609.CrossRefGoogle ScholarPubMed
Moir, J. S., Garner, P. A., Heywood, P. F. & Alpers, M. P. (1989) Mortality in a rural area of Madang Province, Papua New Guinea. Ann. trop. Med. Parasitol. 83, 305.CrossRefGoogle Scholar
Mueller, W. H. (1988) Ethnic differences in fat distribution during growth. In: Fat Distribution During Growth and Later Health Outcomes, pp. 127145. Edited by Bouchard, C. & Johnston, F. E.. Liss, New York.Google Scholar
Naijar, M. F. & Rowland, M. (1987) Anthropometric Reference Data and Prevalence of Overweight, United States, 1976–80. Vital and Health Statistics, NCHS Series 11, No. 238. DHHS Publication No. PHS 87–1688. Washington, DC.Google Scholar
Norgan, N. G., Ferro-Luzzi, A. & Durnin, J. V. G. A. (1982) The body composition of New Guinean adults in contrasting environments. Ann. hum. Biol. 9, 343.CrossRefGoogle ScholarPubMed
Orr-Ewing, A. K., Heywood, P. F. & Coward, W. A. (1986) Longitudinal measurements of breast milk output by a 2H2O tracer technique in rural Papua New Guinean women. Hum. Nutr. clin. Nutr. 40C, 451.Google Scholar
Panter-Brick, C. (1991) Lactation, birth spacing and maternal work-loads among two castes in rural Nepal. J. biosoc. Sci. 23, 137.CrossRefGoogle ScholarPubMed
Prema, K., Vaidu, A. N., Neelakumari, S. & Ramalakshmi, B. A. (1981) Nutrition–fertility interaction in lactating women of low income groups. Br. J. Nutr. 45, 461.CrossRefGoogle ScholarPubMed
Rivera, R., Ortiz, E., Barrera, M., Kennedy, K. & Bhiwandiwala, P. (1985) Preliminary observations on the return of ovarian function among breast-feeding and post-partum non-breast-feeding women in a rural area of Mexico. J. biosoc. Sci. Suppl. 9, 127.CrossRefGoogle Scholar
Rosa, F. W. (1975) Breast-feeding in family planning. PAG Bull. 5, 5.Google ScholarPubMed
Rosetta, L. (1989) Breast feeding and post-partum amenorrhea in Serere women in Senegal. Ann. hum. Biol. 16, 311.CrossRefGoogle ScholarPubMed
Rosner, A. E. & Schulman, S. K. (1990) Birth interval among breast-feeding women not using contraceptives. Pediatrics, 86, 747.CrossRefGoogle Scholar
Scott, E. C. & Johnston, F. E. (1985) Science, nutrition, fat, and policy: tests of the critical-fat hypothesis. Curr. Anthrop. 26, 463.CrossRefGoogle Scholar
Shangold, M. M. (1984) Excercise and the adult female: hormonal and endocrine effects. Exerc. Sport Sci. Rev. 12, 53.CrossRefGoogle Scholar
Short, R. V. (1984) Breast feeding. Sci. Am. 250, 35.CrossRefGoogle ScholarPubMed
Stern, J. M., Konner, M., Herman, T. N. & Reichlin, S. (1986) Nursing behaviour, prolactin and postpartum amenorrhoea during prolonged lactation in American and !Kung mothers. Clin. Endocr. 25, 247.CrossRefGoogle ScholarPubMed
Tracer, D. (1991) Fertility-related changes in maternal body composition among the Au of Papua New Guinea. Am. J. Phys. Anthrop. 85, 393.CrossRefGoogle ScholarPubMed
Vitzthum, V. J. (1989) Nursing behaviour and its relation to duration of post-partum amenorrhoea in an Andean community. J. biosoc. Sci. 21, 145.CrossRefGoogle Scholar
Whitworth, N. S. (1988) Lactation in humans. Psychoneuroendocr. 13, 171.CrossRefGoogle ScholarPubMed
Wilmsen, E. N. (1985) Biological determinants of fecundity and fecundability: an application of Bongaart's model to forager fertility. In: Culture and Reproduction, pp. 5989. Edited by Handwerker, W. P.. Westview Press, Boulder, Colorado.Google Scholar
Wood, J. W., Johnson, P. L. & Campbell, K. L. (1985a) Demographic and endocrinological aspects of low natural fertility in highland New Guinea. J. biosoc. Sci. 17, 57.CrossRefGoogle ScholarPubMed
Wood, J., Lai, D., Johnson, P., Campbell, K. & Maslar, I. (1985b) Lactation and birth spacing in highland New Guinea. J. biosoc. Sci. Suppl. 9, 159.CrossRefGoogle ScholarPubMed
Worthman, C. M., Stallings, J. F. & Hofman, L. F. (1990) A sensitive salivary estradiol assay for monitoring ovarian function. Clin. Chem. 36, 1769.CrossRefGoogle ScholarPubMed