Diversity of influences on infant feeding strategies in women living with HIV in Cape Town, South Africa: a mixed methods study

Abstract

Abstractobjective To explore influences on infant feeding intentions and practices in women living with HIV in South Africa.methods Structured questionnaires were completed by 207 pregnant women and 203 post-partum women in Cape Town, South Africa. Concurrently, 34 semi-structured, qualitative interviews explored the influences on infant feeding strategies in women living with HIV.results Overall, 50% (104) of pregnant women intended to breastfeed and 22% (45) Other important influences included previous infant feeding experiences, desires to protect the infant from HIV and involvement of other care providers. Many women also noted that breastfeeding was not feasible due to work commitments and highlighted concerns around the discontinuation of the free provision of infant formula.conclusion These results suggest that women living with HIV balance complex influences in deciding on their preferred infant feeding strategies. This underscores the need for extensive provider, patient and community education to ensure consistent messaging, while allowing for adaptation to the circumstances of individual mothers.

Infant feeding knowledge, perceptions and practices among women with and without HIV in Johannesburg, South Africa: a survey in healthcare facilities

“…Having HIV infection was associated with decreased adjusted odds of an intention to breastfeed, with a proportion of women with HIV reporting an intention to formula feed because of fears of infecting their infants. Similar to other studies, higher levels of maternal education and discussing infant feeding intentions with others were associated with decreased adjusted odds of an intention to exclusively breastfeed [8, 20]. Zulliger et al [8] found that women with HIV, with lower levels of education, were more likely to express an intention to breastfeed.…”

“…Similar to other studies, higher levels of maternal education and discussing infant feeding intentions with others were associated with decreased adjusted odds of an intention to exclusively breastfeed [8, 20]. Zulliger et al [8] found that women with HIV, with lower levels of education, were more likely to express an intention to breastfeed. Women with higher levels of education are likely to be employed and hence be able to afford infant formula [20].…”

“…Even in the early years of the national PMTCT programme, a study done from 2002 to 2003 showed poor infant feeding practices among both women with and without HIV, with less than 10% exclusively breastfeeding at 12 weeks [7]. High rates of formula feeding were also reported among women with HIV, when free infant formula was available [8–10]. In a study done in Cape Town, over 90% of postpartum women with HIV reported ever using infant formula, including a large proportion of women who had also breastfed [8].…”

“…High rates of formula feeding were also reported among women with HIV, when free infant formula was available [8–10]. In a study done in Cape Town, over 90% of postpartum women with HIV reported ever using infant formula, including a large proportion of women who had also breastfed [8]. Also, in a large, national facility-based evaluation conducted in 2010, almost two-thirds of HIV exposed infants aged four to eight weeks were reported to have received infant formula and no breast milk [9].…”

Individualizing the WHO HIV and infant feeding guidelines

“…Second, an individualized approach may be too cumbersome for healthcare workers to implement, and previous efforts to individualize infant feeding recommendations have led to confusion about feeding recommendations for both HIV-infected and HIV-uninfected women [1, 46, 50–52]. Our results suggest that the individualized approach could lead to moderate benefits compared to the public health approach, but only when RR-RF is very low or very high or ARV availability is limited; some providers may already be individualizing feeding recommendation in such situations [50, 52]. The individualized approach is likely of minimal benefit at the intermediate values of RR-RF expected in most settings, or as programs scale up the availability of maternal ART under Options B/B+.…”