Table 2 Barriers and facilitators to facility-based breastfeeding support in SSA

Health facilities infrastructure and supplies

• Overcrowding and lack of space

• Lack of privacy or quiet place to breastfeed

• Insufficient equipment or supplies

• Supplies that support breastfeeding practice

Supportive policies and policy implementation

• Poor leadership and management structures

• Lack of guidelines/policies or their limited implementation

• Inability to sustain skilled staff with due to staffing and training policies

• Commitment and leadership

• Mechanisms of regulation and supportive supervision

• Clear and consistent guidelines with adequate dissemination and policy implementation

• Adequate training and staffing policies and allocation

Health worker engagement

• Staffing shortages and workload

• Gaps in knowledge, misconceptions and inconsistent messaging

• Gaps in practical skills and management of complications

• Poor health worker attitude or willingness

• Poor respectful maternity care

• Good knowledge among health workers about breastfeeding benefits and practices

• Positive attitudes and willingness

• Providing demonstrations and following up

• Providing respectful maternal care

• Positive work culture and social norms among medical staff supporting breastfeeding

Caregiver engagement

• Gaps in knowledge

• Misconceptions, beliefs and cultural practices

• Fear of HIV transmission or stigma

• Difficulty with breastfeeding practice and receiving inadequate health worker support

• Insufficient milk production

• Health conditions of mother/infant

• Insufficient milk production

• Maternal characteristics

• Acceptability and knowledge

• Received postpartum health worker counselling and/or support

• Learning skills and techniques to improve breastfeeding practice

• Supportive social networks and peer support groups: HIV+ peers

• Absence of breast problems

• Maternal characteristics