An overview of reviews of breastfeeding barriers and facilitators: Analyzing global research trends and hotspots

Abstract

Breastfeeding is the most cost-effective intervention for reducing infant morbidity and mortality, offering benefits for infants and mothers. Despite extensive promotion, global adherence remains below 50 %, resulting in significant clinical, economic, and environmental impacts. Thus, this overview of reviews aims to synthesize barriers and facilitators of breastfeeding, analyze research trends, and identify gaps to guide future research. A comprehensive literature search was conducted, including systematic reviews that examine these factors. The search covered seven electronic data repositories. The methodological quality was assessed using the Risk of Bias in Systematic Reviews tool. Bibliometric analysis focused on identifying top journals, authors, and countries, assessing their impact, and exploring trends over time. Findings were classified and analyzed thematically through line-by-line coding, theme description, and analytical formulation. A total of 123 reviews were included, mostly of high quality and published in top journals. Key trends comprised a growing focus on psychosocial and cultural factors, increased representation from low- and middle-income countries, and improved methodological rigor. However, geographical representation remains biased towards high-income countries, and some breastfeeding outcomes need further exploration. Thematic analysis revealed four categories: Therapeutic and care interventions; Support networks and education; Maternal-infant health issues; and Societal and environmental context. In conclusion, this overview of reviews identifies barriers and facilitators of breastfeeding and emphasizes the need for more inclusive research and tailored support. Addressing gaps in evidence for enhancing healthcare systems and policies can improve breastfeeding practices and outcomes worldwide.

Keywords: Barriers; Bibliometrics; Breastfeeding; Facilitators; Lactation; Research trends; Science mapping.

Fig. 1.

Flow chart of retrieved, screened and included articles.

Fig. 2.

Publications by journal sources (A), impact of retrieved reviews (B), and design used (proportion in C, absolute number in D) across years.

Fig. 3.

Methodological quality and risk of bias assessment of the retrieved reviews.

Fig. 4.

Network visualization map of terms. The node size represents the frequency of term occurrences, with the largest node and label indicating the most frequently used terms. The thickness of the connecting lines represents the frequency of co-occurrence between keywords, with the thickest links representing the most frequent co-occurrences. The different colors represent different clusters of terms. BFHI = Baby-friendly Hospital Initiative; BMI = body mass index; BSE = breastfeeding self-efficacy; COC = combined oral contraceptives; GDM = gestational diabetes mellitus; HSI = health sector initiatives; IBD = inflammatory bowel disease; NHPI = Native Hawaiians and Pacific Islanders; PIMS = perceived insufficient milk supply; POP = progestogen-only pill; PPH = postpartum hemorrhage; PVR = progesterone vaginal ring; SMI = severe mental illness; SSC = skin-to-skin contact; WIC = program for women, infants, and children.

Fig. 5.

Breastfeeding outcomes assessed over time by the retrieved reviews.

Fig. 6.

Themes identified in this overview of reviews regarding breastfeeding facilitators and barriers, mapped onto the Socioecological Model of Health and the Conceptual Model of an Enabling Environment for Breastfeeding.