The onset of lactation: implications for breast-feeding promotion programs.

Abstract

This paper discusses the implications of the onset of lactation (OL) for breast-feeding (BF) promotion programs. It is noted that a delay in OL may lead to an early introduction of infant formula and an early termination of BF even after controlling for maternal original BF intentions. This is evinced by multivariate analyses performed on samples from different countries which consistently indicate that a delayed OL is a risk factor for poor BF outcomes. A longitudinal study conducted in urban Mexico found that OL was inversely associated with the likelihood of BF at 2 months post-partum (pp). In Honduras a cross-sectional survey among women with children 2 years old or younger indicated that OL > 72 hours pp was positively associated with the use of milk-based prelacteal feeds which was in turn associated with a lower likelihood of BF. A longitudinal study conducted in Hartford Connecticut USA found that the median BF duration among women with OL or = 72 hours pp. These data suggest that the longer it takes for women to perceive OL the more likely it is that they will become stressed and begin using breast milk substitutes. This may further delay OL leading to an early termination of BF. Future studies should emphasize the relationship between biological and psychosocial stress with OL and subsequent infant feeding outcomes.