***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Eighty healthy single births born at a gestational age of 259 - 294 days were studied in an open , non-r and omized , group comparative fashion . The mothers were on average 6 weeks postpartum , healthy , and fully breastfeeding at the start of treatment . Forty-two mothers elected to use the etonogestrel-releasing implant , Implanon , while 38 chose use of a non-hormone medicated intrauterine device ( IUD ) . One month after implant placement , the dose of etonogestrel ingested by the infants via breast milk was 19.86 ng/kg/day , which decreased to 10.45 ng/kg/day at the end of the study period ( month 4 ) . The volume of breast milk production was not affected by the use of Implanon . There were no significant differences between groups in milk content of total fat , total protein , and lactose . The timing and quantity of supplementary feedings did not differ between the two groups . Growth of the infants was analyzed by treatment and gender . For the girls , no differences between groups were seen for body weight , body length , and head circumference . The same applied to the boys except for a somewhat larger , although not statistically significant , increase in body weight for boys whose mother used Implanon . There was a low incidence of intercurrent illnesses in the infants of both groups . None of the conditions was of a serious nature . From the present study , we conclude that Implanon did not change the volume and composition of breast milk . The low concentration of etonogestrel ingested by the infant was not associated with adverse effects OBJECTIVE : To evaluate lactogenesis after early postpartum insertion of the etonogestrel contraceptive implant . METHODS : Healthy peripartum women with healthy , term newborns who desired the etonogestrel implant for contraception were r and omly assigned to early ( 1–3 days ) or st and ard ( 4–8 weeks ) postpartum insertion . The primary outcomes , time to lactogenesis stage II and lactation failure , were documented by a vali date d measure . The noninferiority margin for the mean difference in time to lactogenesis stage II was defined as 8 additional hours . Secondary data ( device continuation and contraceptive use , breast milk analysis , supplementation rates , side effects , and bleeding patterns ) were collected at periodic intervals for 6 months . RESULTS : Sixty-nine women were enrolled . Thirty-five were r and omly assigned to early insertion and 34 to st and ard insertion . There were no statistically significant differences between the groups in age , race , parity , mode of delivery , use of anesthesia , or prior breastfeeding experience . Early insertion was demonstrated to be noninferior to st and ard insertion in time to lactogenesis stage II ( early : [ mean±st and ard deviation ] 64.3±19.6 hours ; st and ard : 65.2±18.5 hours , mean difference , −1.4 hours , 95 % confidence interval [ CI ] −10.6 to 7.7 hours ) . Early insertion was also demonstrated to be noninferior to st and ard insertion in incidence of lactation failure ( 1/34 [ 3 % ] in the early insertion group , 0/35 [ 0 % ] in the st and ard insertion group [ risk difference , 0.03 , 95 % CI −0.02 to 0.08 ] ) . Use of formula supplementation was not significantly different between the groups . Milk composition at 6 weeks was not significantly different between the groups . CONCLUSION : Breastfeeding outcomes were similar in women who underwent early compared with st and ard postpartum insertion of the etonogestrel implant . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00847587 . LEVEL OF EVIDENCE : OBJECTIVE The purpose of this study was to identify the impact on breast-feeding patterns of early postpartum initiation of progestin-only birth control methods compared with nonhormonal methods . STUDY DESIGN A prospect i ve , nonr and omized trial was performed comparing progestin-only contraceptive methods administered before hospital discharge with nonhormonal methods on breast-feeding continuation rates , exclusive breast-feeding , and supplementation at 2 , 4 , and 6 weeks after delivery . RESULTS Three hundred nineteen women provided complete data until hospital discharge . The hormonal group had higher risk factors for not breast-feeding , but there was no difference among any of the subgroups in breast-feeding continuation rates except at week 4 . Supplementation or perception of insufficient milk production did not differ between groups . By week 6 , 23.5 % of women discontinued breast-feeding , and 64.5 % of those breast-feeding were supplementing . CONCLUSION This study demonstrates that there is no detectable adverse impact on breast-feeding attributable to progestin-only contraceptive methods initiated within the first 3 days post partum BACKGROUND Mirena is a levonorgestrel-releasing intrauterine system ( LNG-IUS ) that provides highly effective and long-acting progestogen-only contraception . OBJECTIVE The objective of this study was to analyze the possible effects of using LNG-20 microg IUS on breast-feeding performance , infant growth and infant development during the first postpartum year as compared with the Copper T380A intrauterine device ( Cu T380A IUD ) . DESIGN This study is a prospect i ve , controlled and r and omized trial . SETTING The study was conducted at the Department of Obstetrics and Gynecology , Assiut University Hospital , Egypt . METHODS Three hundred twenty lactating women asking for initiation of contraception during the early postpartum stage were assigned r and omly into two groups , the LNG-20 microg IUS group ( n=163 ) and the Cu T380A group ( n=157 ) . The insertions were done 6 - 8 weeks postpartum . Each participant was followed up at three monthly intervals after insertion and until the first birthday of her baby . During these visits , the breast-feeding pattern was assessed , certain infant physical growth parameters were measured and a set of infant development tests was performed . RESULTS No pregnancy occurred in both groups . There were no significant differences in the net continuation rates between the two groups ( 89.3 for LNG-IUS vs. 90.9 for Cu T380A ) . The LNG-20 microg IUS group had comparable rates of breast-feeding continuation , complete weaning , full breast-feeding and partial breast-feeding , with the Cu-IUD group . No statistically significant differences were found between groups with regard to all infant physical growth parameters and various infant development tests . CONCLUSION The findings of the current study confirm that the use of LNG-20 microg IUS during the first postpartum year in lactating women provides highly effective and acceptable contraception and does not negatively influence breast-feeding or the growth and development of breast-fed infants Growth , development and health of infants whose mothers used progestogen-only contraceptives during lactation were examined in a prospect i ve , non-r and omized study that was carried out in seven centres in five countries ( Egypt , Thail and , Kenya , Chile and Hungary ) . The results on development are reported here . Breastfeeding women requesting effective contraception were admitted to the study at six weeks postpartum . Infants of acceptors of progestogen-only methods ( pill , DMPA , NET-EN or NORPLANT implants ) and non-hormonal methods ( IUD , barrier methods or sterilization )  formed the study groups . The follow-up was at monthly intervals until the end of the first postpartum year . At each visit , the infant examination included , among other things , a set of developmental tests covering the following areas : gross motor , vision and fine motor , hearing , language and concept development , and self help and social skills . Participating in the study were 2466 mother-infant pairs . The comparisons between the study groups were carried out within centres using life table methods and Cox-model analysis having the time to first passing the test as the criterion . There were altogether 247 comparisons between the study groups . Thirty-two ( 13 % ) of these comparisons showed statistically significant differences : 20 differences showed that the infants in the progestogen-only groups passed the tests at an earlier age and 12 at a later age than infants in the non-hormonal groups . Since no consistent trends were observed across the centres , we conclude that in this study the progestogen-only contraceptives used during lactation did not adversely affect infant development INTRODUCTION Unmet need for family planning approaches 40 % or higher and many women are at risk of unintended pregnancy . Progesterone contraception after birth is frequently recommended , but concern remain of inhibition of lactation or effects on infant health . In present study we aim ed to evaluate impact of short term use of injectable depot medroxy progesterone acetate ( DMPA ) if given in early post partum period on infant health and breast feeding performance . MATERIAL AND METHODS A prospect i ve case control study was conducted and 250 women immediately after delivery were recruited in the study . 150 women who were recruited as study group received Inj .  DMPA 150 mg intra muscularly after initiation of lactation before discharge from hospital ( Day 2-Day 10 of their delivery ) . 100 post partum women , not using hormonal contraception were taken as controls . All the subjects were followed to complete a full 6 months follow up . Duration and frequency of lactation , gain in weight , gain in height and any illness spells in the infant were noted at 6 weeks , 3 months and 6 months follow up . In the study group 100 subjects completed 6 months follow-up . The statistical analysis was carried out by using SPSS software version 7 . The statistical technique used was z score ( significance shown by z score > 1.96 ) and repeated measure analysis ( two way Anova technique ) . RESULTS Hundred percent of primigravidas in the study group and 95 % in the control group were satisfied with their lactation amount . The average gain in height was comparable in both study and control group { 4.36±0.56 vs 4.33±0.54 ( z score 0.38 ) at 6 weeks , 12.44±0.73 vs 12.40±0.71 ( z score 0.39 ) at 3 months 17.30±0.91 vs 17.28±0.83 ( z score 0.16 ) at 6 months}. Similarly average gain in weight was also not significantly different in two groups { 0.89±0.11 vs 0.93±0.10 ( z score 0.71 ) at 6 weeks , 1.77±0.17 vs 1.78±0.16 ( z score 1.07 ) at 3 months and 3.53±0.30 vs 3.46±0.33 ( z score 1.19 ) at 6 months}. The results were comparable with other studies . CONCLUSION Injectable DMPA use as a contraceptive in the immediate post partum period was found to be a safe and effective alternate method with no deleterious effect on mother 's  milk and infant 's growth Abstract The effect upon lactation of two methods of post-partum contraception was evaluated . An experimental group of 100 healthy young mothers , positively oriented towards breast-feeding , received Chlormadinone diacetate ( Clogestone ) , a C 21 progestogen , 0.6 mg daily in a continuous oral regimen . This group was observed for a total of 1,300 months . A similar group of 173 young women , who received an inert I.U.D. ( Lippes ' D ) was used as control . In this latter group , 100 women were strongly motivated to breast-feed and were encouraged about proper procedures . The remaining 73 were not comparably motivated . Lactation was maintained for the longest period , in the greatest number of mothers in the Clogestone series . The overall lactation performance of women in the I.U.D. series was markedly lower ; motivated mothers were able to breast-feed their infants for longer periods than the disinterested mothers , in whom milk secretion declined rapidly . The  C 21 progestogen  did not interfere with lactation ; more than 40 % of mothers in this series were able to nurse their children for periods over 12 months . Some factors involved in lactation are discussed A clinical study was design ed to test whether sustained administration of progesterone to nursing mothers could prolong lactation and delay the postpartum recovery of fertility . The hormone was administered by subdermal implantation of six pellets that each contained 100 mg of progesterone . This treatment was administered to 84 fully nursing women on day 30 post partum . Control groups were composed of 130 fully nursing women who received an injectably placebo , and by 125 fully nursing women who received a TCu 200 intrauterine contraceptive device .  An exacting list of requirements for admission to and continuation in the study was applied to all groups . No pregnancies occurred in the progesterone-treated group from the second to the sixth postpartum month . This period coincided with the period of elevation plasma progesterone attributable to hormone released from the implants . The cumulative probability of pregnancy in the placebo group was 10.2 per 100 women at the sixth month . Treatment with progesterone did not change the duration of lactation or the rate of child growth , and no adverse effects were recorded . These results warrant further investagation of the use of progesterone as an alternative method to prevent conception in nursing women Bone density and turnover was assessed in a longitudinal study of healthy lactating women who initiated use of Norplant((R ) ) implants ( NOR , n = 29 ) , progesterone v 
    Output:
    
The preponderance of evidence fails to demonstrate adverse breastfeeding outcomes or negative health outcomes in infants such as restricted growth , health problems or impaired development .