Predictors of exclusive breastfeeding: a systematic review and meta-analysis.

Background: Breast milk is the ideal and complete food for infants. Demographic, social, economic and clinical factors affect exclusive breastfeeding (EBF). Identifying and understanding these factors can improve breastfeeding success. This study systematically reviews and analyzes the predictors of EBF.

Methods: This study is a systematic review and meta-analysis. we searched electronic databases including PubMed/MEDLINE, Web of Science, PsycINFO, Cochrane, Scopus, EMBASE, Google Scholar, SID, and Magiran. we examined articles published between 2000 to 2023 using keywords like "risk factors", "related factors", "predictive factors", "exclusive breastfeeding ", and "women". The review included observational studies. Two reviewers independently selected the studies extracted data. Quality assessment was based on the Newcastle-Ottawa Scale. The association between predictive factors and breastfeeding was combined in a meta-analysis using a restricted maximum likelihood method (REML). Heterogeneity was quantified using I² and investigated through meta-regression, subgroup, and sensitivity analyses, while publication bias was assessed via a funnel plot.

Result: Thirty eight articles were included in this review. Predictive factors in EBF were categorized into seven groups: mother's awareness of breastfeeding benefits, support received in breastfeeding and child-rearing, early breastfeeding after birth, mother's education level, annual income, mother's age, and prenatal care. Nineteen articles with a sample size of 70,183 were included in the meta-analysis. Results showed that a mother's awareness of breastfeeding benefits increases the odds of EBF by 2.70 times, support in child-rearing by 2.57 times, early breastfeeding (< 24 h) by 1.853 times, higher education level by 1.44 times, self-efficacy by 1.067, multiparity ≥ 2 by 1.50 times, having upper-middle annual income was associated with 28.3% higher than odds of EBF (95% CI 1.68, 1.54), female sex of infant by 1.07 times, and one to three antenatal visits by 0.108 times, (95% CI 1.27, 4.18). In normal vaginal delivery (NVD), the odds increased 2.22 fold, all statistically significant (95% CI 0.91, 5.43).

Conclusion: The maternal awareness of the benefits of breastfeeding, maternal support, early breastfeeding, high education level, and improved family economic conditions are associated with EBF. Therefore, improving the educational, social, and economic levels of mothers improves EBF.

Systematic review registration: PROSPERO CRD42023483049.