[Breast feeding and birth spacing in Burundi: an approach]

Breast-feeding (BFD), post-partum amenorrhea (PPA), and birth interval (BI) were studied in 247 mothers from Burundi (159 rural and 88 urban). BFD was higher in rural than in urban areas (23.8 +/- 6.8 vs 16.5 +/- 7.2 mths, p less than 0.001), as for PPA (16.9 +/- 8.5 vs 8.9 +/- 8 mths, p less than 0.001) and Bl (29 +/- 11 vs 25.7 +/- 10.7 mths, p less than 0.01). PPA of non exclusively breast-feeding (NEB) mothers was lower than that of the other mothers (5.7 +/- 6.5 vs 13.9 +/- 9 mths, p less than 0.001). The proportion of mothers with PPA less than or equal to 12 months was higher in NEB mothers (88.9% vs 49%, p less than 0.001). The relative risk of pregnancy 9 to 12 mths after a birth was 4 times higher for these mothers (28% vs 9%, RR = 3.9, p less than 0.001). PPA and BI were correlated with BFD (respectively r = 0.644 and r = 0.21, p less than 0.001). A multivariate analysis showed that PPA is lowered when BFD and frequency of sucking are reduced in urban high socio-economic levels (R = 56%, p less than 0.01). BI was not so lowered in urban area than expected with a lower BFD and PPA. These data suggest that post-partum infertility period lowered in urban area would be partially counterbalanced by cultural taboo inhibiting sexual intercourse during breast-feeding. Deep modification in sexual behavior accelerated by use of contraceptives should lead to be careful in their spread in family planning programmes where breast-feeding promotion is more than ever a priority.