Studies should be conducted to investigate the psychological benefits of breastfeeding to the mother and infant.
It is widely believed that breastfeeding has powerful psychological benefits for the mother and infant. Nonetheless, there is relatively little scientific evidence to support that belief. If this belief is correct, the public health implications would be profound. Some of the specific points that should be addressed are the effects of breastfeeding upon the self-esteem of the mother, the mother's concerns with parenting, the ability of the mother to deal with social problems in her family, social interactions between the mother and the infant, the social development of the infant, the ability of the child to adapt to new environmental circumstances, and the possibility that observed effects are related to the transfer of substances to the infant through the milk.
It is essential to determine whether and to what extent breastfeeding protects against infant and early child mortality in populations with generally low rates of infant mortality, and especially in subpopulations with higher than usual infant and child mortality rates.
The rates of infant and early childhood mortality are at or near their historically lowest levels in the industrialized countries; nevertheless, there is every reason to believe that breastfeeding would still confer some benefit on survival. It is unknown at the moment whether infant and early childhood mortality rates are lower among breastfed infants in situations in which death rates are generally low. This information is particularly important among subpopulations, such as ethnic minorities, many of which have higher mortality rates than the population at large.
The potential influence of maternal smoking and moderate alcohol and coffee consumption on milk production, composition, and infant health requires further investigation.
Data are needed on the direct effects of smoking on milk volume, not just on plasma prolactin levels. Studies should include consideration of dose-related effects.
At present, there is no clear basis for determining the level of cigarette smoking or alcohol consumption that could harm the infant. Although the recommendation is not to smoke at all and to drink alcoholic beverages in moderation, if at all, many women may not follow this advice. Furthermore, preliminary evidence from Costa Rica (Muñoz et al., 1988) suggests that coffee