HIV‐positive Malawian women with young children prefer overweight body sizes and link underweight body size with inability to exclusively breastfeed

Abstract

Before the prevention of mother-to-child transmission (PMTCT) program was widely implemented in Malawi, HIV-positive women associated exclusive breastfeeding with accelerated disease progression and felt that an HIV-positive woman could more successfully breastfeed if she had a larger body size. The relationship between breastfeeding practices and body image perceptions has not been explored in the context of the Option B+ PMTCT program, which offers lifelong antiretroviral therapy. We conducted in-depth interviews with 64 HIV-positive women in Lilongwe District, Malawi to investigate body size perceptions, how perceptions of HIV and body size influence infant feeding practices, and differences in perceptions among women in PMTCT and those lost to follow-up. Women were asked about current, preferred, and healthy body size perceptions using nine body image silhouettes of varying sizes, and vignettes about underweight and overweight HIV-positive characters were used to elicit discussion of breastfeeding practices.More than 80% of women preferred an overweight, obese, or morbidly obese silhouette, and most women (83%) believed that an obese or morbidly obese silhouette was healthy. Although nearly all women believed that an HIV-positive overweight woman could exclusively breastfeed, only about half of women thought that an HIV-positive underweight woman could exclusively breastfeed. These results suggest that perceptions of body size may influence beliefs about a woman's ability to breastfeed. Given the preference for large body sizes and the association between obesity and risk of noncommunicable diseases, we recommend that counseling and health education for HIV-positive Malawian women focus on culturally sensitive healthy weight messaging and its relationship with breastfeeding practices.

Body size preferences for women and adolescent girls living in Africa: a mixed-methods systematic review

“…A further five studies found a negative FID (i.e. current < ideal), meaning that women and or/adolescent girls wanted to gain weight (41,52,62,86,115) and two found mixed results. The two studies reporting mixed results included Mchiza et al (77) with a positive FID among mothers and null FID (i.e.…”

“…Of the seventy-three articles, fifty were quantitative (8,9,27,28,40,41,48,(51)(52)(53) , fifteen were qualitative (11,23,(98)(99)(100)(101)(102)(103)(104)(105)(106)(107)(108)(109)(110) Fig. 2 (colour online) Preferred reporting items for systematic reviews and meta-analyses flow diagram showing the selection of studies for the present systematic mixed-methods review and eight mixed methods (24,42,(111)(112)(113)(114)(115)(116) (Table 2). All quantitative studies utilised a cross-sectional design, with the exception of one longitudinal design (87) .…”

“…Using body image scales, one study (51) found that 34•6 % of Kenyan women living in urban Nairobi underestimated their body weight; with 28•8 % of women who underestimated their weight classified as obese, a pattern also observed in Cameroonian urban women (42) . The same was also observed with overweight/obesity in Nigerian students and South African black urban women, as well as in black schoolgirls, Algerian Saharawi refugees, urban (80) Mauritius High Urban/Rural Females Adolescents 13-18 90 Ettarh et al (51) Kenya Medium Urban slums Females Adults 42•0 (no SD) Jafri et al (81) Morocco Medium Urban Females All ≥ 18 425 El Ansari et al (82) Egypt Medium Urban Females Adolescents 18•6 (1•2) Gitau et al (85) South Africa Medium Urban Mixed Adolescents 13 and 17 1302 (♀: 675; ♂: 627) Gitau et al (83) South Africa Medium Urban Females Adolescents 15•0 (no SD) 183 Gitau et al (84) South Tunisian, Moroccan and Malawian women (24,53,79,87,90,96,97,115) . Only 37•1 % of Ghanaian women living in Accra perceived their current body size as overweight or obese, even though 49•9 % were in these weight categories (70) , a pattern also observed by others in the same city (48,78) .…”

“…'If you are too rey [stout] in the village, you will not be able to work or cultivate : : : ' (middle-aged woman, urban, Senegal) (116) Lahmam et al (72) Swami et al (27) Alwan et al (75) Benkeser et al (78) Cohen et al (42) Jafri et al (81) Okoro et al (86) Amenyah & Michels (88) Pedro et al (91) Prioreschi et al (95) Croffut et al (115) Cohen et al (116) Socio Cohen et al (42) Gitau et al (85) Musaiger & Mannai ( 28 Health-related factors BMI Individual BMI was associated with body size preference, although mixed results were found. Overall, increased BMI in women was positively associated with a greater preference for slimmer body sizes (69,78) , with the exception of one study (91) , and negatively associated with a preference for a large(r) body size (8,69) .…”

Drivers of food consumption among overweight mother-child dyads in Malawi

“…To assess body size preferences, a set of seven adult female and seven child body silhouette drawings were used. A local artist adapted mothers' body silhouettes from versions previously used in Malawi [27][28][29] and adapted child body silhouettes from Hager et al [29]. Each body silhouette drawing was printed separately on cardstock and laminated.…”