Indigenous breastfeeding support in Australia, Aotearoa/New Zealand, Canada and the United States: A scoping review

PROBLEM: Culturally responsive support is essential for Indigenous mothers to sustain breastfeeding; however, tailored support remains limited. BACKGROUND: For thousands of years Indigenous women have nourished their infants and children through breastfeeding, as the primary source of nutrition and an important cultural and spiritual practice. In Canada, Australia, New Zealand, and the United States (CANZUS), Indigenous breastfeeding practices have been disrupted by the ongoing impacts of colonisation. AIM: This scoping review aimed to identify breastfeeding supports for Indigenous women in CANZUS countries, whether the supports had been evaluated, describe their development, and explore women's experiences accessing and using these supports. METHODS: A scoping review was conducted following Phillips-Beck et al. and the PRISMA-ScR guidelines to identify literature on breastfeeding support for Indigenous women in CANZUS countries. Multiple academic databases and online sources were systematically searched. Screening and review were managed in Covidence, and findings were synthesized narratively. FINDINGS: Fourteen studies were included: eight from Australia, four from Canada and two from the USA. Breastfeeding support were examined across health settings (3), community (home visits, health education, telehealth) (9), and multiple settings (2). DISCUSSION: Breastfeeding supports by and for Indigenous women remain scarce. Factors linked to successful support included continuity of care, mother-centred and holistic practices, wrap-around services, and trust-building. Notably, few studies detailed culturally responsive components in these supports. CONCLUSION: Indigenous-led research and programs are critical to develop and deliver effective, culturally responsive breastfeeding support across CANZUS countries.