Reasons why Mothers Choose Human Milk as Their Method of Infant Nutrition: A Mixed Methods Systematic Review Protocol

Human milk is a complex, dynamic, living biological fluid uniquely tailored to meet the nutritional needs of the human species. In addition to this it also has a protective role in health by providing beneficial microbes and prebiotic oligosaccharides that aid in developing the neonatal gut microbiome, and by containing immune molecules that help regulate long-term inflammatory responses. Despite growing evidence of human milk's composition and benefits, breastfeeding rates remain low in many countries. Some studies suggest that understanding the health benefits and composition of human milk may increase a mother's motivation to breastfeed or provide human milk. However, first it is necessary to summarize and synthesize the available data on maternal reasons for providing human milk in any form to their infants, to examine the evidence in this area.

A mixed method systematic review will be conducted including qualitative, quantitative, and primary mixed-methods studies that explore the reasons why mothers choose breastmilk as their method of infant nutrition. The PICo framework will inform the search strategy including five databases CINAHL Complete (EBSCOhost), Medline (PubMed), Web of Science and Scopus (Elsevier) from inception to date of searching. Following screening the quality of the studies will be assessed using the standardized JBI critical appraisal tools, selected based on each study's methodology. Data extraction will follow the JBI mixed methods data extraction form, and will involve data transformation, synthesis, and integration. This systematic review will adopt a convergent integrated approach in line with JBI guidelines.

Registered with Prospero (CRD42024586984).