Women Living With HIV in High Income Countries and the Deeper Meaning of Breastfeeding Avoidance: A Metasynthesis

Abstract

Background: Recommendations to avoid breastfeeding for women living with HIV in high income countries has resulted in a gap in the literature on how healthcare professionals can provide the highest standard of lactation counseling. Research aims: (1) Describe social and emotional experiences of infant feeding for women living with HIV in high income countries; (2) raise ethical considerations surrounding the clinical recommendation in high income countries to avoid breastfeeding. Methods: A systematic literature search was conducted between January 1, 2008 and June 20, 2019. A total of 900 papers were screened and six met the inclusion criteria: (a) the sample was drawn from a high-income country regardless of the nativity of participants; (b) some or all participants were women living with HIV. Metasynthesis, according to Noblit and Hare (1988), was used to synthesize the experiences of women living with HIV in high-income countries and their experiences in infant feeding decisions. Results: Participants in this sample suffered a substantial emotional burden associated with infant feeding experiences potentially leading to risk of internalized stigma, suggesting that infant feeding considerations may contribute to HIV stigma in unique ways. Four overarching themes were identified expressing the meaning of avoidance of breastfeeding: maternal self-worth, deculturalization, surveillance, and intersectionality. Conclusion: Women in high-income countries living with HIV deserve the highest standard of lactation care and counseling available. Healthcare professionals in high-income countries are ethically obligated to provide evidenced-based lactation care and counseling to women living with HIV.

Tilting the Scale: Current Provider Perspectives and Practices on Breastfeeding with HIV in the United States

“… 34–36 HIV disproportionately impacts Black people in the US, 19 and BFHIV patient populations in high-income countries include many Black immigrants. 37 Given the degree to which Black communities are affected by HIV in high-income countries and that both maternal 38 and infant 39 mortality are higher for Black patients in the US, it is notable that provider responses in our study overwhelmingly felt neutral or disagreed that a patient identifying as White was a barrier, whereas almost one third of respondents considered a patient identifying as Black, Indigenous, or a Person of Color to be a barrier to supporting BFHIV. These findings underscore the importance of identifying and dismantling social causes of health disparities, including internalized interpersonal and structural racism, implicit bias, poverty, xenophobia, and lack of access to health care.…”

Breastfeeding grief after chest masculinisation mastectomy and detransition: A case report with lessons about unanticipated harm

“…The midwife was dismissive and confused by Elizabeth's distress and did not understand why she sought donor breastmilk. However, an abundance of research shows that Elizabeth was not unusual in seeing breastfeeding as consequential [e.g., (30,(31)(32)(33)(34)]. Her reasons for placing importance on breastfeeding align with those previously identified: breastfeeding is a biologically normal, instinctive behaviour, intrinsically linked with motherhood, is a way of being in relationship with one's infant, and is important to infant health (35).…”

“Go With the Flow:” A Qualitative Description of Infant Feeding Experiences Among Women With HIV in the United States

“…Pregnancy and breastfeeding are inextricably linked as part of the complete reproductive cycle. Although research is scarce surrounding breastfeeding and reproductive autonomy, for WWH in HICs where breastfeeding avoidance is advised, the decision not to breastfeed has been cited as coming at a high emotional cost (Griswold & Pagano-Therrien, 2020; Khan et al, 2021). Current U.S. recommendations do not adequately address how clinicians should counsel WWH who desire to breastfeed (Tuthill et al, 2019), nor are there standardized guidelines for counseling and managing lactation among WWH who do not breastfeed.…”