Infant feeding by South African mothers living with HIV: implications for future training of health care workers and the need for consistent counseling

Abstract

Background Since 2010, the World Health Organization recommends lifelong antiretroviral treatment for all women living with HIV, and exclusive breastfeeding for six-months followed by breastfeeding until 24-months for all HIV positive mothers. Nevertheless, many mothers living with HIV do not initiate breastfeeding or stop prematurely, and many countries are still in the process of updating their national infant feeding guidelines to align with World Health Organization recommendations. We sought to understand uptake of breastfeeding and factors that influence decision-making regarding infant feeding in women living with and without HIV who receive ante- and postnatal care at a primary healthcare setting. Methods Programmatic data on infant feeding intentions and practices among women attending an ante-and postnatal clinic service at a primary care clinic in Johannesburg, South Africa were summarized using descriptive statistics. Qualitative interviews were conducted with 12 healthcare providers, 12 women living with HIV who were breastfeeding and 10 who were formula feeding. Interviews were analyzed using a content analysis approach. Results Pregnant women living with HIV were less likely to express an intent to breastfeed (71% vs 99%). During the first 6 months postpartum, mothers living with HIV were also less likely to exclusively breastfeed compared to HIV-negative mothers. Mixed messages during infant feeding counselling, social and economic factors, and fear of HIV transmission influenced women’s choices to initiate and continue breastfeeding. Conclusions As infant feeding guidelines for women living with HIV have evolved rapidly in the past 10 years, uniform messages on the low risk of mother-to-child transmission of HIV associated with breastfeeding while on ART and on introduction of complementary foods after 6 months of age are needed.

Infant feeding knowledge and practice vary by maternal HIV status: a nested cohort study in rural South Africa

“…Individual questions Overall exclusive breastfeeding uptake in our study was similar to other studies from South Africa and elsewhere [19,20,23,25,29]. Our study mirrors two other studies on differences in exclusive breastfeeding uptake among women living with HIV compared with women not living with HIV in the Option B+ era [19,20], despite being nested within a trial specifically targeting antenatal care quality for all women.…”

“…Median age was 25 years (interquartile range [IQR], [21][22][23][24][25][26][27][28][29][30]. Median gestation at first ANC visit was 19 weeks (IQR 15-24 weeks).…”

“…Within the context of these new guidelines we anticipate more postpartum women to initiate and sustain exclusive breastfeeding in South Africa, because they may be more confident in suppressive ART; be aware of how maternal viral load influences HIV transmission, and be aware of the dangers of mixed feeding and benefits of exclusive breastfeeding. However, despite substantial improvements in exclusive breastfeeding initiation [19][20][21][22], early cessation of exclusive breastfeeding remains a problem [22][23][24][25].…”

Breastfeeding advice for reality: Women's perspectives on primary care support in South Africa

“…Such echoes from previous national guidelines need to be managed in the retraining of health care providers to avoid a detrimental impact on child health. A recent qualitative study undertaken in Johannesburg (West et al, ) also found that mothers living with HIV expressed confusion around continued breastfeeding after the introduction of complementary foods. This confusion was pervasive among both mothers and health care providers.…”

“…This remains a considerable challenge; research from several settings has documented confusion among health workers on how to advise and support women to breastfeed, due to incomplete training coverage and weak supervision (Chinkonde, Sundby, de Paoli, & Thorsen, ; Chopra, Doherty, Jackson, & Ashworth, ; Janse van Rensburg, Nel, & Walsh, ; Piwoz et al, ). In addition, attitudes and fear among health workers have also contributed to inappropriate infant feeding messages and reluctance to promote breastfeeding, particularly sustained breastfeeding, among mothers living with HIV mothers due to the role breastfeeding has in post‐natal HIV transmission (West et al, ).…”