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Women have gotten the message: Breast milk is best for babies. The vast majority begin breastfeeding their infants at birth. So why do most quit earlier than planned?

Paula Meier, Ph.D., RN, has studied this question for decades, during which she has seen the number of breastfeeding moms soar to well over 80%. Yet one stubborn statistic remains: Fewer than half continue for three months, despite their intentions. Many stop after only a few days.

Meier, professor of pediatrics, raised this question with other top lactation experts across the country. Together, Meier and co-editor Leslie Parker, Ph.D., APRN, of the University of Florida invited colleagues and researchers from 11 universities to study how to help mothers during the critical first weeks. The July 2025 special issue of the journal Breastfeeding Medicine showcases their findings in five original research articles and scientific reviews.

The first weeks matter most

The researchers studied the medical, economic, and social barriers faced by both healthy mothers and newborns and those who require hospital care. The findings bring to light the unique and complex biology behind breastfeeding and the economic and practical challenges of the first days and weeks after delivery, Meier said.

"The first two weeks set the stage for programming the body to successfully breastfeed, " Meier said. "If you can't get through the first month, you are unlikely to make it to 6 months or even the three-month mark."

Yet breastfeeding during this crucial time is seldom studied. Arthur Eidelman, MD, the journal's editor-in-chief, said experts in the field continue to focus discussions on getting women to breastfeed longer, to at least 6 months and even beyond age 2.

"The war to support breastfeeding is already being lost in the immediate weeks and months after … birth, " Eidelman writes in his introduction to the special issue.

It's not just 'Go home and keep trying'

Among the project's major findings is how biology can undermine even the best intentions.

"Producing milk requires a complex physical transformation, " Meier said. "The mammary glands undergo major biological changes to produce milk, with crucial stages that occur in the first few days, after one week and during the first month."

If certain milestones aren't met, the process slows or stalls before the mother reaches the threshold needed to consistently produce enough milk, like a switch that opens the gate for a steady supply.

"We don't think of the mammary gland as something that can malfunction, but we have a lot of data from 10 to 15 years of study that indicate overweight and obesity are a huge risk factor, " Meier said. Diabetes, high blood pressure, and pre-eclampsia are as well. Such common metabolic conditions can interfere with the mammary glands' work.

Other health-related challenges arise when a mother or baby needs to be in the hospital. Mothers who cannot directly breastfeed because their infant is in the neonatal intensive care unit or because of their own medical issues must rely on pumping to start and continue milk-making.

The amount of time spent pumping is key to achieving those milestones, according to the research. At the same time, these "NICU mothers" are juggling their own health problems, stress about their baby's condition, the time demands of pumping, the needs of other family members and, sometimes, a metabolic risk factor that hinders milk production.

The financial and personal costs

Economist Tricia Johnson, Ph.D., professor of health systems management at Rush University's College of Health Sciences, joined the project to study the economic and social barriers that cause women to wean their baby early.

Breastfeeding comes with hidden costs, such as time spent feeding or pumping. The burden is heaviest on low-income women who may need to return to work shortly after their baby's birth or care for other family members. They may face money problems or lack paid maternity leave, access to healthy food, transportation to doctor visits, or family support. They may quickly fall behind with breastfeeding or pumping and give up.

"The research sheds light on the unique biology and the enormous amounts of time that feeding and pumping demand, " Johnson said.

Changing the conversation and expanding the scope of support

Current practices for supporting moms with education and encouragement have succeeded in more than doubling the number of women who start to breastfeed. But as more is learned about the medical and social challenges that lead women to stop breastfeeding after only a few weeks, the scope of support needs to expand, the researchers recommend.

The project offers a new framework to analyze and address the reasons—physical and social—that women stop breastfeeding.

The research recommends interventions that target the medical, social, economic, and practical challenges. For example, mothers often think they aren't producing enough milk. Some are right, and some are wrong.

Meier said women may mistakenly believe they aren't providing enough milk, but the healthy newborn needs very little milk in the first few days. But concerned that their baby is not getting enough milk to thrive, they may give them formula. Doing so unintentionally disrupts their body's efforts to provide sufficient milk. The most common message is to keep trying, without any specific assessment or guidance.

Others who think they are not producing enough milk are correct. But it doesn't mean they aren't trying hard enough or committed enough, she added. They need care that pinpoints why there is insufficient milk so that interventions can be targeted.

These targeted interventions often include novel, easy-to-use technologies that take the guesswork out of knowing whether a baby is getting enough.

"It is easy to measure how much milk a baby feeds from the breast, by using precise scales that weigh babies before and after feeding, " Meier said.

Testing drops of milk for diagnostic biomarkers can assure a mother that her milk has "come in" or whether this process is delayed, so that a specific plan can be put in place.

"The time has come to integrate these simple techniques into routine clinical lactation practice instead of telling mothers to "Keep trying, '" Meier said.

During pregnancy, risk factors like high blood pressure, obesity, and diabetes are proactively managed. Similarly, if a mother has a risk factor, she should be told what the clinical team will do to monitor milk production.

"Tell them, 'We're going to measure how much milk your baby is getting, whether weight gain is adequate and that he or she is hydrated and nourished, '" Meier said. "We're not going to send the mothers home and tell them to trust that their breasts will produce enough milk."

More information: Paula P. Meier et al, Overview: Early, Unplanned Cessation of Lactation in Healthy and at-Risk Dyads: Priorities for Research and Practice, Breastfeeding Medicine (2025). DOI: 10.1089/bfm.2025.0115 Arthur I. Eidelman, Breastfeeding in the First Weeks Postpartum. Challenges and Realities, Breastfeeding Medicine (2025). DOI: 10.1089/bfm.2025.0123 Larelle H. Bookhart et al, Integrating Biological, Behavioral, and Economic Factors in the Practice and Study of Early, Unplanned Lactation Cessation, Breastfeeding Medicine (2025). DOI: 10.1089/bfm.2025.0071

Arthur I. Eidelman, Breastfeeding in the First Weeks Postpartum. Challenges and Realities, Breastfeeding Medicine (2025). DOI: 10.1089/bfm.2025.0123

Larelle H. Bookhart et al, Integrating Biological, Behavioral, and Economic Factors in the Practice and Study of Early, Unplanned Lactation Cessation, Breastfeeding Medicine (2025). DOI: 10.1089/bfm.2025.0071