abstract: 'Objective Despite numerous global initiatives on breast-feeding, trend

  data show exclusive breast-feeding (EBF) rates have stagnated over the

  last two decades. The purpose of the present systematic review was to

  determine barriers to exclusive breast-feeding in twenty-five low- and

  middle-income countries and discuss implications for programmes.

  Design A search of Scopus, MEDLINE, CINAHL and PsychINFO was conducted

  to retrieve studies from January 2000 to October 2015. Using inclusion

  criteria, we selected both qualitative and quantitative studies that

  described barriers to EBF.

  Setting Low- and middle-income countries.

  Subjects Following application of systematic review criteria,

  forty-eight articles from fourteen countries were included in the

  review.

  Results Sixteen barriers to EBF were identified in the review. There is

  moderate evidence of a negative association between maternal employment

  and EBF practices. Studies that examined EBF barriers at childbirth and

  the initial 24 h post-delivery found strong evidence that caesarean

  section can impede EBF. There is moderate evidence for early initiation

  of breast-feeding and likelihood of practising EBF. Breast-feeding

  problems were commonly reported from cross-sectional or observational

  studies. Counselling on EBF and the presence of family and/or community

  support have demonstrated improvements in EBF.

  Conclusions Improving the counselling skills of health workers to

  address breast-feeding problems and increasing community support for

  breast-feeding are critical components of infant and young child feeding

  programming, which will aid in attaining the 2025 World Health Assembly

  EBF targets. Legislation and regulations on marketing of breast-milk

  substitutes, paid maternity leave and breast-feeding breaks for working

  mothers require attention in low- and middle-income countries.'
affiliation: 'Kavle, JA (Corresponding Author), MCSP, 1776 Massachusetts Ave NW,Suite
  300, Washington, DC 20036 USA.

  Kavle, JA (Corresponding Author), PATH, Maternal Newborn \& Child Hlth \& Nutr,
  Washington, DC 20001 USA.

  Kavle, JA (Corresponding Author), George Washington Univ, Milken Inst, Sch Publ
  Hlth, Washington, DC 20037 USA.

  Kavle, Justine A., MCSP, 1776 Massachusetts Ave NW,Suite 300, Washington, DC 20036
  USA.

  Kavle, Justine A.; LaCroix, Elizabeth; Dau, Hallie, PATH, Maternal Newborn \& Child
  Hlth \& Nutr, Washington, DC 20001 USA.

  Kavle, Justine A.; LaCroix, Elizabeth; Dau, Hallie, George Washington Univ, Milken
  Inst, Sch Publ Hlth, Washington, DC 20037 USA.

  Engmann, Cyril, PATH, Maternal Newborn \& Child Hlth \& Nutr, Seattle, WA USA.

  Engmann, Cyril, Univ Washington, Dept Pediat, Seattle, WA 98195 USA.

  Engmann, Cyril, Univ Washington, Dept Global Hlth, Seattle, WA 98195 USA.'
author: Kavle, Justine A. and LaCroix, Elizabeth and Dau, Hallie and Engmann, Cyril
author-email: jkavle@path.org
author_list:
- family: Kavle
  given: Justine A.
- family: LaCroix
  given: Elizabeth
- family: Dau
  given: Hallie
- family: Engmann
  given: Cyril
da: '2023-09-28'
doi: 10.1017/S1368980017002531
eissn: 1475-2727
files: []
issn: 1368-9800
journal: PUBLIC HEALTH NUTRITION
keywords: 'Breast-feeding; Exclusive breast-feeding; Barriers; Infant and young

  child feeding programmes; Infant and young child nutrition'
keywords-plus: '1ST 6 MONTHS; CESAREAN DELIVERY; RURAL-POPULATION; MILK SUBSTITUTES;

  DONOR MILK; INFANT; MOTHERS; DETERMINANTS; PROMOTION; COMMUNITY'
language: English
month: DEC
number: '17'
number-of-cited-references: '98'
orcid-numbers: 'Dau, Hallie/0000-0001-6193-4032

  Kavle, Justine/0000-0003-0439-6308'
pages: 3120-3134
papis_id: 78ce516e3445f609258aa219da9fa634
ref: Kavle2017addressingbarriers
researcherid-numbers: 'Dau, Hallie/ABC-8946-2021

  '
tags:
- review
times-cited: '96'
title: 'Addressing barriers to exclusive breast-feeding in low- and middle-income
  countries: a systematic review and programmatic implications'
type: Review
unique-id: WOS:000416056600013
usage-count-last-180-days: '0'
usage-count-since-2013: '24'
volume: '20'
web-of-science-categories: Public, Environmental \& Occupational Health; Nutrition
  \& Dietetics
year: '2017'