Nutrition, infant feeding and post-partum amenorrhoea in rural Bangladesh

The extent to which differences in the duration of postpartum amenorrhea among chronically malnourished women in rural Bangladesh are related to seasonal patterns of food supply, maternal nutrition, education, and patterns of infant feeding was investigated by application of multivariate hazards models with time-varying covariates. The data were derived from the Birth Interval Dynamics study in Matlab and covered close to 1800 births. Parity, education, season of birth, maternal weight, and infant supplementation all were found to affect the duration of postpartum amenorrhea among these women. Education of 5 or more years had a positive effect on the resumption of menses. Higher parity women, who were older, had longer periods of amenorrhea, as did women who gave birth in October-December. As a measure of nutritional status, the woman's weight at pregnancy termination showed a highly significant positive coefficient, indicating that improved maternal nutrition increased the likelihood of resuming menstruation. Food supplementation, which tends to decrease breastfeeding, also significantly increased the risk of resuming menstruation and had an effect independent of the other variables. When the data were analyzed by season, the most striking finding was the strong influence of education on children born during October-December (who are too young to be directly affected by the larger food supply at birth during the harvest season). The other seasons showed weaker effects of education and a stronger effect of supplementation, perhaps because these infants are older during the harvest season and thus can benefit from supplements.