Exclusive Breastfeeding in Ethiopia: An Umbrella Review of Prevalence and Modifiable Health System Determinants

BACKGROUND: Exclusive breastfeeding (EBF) during the first 6 months of life plays a vital role in protecting infant health and supporting maternal well-being. In Ethiopia, several systematic reviews and meta-analyses (SRMAs) have examined EBF, but they report varying prevalence estimates and influencing factors. These inconsistencies make it difficult for clinicians and policymakers to clearly understand the overall picture. OBJECTIVE: This umbrella review was conducted to bring together existing evidence, provide a clearer estimate of national EBF prevalence, and identify modifiable health system factors that could improve practice. MATERIALS AND METHODS: We systematically searched PubMed, Science Direct, Hinari, Google Scholar, and institutional repositories for SRMAs published between 2018 and 2024. The methodological quality of included reviews was evaluated using AMSTAR 2. To assess duplication of primary studies across reviews, we calculated the corrected covered area (CCA). Random effects models were used to generate pooled estimates of prevalence and associated determinants. The certainty of the evidence was assessed using GRADE. RESULTS: 99.88%). A high level of overlap among primary studies (CCA = 31.9%) indicated notable redundancy. Key modifiable factors associated with higher EBF rates included antenatal care attendance, institutional delivery, maternal education, and receipt of breastfeeding counseling. CONCLUSIONS: EBF in Ethiopia remains uneven and below optimal levels. Strengthening structured breastfeeding support within routine antenatal and facility-based maternity services offers an important opportunity to improve national EBF outcomes.