Predictors of exclusive breastfeeding: a systematic review and meta-analysis
Abstract 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 predi...
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| Format: | Article |
| Language: | English |
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BMC
2025-07-01
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| Series: | International Breastfeeding Journal |
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| Online Access: | https://doi.org/10.1186/s13006-025-00744-2 |
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| author | Mehri Kalhor Mansoureh Yazdkhasti Masoumeh Simbar Sepideh Hajian Zahra kiani Behjat Khorsandi Mahtab Sattari Zainab Ezadi Haniyeh Nazem Massoma Jafari |
| author_facet | Mehri Kalhor Mansoureh Yazdkhasti Masoumeh Simbar Sepideh Hajian Zahra kiani Behjat Khorsandi Mahtab Sattari Zainab Ezadi Haniyeh Nazem Massoma Jafari |
| author_sort | Mehri Kalhor |
| collection | DOAJ |
| description | Abstract 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. |
| format | Article |
| id | doaj-art-2773ca14c7d14f0b975a0efedbb494e6 |
| institution | DOAJ |
| issn | 1746-4358 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | International Breastfeeding Journal |
| spelling | doaj-art-2773ca14c7d14f0b975a0efedbb494e62025-08-20T03:04:07ZengBMCInternational Breastfeeding Journal1746-43582025-07-0120112810.1186/s13006-025-00744-2Predictors of exclusive breastfeeding: a systematic review and meta-analysisMehri Kalhor0Mansoureh Yazdkhasti1Masoumeh Simbar2Sepideh Hajian3Zahra kiani4Behjat Khorsandi5Mahtab Sattari6Zainab Ezadi7Haniyeh Nazem8Massoma Jafari9Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical sciencesDepartment of Midwifery, Faculty of Midwifery, Social Determinants of Health Research Center, Alborz University of Medical SciencesMidwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical sciencesMidwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical sciencesMidwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical sciencesDepartment of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical SciencesMidwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical sciencesMidwifery Faculty, Khatam Al Nabieen UniversityMidwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical sciencesHealth Professions Education Research, University of TorontoAbstract 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.https://doi.org/10.1186/s13006-025-00744-2Risk factorRelated factorExclusive BreastFeedingWomen |
| spellingShingle | Mehri Kalhor Mansoureh Yazdkhasti Masoumeh Simbar Sepideh Hajian Zahra kiani Behjat Khorsandi Mahtab Sattari Zainab Ezadi Haniyeh Nazem Massoma Jafari Predictors of exclusive breastfeeding: a systematic review and meta-analysis International Breastfeeding Journal Risk factor Related factor Exclusive BreastFeeding Women |
| title | Predictors of exclusive breastfeeding: a systematic review and meta-analysis |
| title_full | Predictors of exclusive breastfeeding: a systematic review and meta-analysis |
| title_fullStr | Predictors of exclusive breastfeeding: a systematic review and meta-analysis |
| title_full_unstemmed | Predictors of exclusive breastfeeding: a systematic review and meta-analysis |
| title_short | Predictors of exclusive breastfeeding: a systematic review and meta-analysis |
| title_sort | predictors of exclusive breastfeeding a systematic review and meta analysis |
| topic | Risk factor Related factor Exclusive BreastFeeding Women |
| url | https://doi.org/10.1186/s13006-025-00744-2 |
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