Al-Jawaldeh Ayoub, Matbouli Dana, Itani Dima, Diab Sara, Taktouk Mandy, Naalbandian Sally, Nasreddine Lara
Regional Office for the Eastern Mediterranean (EMRO), World Health Organization (WHO), Cairo, Egypt.
Nutrition and Food Sciences Department, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon.
Int Breastfeed J. 2025 May 30;20(1):45. doi: 10.1186/s13006-025-00739-z.
BACKGROUND: Appropriate and timely nutrition during infancy constitutes a critical window of opportunity to ensure proper growth and development. Despite the established benefits of breastfeeding (BF), the proportions of breastfed infants remain disappointingly low in countries of the Gulf Cooperation Council (GCC). Using the Theory of Planned Behavior (TPB), this systematic review aims at examining infant feeding intentions, attitudes, subjective norms, perceived behavioral control and beliefs towards BF amongst women in various countries of the GCC. METHODS: Pertinent data were obtained through a search of peer-reviewed studies published between 2012 and 2024. A total of 12 electronic databases have been searched. RESULTS: A total of 101 studies were retained. The largest number of studies was from the Kingdom of Saudi-Arabia (80 studies). The results were mapped across the five TPB constructs: intention, subjective norms, attitude, perceived behavioural control and beliefs. Findings showed that, although the intention to BF was high, the intention to exclusively BF was considerably lower. BF was found to align well with the religious norms and social expectations in countries of the GCC. However, factors such as shyness, embarrassment and reticence over BF in public and pumping at work were reported by various studies. There was a negative attitude towards the suitability of BF for working mothers and it was common for women to consider that formula feeding and BF provide equal benefits. Perceived behavior control towards exclusive BF and the sufficiency of breast milk supply was identified as low in several studies, particularly amongst primigravida women and mothers of twins. Women believed that BF in public may expose them to the "evil eye" and that BF may lead to breast sagging. CONCLUSIONS: By identifying opportunities and gaps under each of the TPB constructs, the results of this review may assist in the development of future culture-specific interventions aimed at BF promotion in countries of the region. These include multi-level interventions encompassing the educational system, the media and social media, in addition to community and hospital-based interventions. The results also call for the development of policies tailored to the identified factors in each of the TPB constructs.
背景:婴儿期适当且及时的营养是确保正常生长发育的关键机会窗口。尽管母乳喂养(BF)已证实有益,但在海湾合作委员会(GCC)国家,母乳喂养婴儿的比例仍然低得令人失望。本系统评价运用计划行为理论(TPB),旨在研究GCC各国女性对母乳喂养的喂养意图、态度、主观规范、感知行为控制及信念。 方法:通过检索2012年至2024年间发表的同行评议研究获取相关数据。共检索了12个电子数据库。 结果:共纳入101项研究。研究数量最多的是沙特阿拉伯王国(80项研究)。结果按照TPB的五个构念进行梳理:意图、主观规范、态度、感知行为控制和信念。研究结果表明,尽管母乳喂养的意图较高,但纯母乳喂养的意图则低得多。在GCC国家,母乳喂养与宗教规范和社会期望高度契合。然而,多项研究报告称,存在诸如在公共场合母乳喂养时害羞、尴尬和沉默,以及在工作时挤奶等因素。对于职业母亲进行母乳喂养的适宜性存在负面态度,女性普遍认为配方奶喂养和母乳喂养具有同等益处。多项研究发现,对纯母乳喂养的感知行为控制以及母乳供应充足性较低,尤其是在初产妇和双胞胎母亲中。女性认为在公共场合母乳喂养可能会让她们遭遇 “邪眼”,且母乳喂养可能导致乳房下垂。 结论:通过识别TPB各构念下的机会和差距,本评价结果可能有助于制定未来针对该地区各国促进母乳喂养的特定文化干预措施。这些措施包括涵盖教育系统、媒体和社交媒体的多层次干预,以及社区和医院层面的干预。结果还呼吁针对TPB各构念中确定的因素制定相应政策。
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