Knowledge of LAM among participants.

High fertility rates in low and middle-income countries (LMICs), especially in sub-Saharan Africa and Ghana, lead to closely spaced pregnancies and contribute to high maternal and infant morbidity and mortality. Family planning remains critical for reducing rapid repeat and unwanted pregnancies, thus improving the health and survival outcomes. Unfortunately, many women face significant unmet needs due to limited knowledge, misinformation, and limited access to modern family planning methods in particular. Breastfeeding plays a substantial role, and the lactational amenorrhea method (LAM) offers a practical, natural, readily available, and cost-efficient postpartum option when practiced correctly. However, many mothers lack sufficient awareness of LAM and the conditions necessary for its effectiveness. Antenatal care provides a strategic opportunity for targeted education and counselling on contraceptive choices, empowering women with the knowledge to adopt safe, informed, and sustainable practices. Group antenatal care (G-ANC), recommended by WHO for research in LMICs, offers a comprehensive and participatory platform for health education and behavioral change. This study examined G-ANC and its impact on creating awareness and improving knowledge of the lactational amenorrhea method among mothers. A cluster randomized control trial, registered at ClinicalTrials.gov on 25/07/2019 with RCT number NCT04033003, was conducted in Ghana at 14 health facilities with a total of 1761 participants. The study included pregnant women who were at least 15 years old, able to speak English or one of four local languages, and less than 20 weeks of gestation at enrollment. Women classified as high-risk by the midwife were excluded from participation in the study. Facilities were randomized using a matched pair method. Structured interviews were conducted at baseline and subsequent timepoints. The results found that group antenatal care increases maternal awareness and knowledge of the postpartum lactational amenorrhea method of family planning compared to individualized care. Subgroup analysis revealed that a mother’s level of education and parity strongly predict maternal awareness of the lactational amenorrhea method. These findings support group antenatal care as an effective strategy to improve knowledge on the use of lactational amenorrhea as a family planning method.

中低收入国家（low and middle-income countries, LMICs），尤其是撒哈拉以南非洲与加纳，较高的生育率会导致妊娠间隔过短，进而推高孕产妇与婴儿的发病率及死亡率。计划生育对于减少频繁重复妊娠与非意愿妊娠、改善健康结局与存活率至关重要。然而，由于知识储备不足、错误信息泛滥，尤其是难以获取现代计划生育手段，许多女性面临着严重的未满足需求。
母乳喂养发挥着关键作用，而哺乳闭经避孕法（lactational amenorrhea method, LAM）若正确使用，则是一种实用、天然、易于获取且成本效益可观的产后避孕选择。但多数母亲对LAM及其生效所需的条件缺乏足够认知。产前保健（antenatal care, ANC）为针对性开展避孕选择相关的教育与咨询提供了战略契机，可帮助女性掌握相关知识，从而采用安全、知情且可持续的避孕方式。
由世界卫生组织（World Health Organization, WHO）推荐用于中低收入国家开展研究的团体产前保健（group antenatal care, G-ANC），则为健康教育与行为改变提供了兼具全面性与参与性的平台。本研究针对G-ANC及其在提升母亲对LAM的认知与知识水平方面的作用展开了探究。
本研究为整群随机对照试验（cluster randomized control trial, RCT），于2019年7月25日在ClinicalTrials.gov完成注册，注册号为NCT04033003。研究在加纳的14家医疗机构开展，共纳入1761名参与者。纳入标准为：年龄至少15岁、能够使用英语或四种当地语言之一、入组时妊娠时长不足20周的孕妇。助产士判定为高风险的孕妇被排除在本研究之外。研究采用匹配配对法对医疗机构进行随机分组，并在基线及后续时间点开展结构化访谈。
研究结果显示，相较于个体化产前保健，团体产前保健可提升孕产妇对产后哺乳闭经避孕法这一计划生育手段的认知与知识水平。亚组分析显示，母亲的受教育程度与产次是其对LAM认知水平的强预测因子。上述研究结果证实，团体产前保健是提升孕产妇关于哺乳闭经避孕法作为计划生育手段的认知水平的有效策略。