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Table 1 Major themes and sub-themes of barriers to EBF practice

From: A systematic review of qualitative research on barriers and facilitators to exclusive breastfeeding practice in sub-Saharan African countries

Themes Sub-themes Codes Studies
1.Maternal-infant factors 1.1 Maternal factors 1.1.1. Mother’s formal (employment) and informal work schedules [26,27,28,29,30,31,32,33]
   1.1.2 Perceived breast milk insufficiency [26,27,28, 31,32,33,34,35,36,37,38]
   1.1.3 Concerns of effects on mother’s appearance [28, 31, 38, 39]
   1.1.4 Poor understanding/lack of awareness of EBF benefits [32, 34, 35, 40]
   1.1.5 Being HIV positive or fear of transmitting HIV infection to the child [31, 32, 34, 36]
   1.1.6 Schooling or resuming school or work [29, 33, 36, 37, 41]
   1.1.7 Poor maternal nutrition [29, 32,33,34, 41]
   1.1.8 Maternal perceived discomfort and embarrassment [26, 28, 29, 31, 33, 39]
   1.1.9 Reluctance to breastfeed in public/disapproval of public breastfeeding [29, 31, 33, 37]
   1.1.10 Refusal of mothers to breastfeed for several other reasons [31,32,33,34, 41, 42]
  1.2 Infant factors 1.2.1 Crying baby [31, 32, 37, 41, 42]
   1.2.2 Infant’s difficulty in latching or positioning or refusal to breastfeed [31, 33, 37]
   1.2.3 Infant other issues [30,31,32]
  1.3 Breast-related factors 1.3.1 Some breast conditions (cracked, painful or sore nipples) [27, 28, 30, 32, 33, 42]
   1.3.2 Breast milk lightness and lousy odour [39]
2. Support structures related factors 2.1 Family influence 2.1.1 Influence of husband [26, 28, 29, 31, 33, 35, 37, 39]
   2.1.2 Influence of mother/mother-in-law/grandmother [27, 29, 31, 33, 37,38,39, 41]
   2.1.3 Influence of other family members and important others [27, 28, 31,32,33,34,35,36,37, 41, 43]
  2.2 Influence of health systems 2.2.1 Influence of advice or messages shared by HCWs [28, 30, 33, 36, 37, 41]
   2.2.2 Inadequate breastfeeding education, counselling, and support by HCW [28, 33, 38]
  2.3 Influence of workplace 2.3.1 Lack of workplace support [28, 29, 40]
   2.3.2 Short and/or unpaid maternity leave [28, 40, 41]
3. Influence of traditional and sociocultural beliefs 3.1 Use of herbal concoctions for medicinal purposes 3.1.1 Use of traditional herbal concoctions as medicine [26, 32, 34, 39]
  3.2 Norms and beliefs 3.2.1 Traditional / cultural practices, myths, and misconceptions about EBF [29,30,31,32,33,34,35, 39, 42,43,44]