Determinants of early interruption of exclusive breastfeeding: a qualitative meta-synthesis

Breast milk is recognized as the ideal source of nutrition for infants; however, the widespread early interruption of exclusive breastfeeding within the first six months postpartum constitutes a major public health challenge. Despite clear recommendations from the World Health Organization and strong maternal intentions to exclusively breastfeed, complex factors continue to lead to involuntary interruption, and it is estimated that only 44% of infants worldwide are exclusively breastfed. This unplanned cessation not only deprives infants of irreplaceable nutritional and immunological benefits and increases the risk of morbidity, but also negatively affects maternal psychological well-being and results in substantial economic losses. Current evidence on the determinants of this interruption remains scattered across single-region studies, with a lack of cross-cultural and systematic synthesis of qualitative findings. Therefore, this study aimed to systematically review and meta-synthesize global qualitative evidence to identify the multidimensional determinants of early interruption of exclusive breastfeeding, thereby providing an evidence base for developing multilevel and effective intervention strategies. We systematically searched PubMed, CINAHL, the Cochrane Library, Web of Science, and Embase for publications from March 6, 2021 to March 6, 2026. The methodological quality of the included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research, and the JBI meta-aggregation approach was used to summarize and synthesize the findings. A total of 33 studies were included, from which 252 findings were extracted. These findings were grouped into 10 categories and further synthesized into three integrated findings: mothers turning to supplementary feeding amid feeding uncertainty and physical and psychological burden; insufficient social support systems weakening the continuation of exclusive breastfeeding; and sociocultural factors, infrastructure gaps, and the commercial power of formula milk jointly normalizing supplementary feeding. Early interruption of exclusive breastfeeding is influenced by multilevel factors involving mothers, families and communities, healthcare services, work systems, sociocultural contexts, and commercial marketing. Future efforts should move beyond mother-focused health education and establish comprehensive support strategies covering families, communities, healthcare institutions, workplaces, and policy settings to reduce avoidable interruption of exclusive breastfeeding. PROSPERO Number CRD420251179108.