Within breastfeeding research, there’s a widely recognized need to move beyond using only duration of breastfeeding as the measure of “successful breastfeeding” and to integrate person-centered outcomes.
According to Yale School of Medicine (YSM)’s Deanna Nardella, person-centered outcomes — such as the parent’s well-being, emotional health, and other outcomes — are essential to better measure people’s experience of their breastfeeding journey and support received. Whether a person meets or doesn’t meet their prenatal breastfeeding goal, for instance, is one outcome that provides a person-centered perspective.
In a new study, Nardella and her fellow researchers intentionally avoided assessing what parents’ specific goals were for the duration of their breastfeeding journey but rather asked if participants met, didn’t meet, or were still working toward their personal prenatal breastfeeding goal more broadly. Recognizing that prenatal goals may change throughout the infant feeding journey, they asked whether participants “felt okay with” or were “disappointed by” their unmet prenatal goal if reported. They also assessed how satisfied and successful individuals felt with breastfeeding overall, measured on a five-point Likert scale.
What you need to know
Why should we use person-centered outcomes to measure the success of breastfeeding?
There is a widely recognized need to move beyond measuring “successful breastfeeding” by exclusivity and duration of breastfeeding alone and integrate person-centered outcomes into breastfeeding research. Person-centered outcomes are essential to better measure individuals’ experience of their breastfeeding journey and support received. Whether an individual meets or does not meet their prenatal breastfeeding goal is one outcome that provides a person-centered lens.
Are there policies that support breastfeeding in the U.S.?
Several local, state, and national policies have been enacted and expanded to protect and support breastfeeding, such as the Baby-Friendly Hospital Initiative, the Affordable Care Act and PUMP Act.
What did the new Yale study about breastfeeding goals find?
For the study, Yale researchers intentionally did not assess specific goal durations, but rather asked if participants met, did not meet, or were still working towards their prenatal breastfeeding goal. Recognizing that prenatal goals may change throughout the infant feeding journey, they asked whether participants “felt okay with” or were “disappointed by” their unmet prenatal goal. Compared to U.S. studies from one to two decades prior, they found a higher prevalence of breastfeeding intent and lower prevalence of unmet goals among their sample.
The study was published in JAMA Network Open.
Compared to U.S. studies from one to two decades prior, the researchers identified a slightly lower prevalence of unmet goals among respondents. Despite this progress, however, there remains room for more improvement. Of the participants who had ceased breastfeeding by survey completion, 40% had an unmet prenatal breastfeeding goal, and among them 60% were disappointed by this outcome. Those with unmet goals reported several-fold lower satisfaction and success with breastfeeding overall.
“These findings underscore the likely negative impact of unmet breastfeeding goals on individuals’ postpartum mental and emotional health, a relationship that is complex and an important contributor to postpartum morbidity and mortality,” said Nardella, an instructor at YSM and corresponding author of the new study.
New approaches
The most recent research examining unplanned and undesired breastfeeding cessation among U.S. individuals come from data collected, in 2005-2007, by the Centers for Disease Control and Prevention (CDC), and in 2013, by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). These studies reported that half, and as many as three-quarters, of individuals reported ceasing breastfeeding earlier than intended or desired.
Since then, several local, state, and national policies have been enacted and expanded to protect and support breastfeeding, such as the Baby-Friendly Hospital Initiative, the Affordable Care Act, and the PUMP Act.
In the new study, Yale researchers completed a secondary analysis of 2026 national survey data to understand if and how these measures have changed in recent decades — to assess whether progress has been made in regard to person-centered breastfeeding outcomes to better inform future research.
In January 2026, they commissioned a survey panel provider, XandY Analytics, to recruit a national sample of 712 adults with full-term infants between three and 24 months of age who were born in the United States. The survey was primarily designed to examine real-world breast pump use practices. As such, participants had to report ever using a breast pump after their full-term delivery to be included.
Their survey questions were adapted from existing CDC surveys, including the Infant Feeding Practices Survey-II, the National Immunization Survey, and the Pregnancy Risk Assessment Monitoring System. The survey was piloted with several clinical and community-based maternal and child health experts, and interviews were completed with individuals with recent or present pump use experience.
Shaping the future
The researchers observed a lower prevalence of unmet goals among individuals in the sample compared with those from the national samples collected in the prior decades. These findings, researchers say, could be explained in part by increased positive public health opinions about breastfeeding supports and several policies, including the Affordable Care Act, that have improved access to breastfeeding support, devices, and workplace protections for lactating individuals.
Despite this progress, more than one-third of respondents had an unmet prenatal breastfeeding goal, nearly two-thirds of whom were disappointed and reported significantly lower satisfaction and success with breastfeeding. According to the researchers, these findings underscore the potential negative impact of unmet breastfeeding goals on individuals’ postpartum mental and emotional health, an important contributor to postpartum morbidity and mortality.
The high incidence of both prenatal intent and goals related to breastfeeding observed in their sample supports the notion that unmet breastfeeding goals are likely driven in large part by systemic barriers to sustained breastfeeding rather than poor individual motivation, researchers say. With the probability of unmet goals seen to be higher among individuals with medical and mental health conditions, Medicaid insurance, and shorter or lack of family work leave benefits for parents, the study also illuminates the critical role of health systems, payers, and public policy in the support of breastfeeding families.
“Our study can inform future strategies to mitigate unmet goals, including high-impact health services research to reliably identify breastfeeding challenges and deliver accessible, person-centered, and evidence-based treatment for every family,” Nardella said.
The YSM research team also includes Veronika Shabanova, associate professor of pediatrics (general pediatrics) and of biostatistics, and Sarah Taylor, professor of pediatrics and section chief (neonatal-perinatal medicine).
