{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T17:12:55Z","timestamp":1784049175465,"version":"3.55.0"},"reference-count":45,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T00:00:00Z","timestamp":1783814400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Hum Lact"],"abstract":"<jats:p>Breastfeeding is one of the most cost-effective health interventions in existence, improving child survival through improved health and nutritional status and providing numerous benefits to the mother, including lowering the risk of breast, ovarian, and endometrial cancer. Current WHO guidelines recommend exclusive breastfeeding (EBF) for the first 6\u2009months of an infant\u2019s life, which Ministries of Health across Southern Africa support. However, rates of EBF in this region, particularly Sub-Saharan Africa, vary widely and fail to reach global targets. Botswana and South Africa offer specific examples of this variation. Need to return to work has been highlighted as a significant barrier to sustained EBF among women who initiate EBF. Broader workplace structures and expectations for women hinder EBF, particularly in Southern Africa. The informal sector, which employs the majority of women in Southern Africa, often lacks labor protections and social benefits. Conditions within the workplace or at school are also not conducive to the specific demands of EBF, without dedicated space to express milk, facilities to safely store breastmilk, or protected time for breastmilk expression. Guidelines around how best to support breastfeeding women vary widely, and few lay out specific strategies to support EBF in the workplace. Women, regardless of where they live, deserve the choice to elect EBF for their infant. Persistent barriers to EBF prevent postpartum women and their infants, particularly in Southern Africa, from realizing its countless benefits.<\/jats:p>","DOI":"10.1177\/08903344261452911","type":"journal-article","created":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T16:10:21Z","timestamp":1783872621000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["What Does It Really Mean to Support Exclusive Breastfeeding in Southern Africa? It\u2019s Time to Shift the Paradigm"],"prefix":"10.1177","author":[{"given":"Kathleen M.","family":"Powis","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Massachusetts General Hospital, Boston, United States"},{"name":"EQUILACT, Inc., Hingham, MA, United States"},{"name":"T. H. Chan School of Public Health, Harvard University, Boston, MA, United States"},{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5493-4484","authenticated-orcid":false,"given":"Lyra S.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2661-3820","authenticated-orcid":false,"given":"Zoya-Maria R.","family":"Aoun","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Massachusetts General Hospital, Boston, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6138-5731","authenticated-orcid":false,"given":"Sara R.","family":"Schenkel","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Massachusetts General Hospital, Boston, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4992-0900","authenticated-orcid":false,"given":"Jennifer A.","family":"Smit","sequence":"additional","affiliation":[{"name":"Wits MatCH Research Unit, Department of Obstetrics and Gynaecology, University of the Witwatersrand Johannesburg, GP, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nzwakie","family":"Mosery","sequence":"additional","affiliation":[{"name":"Wits MatCH Research Unit, Department of Obstetrics and Gynaecology, University of the Witwatersrand Johannesburg, GP, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gosego","family":"Masasa","sequence":"additional","affiliation":[{"name":"Botswana Harvard Health Partnership, Gaborone, Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7078-9041","authenticated-orcid":false,"given":"Samuel","family":"Kgole","sequence":"additional","affiliation":[{"name":"Botswana Harvard Health Partnership, Gaborone, Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0705-2239","authenticated-orcid":false,"given":"Christina","family":"Psaros","sequence":"additional","affiliation":[{"name":"EQUILACT, Inc., Hingham, MA, United States"},{"name":"Department of Psychiatry, Massachusetts General Hospital, Boston, United States"},{"name":"Harvard Medical School, Boston, MA, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,12]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"crossref","unstructured":"Balogun O. 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