Are we doing enough? Improved breastfeeding practices at 14 weeks but challenges of non-initiation and early cessation of breastfeeding remain: findings of two consecutive cross-sectional surveys in KwaZulu-Natal, South Africa

Abstract

Background: KwaZulu-Natal (KZN) Initiative for breastfeeding support (KIBS) was a multipronged intervention to support the initiation and sustaining of breastfeeding, implemented between 2014 and 2017. We present results of two surveys conducted before and after KIBS implementation to assess changes in infant feeding practices in KZN over this time period. Methods: Two cross-sectional surveys were conducted in primary health care clinics. Multistage stratified random sampling was used to select clinics and participants. Sample size was calculated to provide district estimates of 14-week exclusive breastfeeding (EBF) rates at baseline (KIBS1), and provincial estimates at endpoint (KIBS2). At KIBS1 the sample required was nine participating clinics in each of 11 districts (99 clinics) with 369 participants per district (N = 4059), and at KIBS2 was 30 clinics in KZN with 30 participants per clinic (N = 900). All caregivers aged ≥15 years attending the clinic with infants aged 13-< 16 weeks were eligible to participate. Data was collected using structured interviews on android devices. Multi-variable logistic regression was used to adjust odds ratios for differences between time points.

Growth patterns and clinical outcomes in association with breastfeeding duration in HIV exposed and unexposed infants: a cohort study in KwaZulu Natal, South Africa

“…Only 46% of HU and 61% of HEU infants were breastfed for six months or more. Early cessation of breastfeeding in the South African population has also been reported in other studies independent of HIV exposure [ 13 , 14 ]. In Horwood’s study, mothers who were returning to work or school were less likely to breastfeed (AOR 3.76) [ 14 ].…”

“…For WNLHIV, it was recommended that infants be exclusively breastfed for six months but a longer duration of breastfeeding with complementary feeds thereafter until 24 months [ 11 ]. Two recent studies in SA reported short breastfeeding duration among women in general regardless of their HIV status [ 13 , 14 ].…”

Growth Patterns and Clinical Outcomes in Association with Breastfeeding in HIV Exposed and Unexposed Infants in KwaZulu Natal, South Africa

“…Only 46% of IUH and 61% of IEH were breastfed for six months or more. breastfeeding in the South African population has also been reported in other studies independent of HIV exposure [13,14]. In Horwood's study, mothers who were returning to work or school were less likely to breastfeed (AOR 3.76) [14].…”

“…For women not living with HIV (WNLHIV), it was recommended that infants be exclusively breastfed for six months but a longer duration of breastfeeding with complementary feeds thereafter until 24 months [11]. Two recent studies in South Africa reported short breastfeeding duration among women in general regardless of their HIV status [13,14].…”

Father involvement, maternal depression and child nutritional outcomes in Soweto, South Africa

“…However, we anticipate that the rate of exclusive breastfeeding would fall by the time the infants are 6 months old. Early mother–infant separation remains one of the biggest barriers to exclusive breastfeeding in South Africa, mainly due to mothers returning to economic or educational activities (Horwood et al, 2020 ; Remmert et al, 2020 ) and a lack of supportive economic policies. For example, in South Africa, women working in the formal sector are entitled to a minimum of 4 months paid maternity leave claimed through the Department of Labour, which includes time prebirth and postbirth (Basic Conditions of Employment Act 75 of 1997 ).…”