Exclusive breastfeeding practices and challenges in Nigeria, Sub-Saharan Africa: an integrative review

Exclusive breastfeeding (EBF) remains a key public health strategy for improving infant and maternal outcomes. In Nigeria, despite policy commitments, EBF practice rates remain inconsistent and highly context-dependent. This integrative review assesses the prevalence and patterns of EBF in Nigeria, examines the socio-demographic and systemic factors influencing practice, identifies barriers and enablers, and evaluates existing interventions to promote EBF. Nineteen peer-reviewed primary studies, published between 2013 and 2024, were systematically identified across six geopolitical zones. Data were extracted from PubMed, ScienceDirect, and the University of Hull library database using a PRISMA search strategy, and synthesis followed a deductive coding framework, drawing on qualitative and quantitative findings. The theoretical frameworks for this review were the Socio-Ecological Model (SEM) and the Health Belief Model (HBM), which provide insights into the influence of individual, interpersonal, community, and societal factors on exclusive breastfeeding practices in Nigeria. Analysis of 19 studies in Nigeria revealed that the percentage of women that exclusively breastfed their infant from birth to six months averaged 46.4% (range 12.5%–73.8%), while early initiation within one hour of delivery averaged 57.3%. Despite high awareness, a significant “knowledge-practice gap” exists due to complex socio-contextual and maternal factors. Higher EBF rates correlate with maternal age (31+), tertiary education, and hospital deliveries. Conversely, employment in the formal sector often hinders EBF due to short maternity leave. Primary barriers include cultural myths (viewing colostrum as “dirty” or breastmilk as “insufficient” without water) and lack of spousal/family support. Facilitators include healthcare engagement (ANC/PNC) and high maternal self-efficacy. The review also identified gaps in research, including the limited inclusion of fathers, informal caregivers, and mothers in displaced or rural communities. This review advances the literature by offering a context-sensitive, multi-dimensional interpretation of EBF practices in Nigeria. It highlights the need for equity-focused policies and interventions that move beyond individual awareness to address structural enablers of maternal capabilities.