Integrating Biological, Behavioral, and Economic Factors in the Practice and Study of Early, Unplanned Lactation...

Background: An estimated 60% of mothers experience early, unplanned lactation cessation and do not meet their breastfeeding goals, increasing the risk of maternal and infant health problems and their associated costs. Perceived or real insufficient mothers' own milk (MOM) during the first 14 postpartum days is a frequently reported reason for early, unplanned lactation cessation. These first 14 postpartum days include the lactation phases of secretory activation (SA) and coming to volume (CTV; ≥500 mL MOM daily) achievements and are affected by biological, behavioral, and economic factors. Methods: A framework for studying early, unplanned lactation cessation was developed by researchers with expertise in lactation science, neonatal research, healthy population research, public health, basic sciences, and economics. Results: Current research and clinical models primarily address behavioral factors, including maternal perceptions of insufficient MOM volume and social support from family or peers. While important, these models do not include biological and economic factors known to affect early, unplanned lactation cessation. The proposed integrated framework incorporates biological, behavioral, and economic factors with the centrality of mammary gland stimulation and MOM removal. Conclusion: This framework may be used to develop and test innovative research and clinical models and may especially be useful in addressing inequities among populations at higher risk for early, unplanned lactation cessation.