Mothers' understanding of the term 'exclusive breastfeeding': a systematic review

Ruth Still, Debbi Marais, Jenna Louise Hollis

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)


There is a lack of knowledge and understanding of the term exclusive breastfeeding (EBF) among health professionals. The purpose of this review was to examine the best available literature on mothers' understanding of the term EBF. A systematic search of eight electronic databases (Medline, Embase, CINAHL, CDSR, CENTRAL, Cab Abstracts, Scopus and African Index Medicus) was conducted (Protocol registration in PROSPERO: CRD42015019402). All study designs were eligible for inclusion. Studies were included if they: (1) involved mothers aged 18 years or older; (2) assessed mothers' knowledge/understanding/awareness of the term 'EBF'; (3) used the 1991 WHO definition of EBF and (4) were published between 1988 and 2015. Two reviewers retrieved articles, assessed study quality and performed data extraction. Of the 1700 articles identified, 21 articles met the inclusion criteria. Quantitative findings were pooled to calculate a proportion rate of 70.9% of mothers who could correctly define EBF, although the range varied between 3.1 and 100%. Qualitative findings revealed three themes: (1) EBF was understood by mothers as not mixing two milks; (2) the term 'exclusive' in EBF was incorrectly understood as not giving breast milk and (3) mothers believing that water can be given while exclusively breastfeeding. Research investigating aspects of self-reported EBF may consequently be unreliable. A standardised tool to assess mothers' knowledge of EBF could provide more accurate data. Public health campaigns should emphasise EBF to target mothers, while addressing the education of health professionals to ensure that they do not provide conflicting advice.

Original languageEnglish
Article numbere12336
Pages (from-to)1-20
Number of pages20
JournalMaternal and Child Nutrition
Issue number3
Early online date18 Oct 2016
Publication statusPublished - Jul 2017

Bibliographical note

We thank the Public Health Nutrition Research Group at the University of Aberdeen for all their support and advice. We also thank the Librarians at the Medical Library, University of Aberdeen, for their advice with developing the search strategy and their assistance with inter library loans.

Source of funding
Funding was received from the Graduate School, College of Life Sciences and Medicine, University of Aberdeen. JH is supported by funding from the Rural and Environment Science and Analytical Services Division (RESAS) programme of the Scottish Government.


  • exclusive breastfeeding
  • mothers
  • knowledge
  • awareness
  • understanding


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