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Many important achievements have taken place in the protection, support, and promotion of breastfeeding in the past 20 years, not least of which is the successful introduction and early stages of large-scale implementation of LAM, the lactation amenhorrhea method of contraception. The chance of getting pregnant during exclusive breastfeeding is less than 1% (1) during the first six months as long as menstruation has not yet returned. It gradually increases thereafter depending partly on whether breastfeeding frequency is maintained even once solids are added, and whether there are no long gaps between breast feeds. Believing that much of this progress was possible only where conventional approaches were challenged, I suggest we continue that approach. Having here been asked to speak rather broadly on these topics, I propose to cover a wide range of issues I see as crucial in reducing levels of fertility and malnutrition, perhaps the two greatest challenges humankind will face in the next century.

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