1Maternal and Child Survival Program (MCSP),1776 Massachusetts Avenue NW,Suite 300,Washington,DC 20036,USA.
2PATH, Maternal,Newborn, and Child Health and Nutrition,Washington,DC,USA.
Public Health Nutr. 2017 Dec;20(17):3120-3134. doi: 10.1017/S1368980017002531. Epub 2017 Oct 2.
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.
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.
Low- and middle-income countries.
Following application of systematic review criteria, forty-eight articles from fourteen countries were included in the review.
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.
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.
尽管全球有许多关于母乳喂养的倡议，但趋势数据显示，过去二十年中，纯母乳喂养率停滞不前。本系统评价的目的是确定 25 个低收入和中等收入国家中纯母乳喂养的障碍，并讨论对项目的影响。
对 Scopus、MEDLINE、CINAHL 和 PsychINFO 进行了检索，以检索 2000 年 1 月至 2015 年 10 月的研究。使用纳入标准，我们选择了描述纯母乳喂养障碍的定性和定量研究。
低收入和中等收入国家。
在应用系统评价标准后，从 14 个国家的 48 篇文章中纳入了本综述。
本综述确定了 16 个纯母乳喂养的障碍。有中等证据表明，母亲就业与纯母乳喂养实践呈负相关。研究发现，剖宫产术会阻碍纯母乳喂养，这与分娩时和产后 24 小时内的纯母乳喂养障碍有关。早期开始母乳喂养和可能进行纯母乳喂养的可能性有中等证据。从横断面或观察性研究中经常报告母乳喂养问题。对纯母乳喂养进行咨询以及家庭和/或社区的支持存在，表明可以改善纯母乳喂养。
提高卫生工作者解决母乳喂养问题的咨询技能，并增加社区对母乳喂养的支持，是婴幼儿喂养方案的关键组成部分，这将有助于实现 2025 年世界卫生大会的纯母乳喂养目标。在低收入和中等收入国家，需要注意有关母乳代用品营销、带薪产假和职业母亲母乳喂养休息的立法和规定。
