Factors influencing the infant feeding choices of HIV-positive mothers at a level two hospital in Cape Town

Abstract

Background/Aims: Following the decision by the South African Department of Health in 2012 to withdraw the provision of free infant formula milk to HIV-exposed infants, policy makers have grappled with the need to develop guidelines to help HIV-positive mothers decide whether they should breastfeed their babies. The objectives of this study were to assess the infant feeding choices of HIV-positive mothers and to determine factors influencing their behaviours prior to the process of withdrawing the provision of free infant formula milk. Methods: A quantitative approach was employed in this study, including the use of a survey to collect descriptive data on a consecutive sample (n=100). Data analysis was carried out using the IBM SPSS Version 20. Results: More than half (54%) of the participants indicated that their infants were exclusively breastfed, and 46% of the participants reported exclusively formula feeding. There was no statistical difference between both groups with regards to: race; employment status; obstetric history; HIV disclosure status; knowledge and awareness of infant feeding recommendations or policies regarding breastfeeding promotion. Conclusions: The findings of this study show that health-care workers are the main providers of counselling on infant feeding. Inconsistent messages from health professionals, health facility practices and government policies were also observed.

Barriers and facilitators for early and exclusive breastfeeding in health facilities in Sub-Saharan Africa: a systematic review

“…Almost a third of studies (18 of 56, 32.1%) reported policy-related barriers [ 30 – 32 , 34 , 35 , 38 – 50 ] while 20 studies (35.7%) described facilitators [ 30 , 31 , 33 – 35 , 37 , 39 – 43 , 47 , 50 – 56 ]. Poor leadership and management structures were described as barriers to effective facility-based breastfeeding [ 30 , 40 , 47 , 50 ], such as when hospital management felt that BFHI was extra work to implement.…”

“…Poor leadership and management structures were described as barriers to effective facility-based breastfeeding [ 30 , 40 , 47 , 50 ], such as when hospital management felt that BFHI was extra work to implement. Also frequently reported was limited implementation of breastfeeding policies [ 34 , 35 , 39 , 41 , 43 , 45 – 50 , 57 ], particularly at peripheral health facilities. For example, a study in Ghana found that although almost all policy makers and implementers were aware of the national breastfeeding policy, there was a lack of written guidelines and posters at peripheral health facilities because materials were passed from national to regional, district and then health facilities with bureaucracy and transport barriers encountered between each level [ 50 ].…”

“…Poor dissemination was an issue with changing infant feeding guidelines for HIV-positive mothers. A study from South Africa found that the phasing out of free formula for HIV-positive mothers was not clearly explained to health workers particularly at the grassroots level, which led to inconsistent messaging to HIV-positive mothers [ 43 ]. Challenges with policy dissemination and implementation were compounded by lack of funding and inadequate staffing and training policies that led to an inability to sustain skilled staff in maternity wards [ 30 – 32 , 34 , 35 , 38 , 40 – 42 , 44 – 48 ].…”

“…Facilitators included committed leadership and supportive supervision, in particular by local management at the health facility [ 30 , 34 , 40 , 52 ]. Clear and consistent guidelines with adequate dissemination [ 30 , 54 ] and implementation of policies such as rooming-in, skin-to-skin, and discouraging formula and/or mixed feeding [ 30 , 35 , 43 , 47 , 58 ] were helpful in facilitating breastfeeding practices. A major facilitator was policies around staffing allocation and training [ 31 , 33 – 35 , 37 , 39 – 42 , 50 , 51 , 53 – 56 ].…”

Improved rates of exclusive breastfeeding at 14 weeks of age in KwaZulu Natal, South Africa: what are the challenges now?

“…Increasing the rate of exclusive breastfeeding (EBF) in the first six months of life to 50% is one of six major global targets set by the United Nations (UN) Decade of Nutrition [ 1 ], and improving exclusive and sustained breastfeeding rates is essential for achieving sustainable development goals (SDGs) to eradicate hunger and end malnutrition by 2030 [ 2 ]. If implemented globally at near universal levels (> 90%), optimal breastfeeding practices could reduce global child deaths by more than 800,000 [ 3 ], which makes breastfeeding the most effective preventive intervention to improve infant mortality [ 4 ].…”