BACKGROUND Promoting breastfeeding is an important public health intervention, with benefits for infants and mothers. Even modest increases in prevalence and duration may yield considerable economic savings. However, despite many initiatives, compliance with recommendations is poor in most settings - particularly for exclusive breastfeeding. Mothers commonly consult health professionals for infant feeding and behavioural problems. MAIN BODY We argue that broader consideration of lactation, incorporating evolutionary, comparative and anthropological aspects, could provide new insights into breastfeeding practices and problems, enhance research and ultimately help to develop novel approaches to improve initiation and maintenance. Our current focus on breastfeeding as a strategy to improve health outcomes must engage with the evolution of lactation as a flexible trait under selective pressure to maximise reproductive fitness. Poor understanding of the dynamic nature of breastfeeding may partly explain why some women are unwilling or unable to follow recommendations. CONCLUSIONS We identify three key implications for health professionals, researchers and policymakers. Firstly, breastfeeding is an adaptive process during which, as in other mammals, variability allows adaptation to ecological circumstances and reflects mothers' phenotypic variability. Since these factors vary within and between humans, the likelihood that a 'one size fits all' approach will be appropriate for all mother-infant dyads is counterintuitive; flexibility is expected. From an anthropological perspective, lactation is a period of tension between mother and offspring due to genetic 'conflicts of interest'. This may underlie common breastfeeding 'problems' including perceived milk insufficiency and problematic infant crying. Understanding this - and adopting a more flexible, individualised approach - may allow a more creative approach to solving these problems. Incorporating evolutionary concepts may enhance research investigating mother-infant signalling during breastfeeding; where possible, studies should be experimental to allow identification of causal effects and mechanisms. Finally, the importance of learned behaviour, social and cultural aspects of primate (especially human) lactation may partly explain why, in cultures where breastfeeding has lost cultural primacy, promotion starting in pregnancy may be ineffective. In such settings, educating children and young adults may be important to raise awareness and provide learning opportunities that may be essential in our species, as in other primates.

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“优化”母乳喂养：我们可以从哺乳的进化，比较和人类学方面学到什么？

背景技术促进母乳喂养是一项重要的公共卫生干预措施，对婴儿和母亲都有好处。即使患病率和持续时间略有增加，也可能产生可观的经济节省。但是，尽管采取了许多举措，但在大多数情况下，尤其是纯母乳喂养时，对建议的遵守仍然很差。母亲通常会就婴儿喂养和行为问题咨询保健专业人员。主要身体我们认为，对泌乳的更广泛考虑，包括进化，比较和人类学方面，可以为母乳喂养的做法和问题提供新的见解，加强研究，并最终有助于开发新颖的方法来改善起始和维持。我们当前将母乳喂养作为改善健康状况的策略的重点，必须在选择性压力下使哺乳期作为一种灵活的性状进化，以最大程度地提高生殖健康。对母乳喂养的动态性质的了解不足，可能在一定程度上解释了为什么某些妇女不愿或无法遵循建议的原因。结论我们确定了对卫生专业人员，研究人员和政策制定者的三个主要影响。首先，母乳喂养是一个适应性过程，在此过程中，与其他哺乳动物一样，变异性可以适应生态环境并反映母亲的表型变异性。由于这些因素在人类内部和人类之间存在差异，因此“统一大小”方法适用于所有母婴二元组的可能性是违反直觉的；期望灵活性。从人类学的角度来看，由于遗传“利益冲突”，哺乳期是母子之间的紧张时期。这可能是常见的母乳喂养“问题”的基础，包括感觉不到的牛奶不足和婴儿哭闹问题。了解这一点并采用更灵活，个性化的方法可能会允许采用更具创造性的方法来解决这些问题。纳入进化概念可能会加强对母乳喂养期间母婴信号传递的研究。在可能的情况下，研究应该是实验性的，以便确定因果关系和机制。最后，灵长类动物（尤其是人类）泌乳的学习行为，社会和文化方面的重要性可能部分解释了为什么在母乳喂养失去文化主导地位的文化中，从怀孕开始升级可能无效。在这种情况下，对儿童和年轻人进行教育对于提高认识和提供学习机会可能很重要，就像其他灵长类动物一样，这对于我们的物种至关重要。