Determinants of Early Initiation of Breastfeeding among Mothers in Sub-Saharan Africa: A Systematic Review and Meta-Analysis, 2010–2025

Background Early initiation of breastfeeding, within the first hour of life, is a cost-effective strategy to improve neonatal survival and reduce morbidity. Despite its benefits, EIBF remains low in SSA. This study aimed to estimate the pooled prevalence of EIBF and its determinants. Methods Following PRISMA, studies from January 2010 to December 2025 were saved from key databases. Data were extracted in Excel and analyzed in STATA 17 using a random-effects model. Study quality, heterogeneity (I²), and publication bias were assessed. Protocol: PROSPERO CRD: 420251272129. Results Thirty-one studies, including 23,585 mothers, were analyzed. The pooled prevalence of EIBF was 58.98% (95% CI: 52.42–65.55). significantly associated with EIBF was vaginal delivery (AOR: 4.30; 95% CI: 3.21–5.76), place of residence (AOR: 2.30; 95% CI: 2.00–3.39), ≥ 4 antenatal visits (AOR: 1.82; 95% CI: 1.29–2.57), maternal education ≥ primary level (AOR: 1.69; 95% CI: 1.08–2.63), maternal knowledge (AOR: 2.42; 95% CI: 1.56–3.76), multiparity (AOR: 1.67; 95% CI: 1.24–2.24), facility delivery (AOR: 1.95; 95% CI: 1.29–2.94), immediate skin-to-skin contact (AOR: 2.23; 95% CI: 1.34–3.71), colostrum feeding (AOR: 2.65; 95% CI: 1.91–3.67), good neonatal condition (AOR: 2.95; 95% CI: 1.96–4.42), absence of postpartum complications (AOR: 2.67; 95% CI: 1.03–6.92), and support from healthcare providers (AOR: 2.51; 95% CI: 1.60–3.95). Conclusion Early initiation of breastfeeding in Sub-Saharan Africa remains below recommended levels. Strengthening health facilities and training skilled healthcare providers are essential, and future implementation strategies are needed to reduce neonatal mortality and morbidity.