Figure 2 shows the search and identification process of potential references from the literature. Initially, a total of 1023 documents were obtained after searching the databases, after which duplicates (n = 579) were identified and removed. In the first stage, the title and abstract of 444 documents were screened, after which 215 documents were excluded. The second stage of screening, characterized by going over the full text of 229 documents, led to the exclusion of 128 irrelevant documents. A total of 101 documents were then retained in this review.

As shown in Fig. 3, the number of published studies increase over time (2012–2023) in countries of the region. The largest number of studies was from KSA (80 studies) [14, 33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112], whereas the number of studies from other GCC countries was considerably lower: UAE (8 studies) [9, 113,114,115,116,117,118,119], Kuwait (5 studies) [120,121,122,123,124], Qatar (4 studies) [125,126,127,128], and Oman (4 studies) [13, 129,130,131]. Per construct, the highest number of publications were for attitudes (51) followed by intentions (29), subjective norms (22), beliefs (18) and perceived behavioral control (17) (some publications tackled more than one construct).

Search and identification process of potential references from the literature. *The records identified from the various databases were as follows: Academic Search Ultimate (n = 35); Al Manhal (n = 9); APA PsyclNFO (n = 5); Arab World Research Source (AWRS) (n = 10); CAB Direct (n = 69); CINAHL Ultimate (n = 68); Directory of Open Access Journals (n = 64); E-Marefa (n = 4); Embase (n = 126); MEDLINE (n = 103); Scopus (n = 172); Web of Science Core Collection (n = 145)

Total number of publications from GCC countries for the period between 2012 and 2023 Abbreviations: GCC: Gulf Cooperation Council

The results pertinent to each of the constructs of the TPB are presented in the sections below and summarized in Supplementary Tables S2-S6.

Amongst the 101 articles included in the systematic review, there were 85 cross-sectional studies, 6 qualitative studies, 4 cohort studies, 3 quasi-experimental studies, 2 review studies, and 1 systematic review, which were evaluated using appropriate appraisal tools tailored to their respective study designs. All studies scored greater than 50% of the available points on their respective appraisal tools.

More specifically, the scores for the cross-sectional studies ranged from 55 to 100% (mean = 82.4%, median = 85%). These studies met the majority of the AXIS criteria, demonstrating high consistency and overall moderate to high-quality evaluations. The cohort studies were evaluated using the JBI Checklist for Cohort Studies, with scores ranging from 81.8 to 100% (mean = 93.2%, median = 95.5%). All studies met the majority of the JBI criteria. The quasi-experimental studies were evaluated using the JBI Checklist for Quasi-Experimental Studies, with scores ranging from 55.6 to 100% (mean = 74.1%, median = 66.7%). These studies showed lower overall quality, with some lacking sufficient measures to address non-responders. It is important to mention that only the baseline data were extracted from the cohort and the quasi-experimental studies. 6 qualitative studies were assessed using the JBI Critical Appraisal Checklist for Qualitative Research, with scores ranging from 80 to 100% (mean = 92%, median = 95%). These studies met most of the JBI criteria, demonstrating a good level of methodological quality. The review studies were evaluated using the JBI Checklist for Textual Evidence: Narrative, each scoring 100% (median = 100%); and the systematic review was assessed using the JBI Checklist for Systematic Reviews, scoring 90.9%.

Supplementary Table S2 summarizes the results pertinent to intentions.

In a study by Al-Darweesh et al. 86.8% of married women of childbearing age in Kuwait expressed that they intended to at least give BF a try [121] (Fig. 4). However, despite this high percentage, the study showed that the proportions of women who intended to continue to BF declined with the duration of BF (82.5% intended to BF for one month; 75.5% for 3 months and 58.5% for 6 months) [121]. In two studies involving women (pregnant or postpartum women) in Qatar, the proportions of those intending to BF were reported as 82.4%, and 84.3% respectively [125, 128]. In KSA, the intention to BF varied considerably between studies, ranging between 55.2% and 82.30% amongst female university students [51, 64], between 54.5% and 96% amongst pregnant women [50, 52, 62, 85, 111, 112], and between 44.3% and 94.3% amongst mothers [53, 76, 88, 101, 104], (Fig. 4).

Proportions (%) of women reporting the intention to breastfeed based on available data in countries of the GCC Abbreviations: GCC: Gulf Cooperation Council; KSA: Kingdom of Saudi Arabia

The intention to exclusively BF amongst mothers varied between 24% in Abu Dhabi (UAE) [