Exclusive Breastfeeding Coverage in Saudi Arabia’s Primary Healthcare System: A Retrospective Analysis of National Surveillance Data and Alignment with World Health Organization Global Nutrition Targets 2025

A BSTRACT Background: Exclusive breastfeeding (EBF) is a cornerstone preventive intervention reducing infant mortality and conferring long-term nutritional and developmental benefits. Comprehensive national analyses of EBF coverage in Saudi Arabia against international benchmarks remain limited. Objectives: The objective of this study was to characterize EBF coverage patterns in Saudi Arabia’s primary healthcare system and evaluate alignment with the World Health Organization (WHO) Global Nutrition Targets of ≥50% EBF at 6 months by 2025. Materials and Methods: This cross-sectional descriptive study analyzed secondary data from WHO/UNICEF Global Breastfeeding Scorecard databases (2016–2023), Saudi Ministry of Health Annual Statistical Yearbooks, and the 2018 Saudi Health Interview Survey ( n = 6348 mother–infant dyads). Key indicators included early initiation, EBF at 3 and 6 months, and continued breastfeeding at 12 and 24 months, analyzed by geographic region and urban–rural classification. Results: The national EBF rate at 6 months was 31% in 2023, substantially below the WHO target of ≥50%. Early initiation within 1 h of birth was 52%. The western region achieved the highest EBF rate (38%) versus border regions (21%). Urban EBF at 6 months (34%) exceeded rural rates (28%), while rural communities demonstrated higher early initiation (56%) and longer continued breastfeeding. Only 14 of 96 health directorates (14.6%) met the WHO target. EBF improved modestly from 26% in 2016 to 31% in 2023, with a temporary pandemic-related decline in 2020. Conclusions: Saudi Arabia’s EBF rates remain substantially below WHO targets. Strengthening lactation support, implementing workplace breastfeeding legislation, regulating commercial formula marketing, and expanding community health worker programs are essential to achieve equitable improvements in neonatal nutrition outcomes.