A narrative synthesis using the ecological systems theory for understanding a woman’s ability to continue breastfeeding

There is a large body of evidence which demonstrates that breastfeeding a child to the age of two years and beyond provides the optimal health benefits for both women and child. However, the wider perception of the ideal breastfeeding duration is often debated and there are stark differences in prevalence of breastfeeding beyond infancy globally. Therefore, this narrative synthesis was employed as a way of rapidly and efficiently gathering relevant information to provide context to understanding a woman’s ability to continue breastfeeding. Extracted emerging themes were categorised against the Bronfenbrenner’s Ecological Systems framework, a widely accepted theoretical model which offers explanation on how individual’s behaviour interplays with five layers of social environment ‘systems’. The themes include 1) Microsystems: Postnatal challenges, Parental style and preference, Age, First-time mothers and Adversity and trauma. 2) Mesosytems: Fathers/domestic relationships, Grandparents, Peer to peer. 3) Exosystems: Public perception and representations, Returning to work. 4) Macrosystems: ethnic group distinctions, religion, national systems. 5) Chronosytems: inequality groups, immigration, and historical context. The review has demonstrated that breastfeeding, and any interventions targeted to support the initiation or continuation of it, must be viewed with an intersectional lens.