Defining and measuring maternal intentions and practices regarding infant feeding: a scoping review

TL;DR

This review examines how maternal intentions and infant feeding practices are defined and measured, highlighting inconsistencies that hinder research comparisons.

Contribution

The study systematically maps definitions and measurement approaches for maternal infant feeding intentions and practices, identifying gaps for standardization.

Findings

Definitions of maternal intention varied from single-item measures to validated scales.

Exclusive breastfeeding was most commonly defined, but classifications for mixed and formula feeding lacked consistency.

Measurement timing and data sources showed considerable heterogeneity across studies.

Abstract

Maternal decisions regarding infant feeding are shaped by personal values, social and cultural factors, and healthcare guidance. Although breastfeeding is widely recommended, diverse feeding practices, including mixed and formula feeding, are common across many settings. Previous studies have examined maternal intentions and practices related to infant feeding; however, their conceptual definitions and measurement approaches vary substantially, limiting comparability across studies. The purpose of this scoping review was to systematically map how maternal intentions and practices related to infant feeding have been defined and measured in the existing literature in order to clarify methodological heterogeneity and inform future research design and measurement standardization.

This review followed a standard methodological framework, adhering to PRISMA-ScR guidelines and the Arksey and O’Malley framework. PubMed, CINAHL, and Ichushi-Web were used for studies published between January 2010 and June 2025. Eligible studies included quantitative, qualitative, and mixed-method studies on maternal intentions or practices regarding breastfeeding, mixed feeding, or formula feeding. Extracted variables included study characteristics, definitions and measurements of intention and practice, timing of assessment, and feeding categories.

Fifty-five studies met the inclusion criteria. Definitions of maternal intention varied widely, ranging from single-item measures for exclusive breastfeeding to validated multi-item scales. Measurement approaches included custom questionnaires, validated scales, qualitative interviews, and single-item assessments, with considerable variations in timing. Practice was most often defined as exclusive breastfeeding; however, operational definitions differed markedly across studies, and only a few studies strictly followed the World Health Organization criteria. Mixed and formula feeding were inconsistently categorized across studies. The intention–practice gap was not specifically examined in any study as a primary outcome. Considerable heterogeneity was observed in measurement timing, feeding classifications, and data sources.

This review highlights substantial variability in the conceptualization and measurement of maternal intentions and practices related to infant feeding. Standardized definitions, consistent feeding classifications, and alignment of measurement timing are necessary for enhancing comparability across studies. Definitive operationalization of the intention–practice gap should be prioritized in future research to advance our understanding of maternal feeding behaviors and inform the development of supportive interventions.

The online version contains supplementary material available at 10.1186/s12884-026-08768-0.

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