Table 1.

Major themes and sub-themes of barriers to EBF practice

Themes	Sub-themes	Codes	Studies
1.Maternal-infant factors	1.1 Maternal factors	1.1.1. Mother’s formal (employment) and informal work schedules	[26–33]
		1.1.2 Perceived breast milk insufficiency	[26–28, 31–38]
		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, 32–34, 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	[31–34, 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	[30–32]
	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, 37–39, 41]
		2.1.3 Influence of other family members and important others	[27, 28, 31–37, 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	[29–35, 39, 42–44]