Monitoring of the Main Reasons for Early Abandonment of Breastfeeding during the First Six Months of Life: A Secondary Analysis

Ci a ion: Vale o-Chille ón, M.J.;
So iano-Vidal, F.J.; Mena-Tudela, D.;
Ce e a-Gasch, Á.; Vila-Candel, R.;
Llagos e a-Re e e , I.; And eu-Pejó, L.;
O íz-Mallasén, V.; González-Cho dá,
V.M. Moni o ing o he Main Reasons
o Ea ly Abandonmen o
B eas eeding du ing he Fi s Six
Mon hs o Li e: A Seconda y Analysis.
Nu s. Rep. 2024,14, 1937–1947.
h ps://doi.o g/10.3390/
nu s ep14030144
Academic Edi o : Richa d G ay
Recei ed: 10 June 2024
Re ised: 1 Augus 2024
Accep ed: 4 Augus 2024
Published: 9 Augus 2024
Copy igh : © 2024 by he au ho s.
Licensee MDPI, Basel, Swi ze land.
This a icle is an open access a icle
dis ibu ed unde he e ms and
condi ions o he C ea i e Commons
A ibu ion (CC BY) license (h ps://
c ea i ecommons.o g/licenses/by/
4.0/).
A icle
Moni o ing o he Main Reasons o Ea ly Abandonmen o
B eas eeding du ing he Fi s Six Mon hs o Li e: A
Seconda y Analysis
Ma ía Jesús Vale o-Chille ón1,2 , F ancisco Ja ie So iano-Vidal 2,3,4,5,* , Desi ée Mena-Tudela 1,2,6 ,
Águeda Ce e a-Gasch 1,2 , Ra ael Vila-Candel 2,3,7,8 , I ene Llagos e a-Re e e 1, Lau a And eu-Pejó1,2 ,
Víc o O íz-Mallasén1and Víc o Manuel González-Cho dá1,2,9
1Nu sing Resea ch G oup (GIENF Code 241), Nu sing Depa men , Uni e si a Jaume I, 12071 Cas ellón, Spain
2Join Resea ch Uni PECAWOL (Pe ina al Ca e and Women’s Heal h) FISABIO-UJI, 46020 Valencia, Spain
3Founda ion o he P omo ion o Heal h and Biomedical Resea ch in he Valencian Region (FISABIO-SP),
46020 Valencia, Spain
4Depa men o Nu sing, Uni e si a de València, 46010 Valencia, Spain
5Depa men o Obs e ics and Gynaecology, Hospi al Lluis Alcanyis, 46800 Xà i a, Spain
6Feminis Ins i u e, Uni e si a Jaume I, 12071 Cas ellón, Spain
7La Ribe a P ima y Heal h Depa men , 46600 Alzi a, Spain
8Facul y o Heal h Sciences, Uni e sidad In e nacional de Valencia (VIU), 46002 Valencia, Spain
9Nu sing and Heal hca e Resea ch Uni (INVESTÉN-ISCIII), Ins i u e o Heal h Ca los III, 28029 Mad id, Spain
*Co espondence: [email p o ec ed]
Abs ac : The a e o six-mon h-old in an s exclusi ely b eas ed in Spain emains below he ec-
ommended a e. This s udy aimed o explo e in de ail he e olu ion o eeding du ing he i s six
mon hs o li e o a g oup o newbo ns, as well as o iden i y he easons epo ed by he mo he s
o eeding change. A seconda y analysis o wo p ospec i e longi udinal obse a ional s udies
was conduc ed. In bo h s udies, women pa icipan s, du ing he clinical pue pe ium, op ed o
exclusi e b eas eeding o hei newbo ns. The pa icipan s we e ollowed up du ing he in an s’
i s six mon hs. A sample size o 314 pa icipan s was ob ained, o which 77.1% (n= 232) we e
o Spanish o igin, and 51% (n= 160) we e p imipa ous. The p e alence o exclusi e b eas eeding
a six mon hs was 55.4% (n= 174). Du ing he i s ou mon hs o li e, he main eason o ea ly
abandonmen o b eas eeding was he pe cep ion o insu icien milk p oduc ion. A e he ou h
mon h, he p edominan eason was s a ing wo k. S a is ically signi ican di e ences we e obse ed
be ween he easons o gi ing up and he o al weeks o exclusi e b eas eeding (p< 0.001) and o al
weeks o b eas eeding (p= 0.002). Ea ly weaning om b eas eeding is a mul i ac o ial phenomenon.
Howe e , depending on he momen cessa ion occu s, some easons p edomina e o e o he s and,
in many cases, can be p e en ed. These esul s indica e he need o con inue in es ing e o s o
p omo e and p o ec b eas eeding in Spain.
Keywo ds: b eas eeding; exclusi e b eas eeding; ea ly weaning; exclusi e b eas eeding cessa ion;
b eas eeding abandonmen ; nu sing; women
1. In oduc ion
B eas milk is he op imal ood o in an s’ p ope g ow h and de elopmen . I
p o ides all he ene gy and nu ien s necessa y du ing he i s six mon hs o an in an ’s li e
and con inues o p o ide hal o mo e o he nu i ional equi emen s up o he i s yea
o li e and up o a hi d du ing he second yea [
1
]. B eas eeding, in gene al, especially
na u al b eas eeding o e ed di ec ly om he mo he ’s b eas , p esen s bo h sho - and
long- e m bene i s o in an s, mo he s, socie y, and he en i onmen [2].
Nu s. Rep. 2024,14, 1937–1947. h ps://doi.o g/10.3390/nu s ep14030144 h ps://www.mdpi.com/jou nal/nu s ep
Nu s. Rep. 2024,14 1938
In e na ional o ganisa ions, such as he Wo ld Heal h O ganiza ion (WHO) and he
Uni ed Na ions Child en’s Fund (UNICEF), along wi h a ious scien i ic socie ies, ecom-
mend exclusi e b eas eeding du ing he i s six mon hs o an in an ’s li e and om hen
on o con inue b eas eeding wi h complemen a y oods [3–5].
Howe e , he igu es o exclusi e b eas eeding a e below he a ge se by he WHO
o 2025 o ensu e ha a leas 50% o in an s a e exclusi ely b eas ed [
6
]. In ac , acco ding
o he 2017 Na ional Heal h Su ey in Spain, only 39% o in an s unde six mon hs we e
b eas ed [7].
The abandonmen o b eas eeding is a mul i ac o ial and mul ile el phenomenon.
The abandonmen o b eas eeding is a mul i ac o ial phenomenon in which a ious de-
e minan s can in e ene, such as sociocul u al and socioeconomic ac o s. In he same
way, i is also a mul ile el phenomenon since indi idual ac o s o he mo he o baby may
in e ene, as well as he mo he ’s in e ac ion wi h heal h se ices, he amily, o he wo k
en i onmen [
8
]. In Spain, a ious s udies o e he yea s ha e add essed a ious easons
o ea ly abandonmen o b eas eeding [
9
–
12
]. The objec i e o his s udy was o explo e
in de ail he e olu ion o eeding du ing he i s six mon hs o li e in a g oup o newbo ns
om he Valencian Communi y who, upon hospi al discha ge, we e exclusi ely b eas ed.
This s udy also aimed o iden i y he main easons epo ed by mo he s ha lead o ea ly
weaning om b eas eeding.
2. Ma e ials and Me hods
2.1. S udy Design
A seconda y analysis o he da a ob ained om wo obse a ional, longi udinal,
and p ospec i e s udies was ca ied ou a h ee hospi als in he Valencian Communi y
(Spain): The Gene al Uni e si y Hospi al o Cas ellón (Depa men o Heal h, Cas ellón),
he Uni e si y La Ribe a Hospi al (Depa men o Heal h, La Ribe a), and he Lluís Alcanyís
Hospi al o Xá i a (Depa men o Heal h, Xá i a-On inyen ).
2.2. Da a Collec ion P ocedu e
The ec ui men o he pa icipan s ook place du ing he clinical pue pe ium. Speci -
ically, he ec ui men pe iod o he i s s udy was om Decembe 2018 o May 2019
(
n= 114)
[
13
], while ha o he second s udy was om Ap il 2022 o Ma ch 2023 (n= 200)
( his s udy is cu en ly in he p ocess o being published). The wo s udies om which he
p esen seconda y s udy o igina ed pu sued wo di e en objec i es ela ed o b eas eed-
ing. The e o e, exclusi e b eas eeding and o al b eas eeding we e moni o ed du ing he
i s six mon hs o he babies’ li es. Likewise, in bo h cases, he main eason o abandoning
b eas eeding was eco ded i i occu ed be o e he end o ollow-up. The e o e, in his
seconda y s udy, he sha ed a iables om p e ious s udies we e combined o deepen
ou knowledge o he e olu ion o b eas eeding in ou en i onmen . A combined sample
o 314 pa icipan s was ob ained. The selec ion c i e ia we e iden ical in bo h s udies.
The inclusion c i e ia applied a he ime o ec ui men we e being o legal age, ha ing
chosen o eed hei newbo ns wi h exclusi e b eas eeding, and olun a ily pa icipa ing
in he s udy. Mul iple p egnancies we e excluded, as well as hose cases in which he
mo he and newbo n we e sepa a ed a e childbi h due o ma e nal and/o neona al
heal h complica ions.
Fu he mo e, in bo h s udies, women ecei ed he same suppo o p omo e and
p o ec b eas eeding. Speci ically, du ing he clinical pos pa um pe iod, nu sing s a and
midwi es e iew he e ec i eness o b eas eeding. A e discha ge, midwi es (up o he
i s 6 weeks), pedia ic nu ses, and paedia icians assess he main enance o b eas eeding.
The ollow-up and moni o ing a e es ablished h ough he newbo n p og amme, which
includes a isi wi hin 7 days pos pa um by he midwi e o bo h he mo he and newbo n,
a 15-day check-up by he pedia ic nu se and paedia ician, a 5–6 week check-up by he
midwi e, and ollow-up isi s a 2, 4, and 6 mon hs by he paedia ician.
Nu s. Rep. 2024,14 1939
In bo h s udies, b eas eeding was moni o ed h ough elephone calls o he pa ici-
pan s du ing he i s six mon hs o he newbo n’s li e o un il he de ini i e abandonmen
o b eas eeding occu ed. I he e was a change in he in an s’ eeding, he main eason
ha had led o he change in he in an s’ eeding was eco ded, as well as he o al weeks
hey we e ed wi h each ype o eeding (EBF: exclusi e b eas eeding; SBF: supplemen ed
b eas eeding; FF: o mula eeding; o al BF: sum o he weeks o EBF and SBF).
Those cases whe e b eas eeding moni o ing began in he i s mon h o he in an ’s
li e, bu i was impossible o con ac he pa icipan s a any subsequen ollow-up poin
we e ea ed as censou ed da a.
2.3. Measu emen
F om he wo coho s om which he da a we e ex ac ed, sociodemog aphic a i-
ables we e eco e ed, such as he age o he pa icipan s and na ionali y (Spanish/o he ).
Obs e ic a iables, such as pa i y (p imipa ous/mul ipa ous) and a iables ela ed o
b eas eeding ( o al weeks ha EBF had been main ained, he SBF, and he main eason o
change in he in an ’s eeding: 1-Pe cep ion o insu icien milk p oduc ion; 2-Weigh gain
less han ecommended; 3-B eas p oblems esul ing om b eas eeding; 4-B eas p ob-
lems un ela ed o b eas eeding; 5-Employmen inco po a ion; 6-Any lack o b eas eeding
suppo ; 7-Ano he eason; 8-In oduc ion o Complemen a y Feeding).
2.4. Ope a ional De ini ions
Acco ding o p e ious s udies [
13
,
14
], he ollowing key si ua ions can be dis inguished.
•
EBF cessa ion: a si ua ion in which he baby s opped being ed wi h EBF o be ed
wi h supplemen ed eeding
•
Abandonmen o BF: a si ua ion in which he baby s opped ecei ing BF o be ed o mula.
2.5. S a is ical Analysis
Desc ip i e analysis used absolu e and ela i e equencies o quali a i e a iables
and mean and s anda d de ia ion (SD) o quan i a i e a iables. Bi a ia e analysis o
he weeks un il ea ly EBF cessa ion and comple e abandonmen o b eas eeding was
pe o med using he Mann–Whi ney U es (dicho omous a iables) and K uskal–Wallis
es (polycho omous a iables). In addi ion, a de ailed ollow-up o he b eas eeding o
each pa icipan was ca ied ou , e lec ing he e olu ion o eeding du ing he i s six
mon hs. In case a change in eeding occu ed, he main eason o he change was de ailed.
In his way, he p obabili y o eeding wi h each ype o eeding (EBF, SBF, and FF) was
calcula ed, as well as he p obabili y ha each eason o abandonmen occu ed depending
on he ollow-up ime.
The o mulas used o calcula e he p obabili y o eeding wi h each ype o eeding a
di e en ollow-up imes a e as ollows:
The p e alence (p e ) o each eeding a each ollow-up poin was calcula ed as
ollows. In he nume a o , we de e mined he ype o eeding a ha ollow-up poin . In
he denomina o , we ound all he cases ha , a he immedia ely p e ious ollow-up poin ,
we e able o op o he nume a o ype o eeding pe 100 pa icipan s:
p e EBF = (nEBF i/nEBF p e ious)×100 (1)
p e SBF = [nSBF i/(nEBF p e ious +nSBF p e ious)] ×100 (2)
p e FF = (nFF i/n o al)×100 (3)
The cumula i e ela i e equencies o eeding changes a each ollow-up poin we e
calcula ed as ollows: he nume a o con ains he o al numbe o in an s who we e ed
by each o he eeding ypes a each ollow-up poin , while he denomina o con ains he
o al numbe o in an s who, a he immedia ely p eceding ollow-up poin , we e ed by
he o iginal eeding ype, pe 100 pa icipan s.
Nu s. Rep. 2024,14 1940
Fo example, he calcula ion o he cumula i e ela i e equency (Fi) o hose in an s
who, be ween he second and ou h mon hs o ollow-up, swi ch om exclusi e b eas -
eeding o o mula eeding is as ollows: [(nume a o : o al numbe o in an s who a e
ed by o mula eeding a he ou h mon h o ollow-up)/(denomina o : o al numbe o
in an s who a e ed by exclusi e b eas eeding a he second mon h o ollow-up)] ×100:
Cumula i e ela i e equencies o changing om EBF o FF (Fi 1)=(nFF i/nEBF p e ious) ×100 (4)
Cumula i e ela i e equencies o changing om EBF o SBF (Fi 2)=(nSBF i/nEBF p e ious) ×100 (5)
Cumula i e ela i e equencies o changing om SBF o FF (Fi 3)=(nFF i/nSBF p e ious) ×100 (6)
The da a we e analysed wi h he SPSS .28 so wa e, and a s a is ical signi icance le el
o p< 0.05 was es ablished.
3. Resul s
The sample consis ed o 314 mo he /baby dyads. The a e age age o he mo he s
was 33 yea s old (SD = 5), o whom 77.1% (n= 232) we e o Spanish o igin, and 51%
(
n= 160
) we e p imipa ous. By he i s mon h, 10.2% (n= 32) o he pa icipan s had
ceased exclusi e b eas eeding (EBF). By he six h mon h o ollow-up, only 55.4% (n= 174)
o he pa icipan s had con inued EBF (Table 1).
Table 1. Dis ibu ion o sociodemog aphic cha ac e is ics and eeding pa e ns du ing he i s six
mon hs o li e.
n%
Coun y o o igin
Spain 232 77.1
O he 68 22.9
Pa i y
P imipa ous 160 51
Mul ipa ous 154 49
Feeding in he i s mon h
Exclusi e B eas eeding 282 89.8
Supplemen ed B eas eeding 28 8.9
Fo mula Feeding 4 1.3
Feeding in he second mon h
Exclusi e B eas eeding 254 80.9
Supplemen ed B eas eeding 34 10.8
Fo mula Feeding 18 5.7
Censo ed Da a 8 2.5
Feeding in he ou h mon h
Exclusi e B eas eeding 219 69.7
Supplemen ed B eas eeding 36 11.5
Fo mula Feeding 37 11.8
Censo ed Da a 22 7
Feeding in he six h mon h
Exclusi e B eas eeding 174 55.4
Supplemen ed B eas eeding 57 18.1
Fo mula Feeding 53 16.9
Censo ed Da a 30 9.6
Figu e 1shows he e olu ion o b eas eeding o e he i s six mon hs o he in an s’
li es. Each moni o ing poin is shown in he columns o he igu e. The ows show he
di e en ypes o eeding and he absolu e equencies and p e alence (p e ) o in an s ed
each ype o eeding h oughou he ollow-up pe iod. Be ween one moni o ing poin and
he nex , he low o in an s who change hei eeding ype is shown, making i possible o
Nu s. Rep. 2024,14 1941
iden i y he absolu e and ela i e equencies o he main eason o he change in eeding
and he espec i e accumula ed ela i e equencies (Fi).
Nu s.Rep.2024,14,FORPEERREVIEW5


Exclusi eB eas eeding17455.4
Supplemen edB eas eeding5718.1
Fo mulaFeeding5316.9
Censo edDa a309.6
Figu e1shows hee olu iono b eas eedingo e  he i s sixmon hso  hein an s’
li es.Eachmoni o ingpoin isshownin hecolumnso  he igu e.The owsshow he
di e en  ypeso  eedingand heabsolu e equenciesandp e alence(p e )o in an s
edeach ypeo  eeding h oughou  he ollow‐uppe iod.Be weenonemoni o ingpoin 
and henex , he lowo in an swhochange hei  eeding ypeisshown,makingi pos‐
sible oiden i y heabsolu eand ela i e equencieso  hemain eason o  hechangein
eedingand he espec i eaccumula ed ela i e equencies(Fi).
Figu e1shows ha  hep e alenceo supplemen alb eas eeding(SBF)andFo mula
Feeding(FF)inc easesas hemon hsgoby.Incon as , hep e alenceo EBFdec eases
in he i s mon h, emainsun il hesecond,anddec easesun il hesix hmon h.As o 
hecumula i e ela i e equencieso apa icula  eedingchangeoccu ing,i isobse ed
ha  hechange omEBF oSBFoccu s oag ea e ex en be ween he ou handsix h
mon hs(Fi2=17.352),aswellasbe weenhospi aldischa geand he i s mon h(Fi2=
8.917).Thechange omEBF oFFis heleas commonchange h oughou  heen i e ol‐
low‐up, eachingi shighes  aluebe ween hesecondand ou hmon h(Fi1=3.150).In
addi ion,app oxima elyone‐ hi do  hein an s edwi hSBFendupwi hFF h oughou 
he ollow‐up,al houghasligh dec easein hisp obabili y(Fi3)isobse edas hemon hs
goby.

Figu e1.E olu iono b eas eeding h oughou  he i s sixmon hs.
Du ing he i s  womon hso b eas eeding, hemain eason o EBFcessa ionwas
heinsu icien weigh gaino  henewbo ns(A e discha ge:( eason2)n=17,60.7%;
Fi s mon h:( eason2)n=7,43.8%).Among hepa icipan swhoop ed o SBF, hemain
eason o comple eabandonmen o b eas eeding h oughou  heen i e ollow‐upwas
Figu e 1. E olu ion o b eas eeding h oughou he i s six mon hs.
Figu e 1shows ha he p e alence o supplemen al b eas eeding (SBF) and Fo mula
Feeding (FF) inc eases as he mon hs go by. In con as , he p e alence o EBF dec eases
in he i s mon h, emains un il he second, and dec eases un il he six h mon h. As
o he cumula i e ela i e equencies o a pa icula eeding change occu ing, i is
obse ed ha he change om EBF o SBF occu s o a g ea e ex en be ween he ou h
and six h mon hs (Fi
2
= 17.352), as well as be ween hospi al discha ge and he i s mon h
(
Fi2= 8.917
). The change om EBF o FF is he leas common change h oughou he en i e
ollow-up, eaching i s highes alue be ween he second and ou h mon h (Fi
1
= 3.150). In
addi ion, app oxima ely one- hi d o he in an s ed wi h SBF end up wi h FF h oughou
he ollow-up, al hough a sligh dec ease in his p obabili y (Fi
3
) is obse ed as he mon hs
go by.
Du ing he i s wo mon hs o b eas eeding, he main eason o EBF cessa ion was
he insu icien weigh gain o he newbo ns (A e discha ge: ( eason 2) n= 17, 60.7%;
Fi s mon h: ( eason 2) n= 7, 43.8%). Among he pa icipan s who op ed o SBF, he main
eason o comple e abandonmen o b eas eeding h oughou he en i e ollow-up was
he pe cep ion o insu icien milk p oduc ion (Fi s mon h: ( eason 1) n= 6, 60%; Second
mon h: ( eason 1) n= 5, 45.5%; Fou h mon h: ( eason 1) n= 5, 45.5%). F om he ou h
mon h o b eas eeding, e u ning o wo k is he main eason o swi ching om EBF o
SBF (( eason 5) n= 16, 42.1%), om EBF o FF (( eason 5) n= 4, 80%), as well as he second
main eason o swi ching om SBF o FF (( eason 5) n= 4, 36.4%).
Table 2shows he bi a ia e analysis o he a e age numbe o weeks ha bo h EBF and
o al b eas eeding (EBF + SBF) a e main ained. Signi ican di e ences we e obse ed in
e ms o pa i y and eason o ea ly weaning om b eas eeding. Speci ically, mul ipa ous
women main ained, on a e age, almos 5 weeks mo e EBF (p< 0.001) and 3 weeks mo e
b eas eeding in o al (p< 0.001). Howe e , no di e ences we e obse ed be ween he
coun y o ma e nal o igin and du a ion o b eas eeding.

Nu s. Rep. 2024,14 1942
Table 2. Bi a ia e esul s ega ding weeks o main aining EBF and b eas eeding in o al.
Weeks Un il Ea ly EBF Cessa ion Weeks Un il Comple e
Abandonmen o BF
n m SD p n m SD p
Coun y o o igin
Spain 232 19.3 9.2 0.347 1232 22.1 7.2 0.724 1
O he 68 18.2 9.4 68 21.7 7.6
Pa i y
P imipa ous 160 16.8 9.9 <0.001 1160 20.5 8.3 <0.001 1
Mul ipa ous 154 21.4 7.8 154 23.7 5.7
Reason o ea ly EBF cessa ion/comple e abandonmen o BF, espec i ely
Pe cep ion o lack o milk 11 8.7 6.6
<0.001 2
18 12.6 7
0.002 2
Less han ecommended weigh gain 32 6.2 6 7 8.7 4.3
B eas p oblems esul ing om BF 1 5.4 3.7 9 6.8 5.3
B eas p oblems un ela ed o BF 1 2 - 2 10 4.2
Back o wo k 22 18.4 4.6 9 19.4 4.4
Any lack o b eas eeding suppo 4 2.6 1.9 3 5.7 2.9
Ano he eason 14 9.8 7.1 5 14.3 8.5
In oduc ion o Complemen a y Feeding 13 21.2 0.6 - - -
1U de Mann–Whi ney; 2K uskal–Wallis.
On he o he hand, s a is ically signi ican di e ences a e obse ed be ween he a -
e age numbe o weeks ha EBF (p< 0.001), as well as o al b eas eeding (p= 0.002), a e
main ained based on he eason o EBF cessa ion o abandonmen o BF, espec i ely.
I was possible o di e en ia e h ee g oups o easons based on he weeks ha each o
he b eas eeding ypes is main ained, wi h any lack o b eas eeding suppo and b eas
p oblems being he ones ha de e mine a smalle numbe o weeks o EBF (2–5.4 weeks)
and o al b eas eeding (5.7–10 weeks); insu icien weigh gain and he pe cep ion o
insu icien milk p oduc ion a e he easons ha p edomina e in he cen al weeks o he
ollow-up (EBF: 6.2–8.7 weeks; o al BF: 8.7–12.6 weeks), and e u ning o wo k is he la e
eason ha p omp s he ea ly abandonmen o bo h EBF and o al b eas eeding.
4. Discussion
Ou s udy highligh s he impo ance o ho oughly unde s anding he pa e ns and
ac o s ha in luence EBF and i s ansi ion o supplemen al b eas eeding o o al aban-
donmen o b eas eeding. Despi e he desi e o Spanish mo he s o b eas eed hei babies,
cu en da a show a signi ican gap be ween ma e nal aspi a ion and he ac ual p ac ice
o EBF. The p esen s udy o e s an in aluable oppo uni y o examine how b eas eed-
ing e ol es h oughou he i s six mon hs o an in an ’s li e and wha ac o s in luence
mo he s’ in an eeding decisions. I is impo an o no e ha in ou coun y, he e is no
o icial eco d o b eas eeding igu es, which makes compa ison di icul . The p esen
s udy o e s an in aluable oppo uni y o examine how b eas eeding e ol es h oughou
he i s six mon hs o an in an ’s li e and wha ac o s in luence mo he s’ in an eeding
decisions h ough an inno a i e me hodological app oach.
Acco ding o Balles a-Cas illejos e al. [
15
], 97.5% o mo he s in Spain wish o b eas -
eed hei babies. Howe e , he la es o icial da a om 2017 epo ed ha only 39% o
in an s unde six mon hs we e exclusi ely b eas ed (EBF) [
7
]. These esul s align wi h
obse a ions in he p esen s udy, whe e he likelihood o ansi ioning om EBF o sup-
plemen ed b eas eeding (SBF) is highe a all ollow-up poin s (5.674–17.352) han he
p obabili y o swi ching om EBF o o mula eeding (FF) (1.418–3.150). These esul s
suppo he idea ha mo he s ha e a genuine desi e o b eas eed. E en when unable o
exclusi ely b eas eed, hey pe sis by supplemen ing b eas eeding as a inal e o p io o
ul ima ely ceasing i . Howe e , once hey s a SBF, he likelihood o ansi ioning o FF in-
c eases signi ican ly (30.556–35.714). These da a highligh he impo ance o unde s anding
he easons behind supplemen a ion o abandonmen o b eas eeding.
Nu s. Rep. 2024,14 1943
One o he main ac o s nega i ely a ec ing he ini ia ion and/o he con inua ion o
b eas eeding is he lack o knowledge ega ding he physiology o b eas eeding
[10,16,17]
and he c ea ion o alse expec a ions abou he b eas eeding p ocess. The e is a mispe -
cep ion ha b eas eeding is easy because o i s inhe en na u e when, in ac , i equi es
lea ning and suppo [
18
]. The epo ed lack o knowledge nega i ely impac s mo he s’
abili y o handle physiological b eas eeding si ua ions, such as g ow h spu s, ein o c-
ing he sui abili y o educa ing mo he s du ing he p ena al s age [
11
], heo e ically and
p ac ically [19].
Du ing g ow h spu s, he baby inc eases b eas demand due o he need o boos
milk p oduc ion [
20
]. Addi ionally, babies may exhibi beha iou s such as ussing a he
b eas , pulling away and seeking i cons an ly, and showing es lessness, among o he s.
Howe e , despi e hei aim o inc ease milk p oduc ion, a lack o knowledge can lead
mo he s o misin e p e hese signals as in an dissa is ac ion [
21
–
23
] o a alse pe cep ion
o insu icien milk p oduc ion [
10
,
16
,
18
,
21
,
22
,
24
]. The mispe cep ion o insu icien milk
p oduc ion can esul in an absolu e dec ease in milk p oduc ion i he in an is inadequa ely
supplemen ed [23,24].
F om hospi al discha ge un il he i s mon h o ollow-up, he p e alence o EBF
dec eases by jus o e 10 pe cen age poin s. Du ing his pe iod, he i s g ow h spu
ypically occu s a ound he second– hi d week o li e [
20
]. These da a highligh he im-
po ance o knowledge o b eas eeding physiology in o e coming he i s g ow h spu
while main aining EBF. Mo he s need o expe ience small successes wi h b eas eeding
du ing he ea ly pos pa um pe iod o de elop sel -e icacy in hei abili y o b eas eed
and o e come b eas eeding challenges, as women’s sel -e icacy is associa ed wi h he
du a ion o EBF [25,26].
In he p esen s udy, he p ima y cause o EBF cessa ion du ing he i s mon h is
insu icien weigh gain in newbo ns, consis en wi h p e ious s udies [
27
]. Addi ionally,
o he p edominan easons include he pe cep ion o insu icien milk p oduc ion and
a pe cei ed lack o b eas eeding suppo . The e o e, hese esul s unde sco e he need
o be e pos na al suppo ocused on empowe ing mo he s in b eas eeding, as well as
g ea e in ol emen o pa ne s in b eas eeding o achie e p ope EBF es ablishmen . By
sa egua ding he ini ia ion o EBF, inadequa e weigh gain in newbo ns can be p e en ed,
hus a oiding ea ly b eas eeding supplemen a ion [
23
]. I is impo an o no e ha mo he s
who epo ed a lack o b eas eeding suppo as a eason o changing hei babies’ eeding
p ac ices main ained EBF o only wo and a hal weeks and SBF o less han six weeks on
a e age. These da a a e consis en wi h o he s udies showing ha a posi i e a i ude om
he pa ne owa ds b eas eeding and adequa e pa ne suppo pe cei ed by he mo he
g ea ly in luence he ini ia ion [12,28–30] and du a ion o b eas eeding [28–30].
The p obabili y o main aining EBF in he second mon h is almos he same as ha
in he i s mon h, while i dec eases conside ably by he ou h mon h. These esul s
sugges ha he second g ow h spu , usually a ound six weeks o li e [
20
], is easie o
o e come han he hi d g ow h spu , which occu s a ound h ee mon hs. The eason
why he second g ow h spu is mo e accessible o o e come han he hi d one may
be because, du ing he i s wo mon hs, mo e pos na al isi s a e scheduled in Spain,
bo h wi h midwi es and paedia icians, acili a ing be e newbo n weigh con ol and
esolu ion o doub s, p o ided ha p o essionals commi ed o b eas eeding a e a ailable
o a oid undue supplemen a ion. Howe e , a e wo mon hs, scheduled consul a ions
become less equen , educing passi e suppo om heal h p o essionals o add ess he
hi d g ow h spu . Addi ionally, he hi d g ow h spu p esen s o he cha ac e is ics
ha may jeopa dise ma e nal b eas eeding con idence, such as egula ed milk p oduc ion
educing he eeling o b eas ullness, inc eased baby dis ac ions du ing eeding, and
slowed g ow h, among o he s.
In line wi h p e ious s udies, as du ing he i s mon h, he main eason o EBF
cessa ion du ing he i s wo mon hs is insu icien in an weigh gain [
10
,
27
], while he
p ima y eason o comple e b eas eeding cessa ion du ing he i s ou mon hs is he
Nu s. Rep. 2024,14 1944
pe cep ion o insu icien milk [
10
]. Acco dingly, when mo he s ci e insu icien in an
weigh gain as he p ima y eason o s opping b eas eeding, hey main ain an a e age
o six weeks o EBF and eigh weeks o o al b eas eeding, consis en wi h he a e age
o 8.7 weeks obse ed in a p e ious s udy conduc ed in Spain [
9
]. In addi ion, when
mo he s pe cei e insu icien milk as he p ima y eason, hey main ain an a e age o
eigh weeks o EBF and wel e weeks o o al b eas eeding, which aligns wi h he a e age
o 9.7 weeks ound by O ibe e al. [
9
]. These da a highligh ha a lack o b eas eeding
knowledge, coupled wi h insu icien commi men om heal h p o essionals, o en leads o
ea ly b eas eeding supplemen a ion, which, along wi h alse pe cep ions and ma e nal
insecu i ies, esul s in b eas eeding ailu e [23].
I is also impo an o men ion ha du ing he i s wo mon hs, he p ima y eason
o swi ching om EBF o comple e b eas eeding cessa ion is b eas eeding- ela ed b eas
p oblems. In ac , on a e age, women who epo ed b eas p oblems du ing lac a ion only
main ained EBF o i e weeks and o al b eas eeding o less han se en weeks. These
esul s align wi h o he p e ious s udies conduc ed in Spain, which show ha expe iencing
b eas o b eas eeding p oblems cons i u es he eason o he sho es b eas eeding
du a ion [
9
,
11
]. These da a ein o ce he need o p o ide adequa e b eas eeding suppo ,
especially du ing he ea ly pos pa um pe iod, o ensu e e ec i e and p ope ly es ablished
b eas eeding [27].
Addi ionally, om he ou h mon h o ollow-up onwa ds, he p ima y eason o
swi ching om EBF o SBF o FF is e u ning o wo k. These esul s a e consis en wi h
p e ious s udies conduc ed in Spain [
9
,
10
,
31
], highligh ing he need o ad oca e o social
policies suppo ing b eas eeding ha enable EBF un il six mon hs o age and acili a e he
econcilia ion o b eas eeding wi h wo k esump ion [2,23].
Limi a ions
Among he s udy’s limi a ions, he small sample size and he non-p obabilis ic sam-
pling me hod used o ec ui pa icipan s should be no ed. Addi ionally, since his s udy
is a seconda y analysis o wo p e ious s udies conduc ed on he same popula ion bu a
di e en imes, he same a iables we e no conside ed in he espec i e da a collec ion
no ebooks, esul ing in a limi ed numbe o s anda d a iables in bo h da abases. Like-
wise, in bo h s udies, any pe cep ion o lack o b eas eeding suppo was conside ed as
a eason o abandonmen , wi hou di e en ia ing whe he he lack o suppo was om
p o essionals, he amily, o he couple. Likewise, i is challenging o compa e ins i u ional
suppo o b eas eeding. Speci ically, i is known ha du ing he second da a collec ion
pe iod, he pa icipa ing hospi als we e in phase 3D (Hospi al Gene al Uni e si a io de
Cas ellón and Hospi al Lluís Alcanyís) and phase 1D (Hospi al Uni e si a io de La Ribe a)
o he Baby F iendly Hospi al Ini ia i e. Howe e , he acc edi a ion phase du ing he i s
da a collec ion pe iod is unknown. Unde s anding he implemen a ion and impac o hese
e idence-based p ac ices could p o ide aluable insigh s in o how heal hca e policies and
in e en ions in luence b eas eeding p ac ices and ou comes.
Howe e , despi e hese limi a ions, he esul s encou age u u e s udies o deeply
e alua e b eas eeding e olu ion wi h la ge samples and g ea e me hodological igou ,
such as p obabilis ic sampling and expanding he numbe o a iables and he possible
easons o ea ly cessa ion o EBF and o al b eas eeding.
5. Conclusions
The abandonmen o b eas eeding is a mul i ac o ial phenomenon. E en so, i seems
ha a speci ic ac o gene ally p edomina es. B eas p oblems, as well as a lack o b eas -
eeding suppo , a e obse ed as he easons ha p omo e he ea lies abandonmen o
b eas eeding. In addi ion, ea ly supplemen a ion due o in an s’ insu icien weigh gain is
a p e alen eason in ou en i onmen . Likewise, ea ly supplemen a ion usually leads o
he pe cep ion o a lack o milk and p omp s, which, wi hin a ew weeks, is he de ini i e
Nu s. Rep. 2024,14 1945
abandonmen o b eas eeding. F om he ou h mon h o ollow-up, e u ning o wo k
seems o be he p edominan eason o abandoning EBF.
Ou s udy highligh s he need o con inue in es ing e o s o p o ec b eas eeding
in ou en i onmen . Speci ically, i s , g ea e in ol emen in suppo o b eas eeding
is needed om pa ne s du ing he p ena al s age and ea ly pos pa um. Second, a mo e
signi ican commi men om heal h p o ide s is needed o empowe mo he s du ing he
pe ina al s age and p e en ea ly and imp ope supplemen a ion o b eas eeding. Thi d,
i would be ad isable o be on social policies ha make he main enance o EBF iable
un il he in an s a e six mon hs old. Finally, hese indings no only in o m on he need
o adequa e suppo and educa ion o mo he s du ing he b eas eeding p ocess bu
also highligh he impo ance o social policies ha suppo b eas eeding and acili a e
i s sus ained p ac ice o e ime, which has signi ican implica ions o child and ma e nal
heal h in Spain.
Au ho Con ibu ions: Concep ualisa ion, F.J.S.-V., D.M.-T. and R.V.-C.; me hodology, V.M.G.-C. and
M.J.V.-C.; so wa e, M.J.V.-C., V.O.-M. and I.L.-R.; o mal analysis, M.J.V.-C., V.M.G.-C. and I.L.-R.;
in es iga ion, M.J.V.-C. and Á.C.-G.; da a cu a ion, M.J.V.-C., V.O.-M. and I.L.-R.; w i ing—o iginal
d a p epa a ion, M.J.V.-C., L.A.-P. and D.M.-T.; w i ing— e iew and edi ing, F.J.S.-V., R.V.-C. and
Á.C.-G.; p ojec adminis a ion, F.J.S.-V.; unding acquisi ion, F.J.S.-V. All au ho s ha e ead and
ag eed o he published e sion o he manusc ip .
Funding: This p ojec has been unded by Fundación pa a el Fomen o de la In es igación Sani a ia y
Biomédica de la Comuni a Valenciana (FISABIO) o he conduc ion o II G an on Nu sing I&D&I
2020 (UGP-20-250).
Ins i u ional Re iew Boa d S a emen : The wo s udies om which he da a we e ex ac ed we e
app o ed by he e hics and esea ch commi ees o he pa icipa ing hospi als (PIC-2018-18; HIP/CI
1 June 2021; HURL_20220223; HIP/CI 2 Decembe 2021). The pa icipan s ecei ed su icien
in o ma ion abou he espec i e s udies and signed he in o med consen . The s udies complied wi h
he legisla ion in Spain (O ganic Law 15/1999, o 13 Decembe on Pe sonal Da a P o ec ion; O ganic
Law 3/2018 o 5 Decembe , on Pe sonal Da a P o ec ion and Gua an eeing Digi al Righ s), as well
as Regula ion (EU) 2016/679 o he Eu opean Pa liamen and o he Council o 27 Ap il 2016 on he
p o ec ion o na u al pe sons conce ning he p ocessing o pe sonal da a and on he ee mo emen
o such da a. The p inciples o he Decla a ion o Helsinki we e ollowed.
In o med Consen S a emen : In o med consen was ob ained om all subjec s in ol ed in he s udy.
Da a A ailabili y S a emen : The da a p esen ed in his s udy a e a ailable upon easonable eques
and subjec o p i acy and e hical es ic ions. Fo u he in o ma ion on how o submi a eques o
da a access, please con ac he co esponding au ho .
Public In ol emen S a emen : No public in ol emen in any aspec o his esea ch.
Guidelines and S anda ds S a emen : This manusc ip was d a ed agains he S eng hening he
Repo ing o Obse a ional S udies in Epidemiology (STROBE) S a emen : guidelines o epo ing
coho s udies.
Use o A i icial In elligence: AI o AI-assis ed ools we e no used in d a ing any aspec o
his manusc ip .
Acknowledgmen s: The au ho s wish o acknowledge he women o hei pa icipa ion.
Con lic s o In e es : The au ho s decla e no con lic s o in e es .
Re e ences
1.
Wo ld Heal h O ganiza ion; Uni ed Na ions Child en’s Fund (UNICEF). P o ec ing, P omo ing and Suppo ing B eas -Feeding: The
Special Role o Ma e ni y Se ices/a Join WHO/UNICEF S a emen ; Wo ld Heal h O ganiza ion: Gene a, Swi ze land, 1989.
2.
Vic o a, C.G.; Bahl, R.; Ba os, A.J.D.; F ança, G.V.A.; Ho on, S.; K ase ec, J.; Mu ch, S.; Sanka , M.J.; Walke , N.; Rollins,
N.C. B eas eeding in he 21s Cen u y: Epidemiology, Mechanisms, and Li elong E ec . Lance 2016,387, 475–490. [C ossRe ]
[PubMed]
3.
Wo ld Heal h O ganiza ion. Uni ed Na ions Child en’s Fund. A ailable online: h ps://i is.who.in /handle/10665/42695?locale-
a ibu e=es& (accessed on 13 Feb ua y 2019).