Determinants of early initiation of breastfeeding in Ethiopia: a systematic review and meta-analysis

Timely initiation of breastfeeding is among the major public health problems that contribute to childhood undernutrition, morbidity, mortality, impaired intellectual development, suboptimal adult work capacity, and increased risk of non-communicable chronic diseases worldwide, including in Ethiopia Nevertheless, the country-specific determinants of early initiation of breastfeeding in Ethiopia show inconsistent results, and therefore we aimed at synthesizing the existing literature on early initiation of breastfeeding in Ethiopia. While previous national systematic reviews have aggregated broad institutional data, local findings remain highly divergent, and an updated synthesis filtering for rigorous adjustment of confounding factors is lacking. This study aims to bridge this evidence gap by pooling contemporary data to provide clearer policy relevance for maternal and child health interventions.

Biomedical electronic databases, including PubMed/Medline, HINARI, Science Direct, African Journal Online (AJOL), and Google Scholar, based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), were used, and the protocol was registered in PROSPERO (CRD420261307602). The available literature was critically reviewed, and STATA software version 13 was used to analyses the extracted data. Heterogeneity among studies was assessed using I2 and meta-bias statistics for publication bias. A random-effects model with a 95% confidence interval was used for pooled estimations.

Of the 146 articles screened, 19 of them revealed that mothers residing in urban areas OR = OR = 2.02 (95% CI: 1.31-3.10), counselled during antenatal care OR = OR = 2.97 (95% CI: 2.00-4.41), advised during postnatal care OR = 6.27 (95% CI: 2.09-18.74), had normal delivery (spontaneous vertex delivery) OR = 2.99 (95% CI: 1.27-7.06), delivered at health institutions OR = 5.24 (95% CI: 2.16-12.74), and did not practice pre-lacteal feeding to their newborns OR = 7.95 (95% CI: 3.62-17.47) were the significant factors associated with early initiation of breastfeeding in Ethiopia.

This review provides consolidated evidence regarding the key structural, institutional, and behavioral predictors of EIBF in Ethiopia. Because the primary data are derived from observational designs, these associations reflect strong prognostic indicators rather than definitive causal links. To increase the practice of early breastfeeding initiation, a combination of actions like behavioral change communication and the need for expanded maternal healthcare access, addressing home birth barriers, as well as implementing health service protocols are recommended.