Rapid Cessation of Exclusive Breastfeeding in Durban, South Africa: A Qualitative Assessment of the Experiences of HIV-infected Mothers and the Perspectives of Their Counsellors and Close Social Networks.

BACKGROUND AND INTRODUCTION At the end of 2007 an estimated 2.1 million children were living with HIV/AIDS, and 2 million of those were in sub-Saharan Africa. It is estimated that 90% of children living with HIV acquired the virus through mother-to-child transmission (MTCT). The United Nation’s Millennium Development Goal (MDG) number four is to reduce child mortality by two-thirds from 1990 to 2015. In order for this goal to be achieved PMTCT should be part of a comprehensive approach in maternal and child health services. In the recent guidelines the World Health Organisation (WHO) has endorsed exclusive breast milk as ideal food for all infected and uninfected infants from birth to six months because of its nutritional superiority over commercial formulas and the significant protection it gives infants against acute and chronic illnesses. Without specific support exclusive breastfeeding is only practised by a minority of women worldwide. Some studies have shown that with enough support breastfeeding can be made safe through promotion of exclusive breastfeeding in communities where replacement feeding is not AFASS (acceptable, feasible, affordable,sustainable and safe). AIMS AND OBJECTIVES: To assess how HIV-infected women experience abrupt cessation of exclusive breastfeeding. To explore the perspectives of social networks of HIV-infected mothers when stopping breastfeeding METHODS: In-depth interviews with HIV-infected mothers (n=16), counsellors (n=13) and focus group discussions (n=68) RESULTS: HIV-infected mothers chose rapid cessation of exclusive breastfeeding because they were motivated not to infect their babies even though it was extremely difficult. The counsellors were also pro-breastfeeding therefore they influenced mothers’ choices. The counsellors did not have much practical advice on how to stop breastfeeding. In the focus group discussions the participants said that there need to be partner, family, and community involvement infant feeding issues. They stated that it should be emphasized that exclusive breastfeeding is for 8 everyone not just the HIV-infected mothers. Mixed feeding is a normal practice in the study area and there is a lot of family and cultural influence on a mother’s infant feeding choice. CONCLUSION The constantly changing infant feeding guidelines are confusing. It is important for the policy makers to acknowledge that a mother does not live in isolation. When making infant feeding recommendations there is a need to take into consideration that the mother is influenced by her close social networks when she carries out her infant feeding option. SEARCH TERMS Breastfeeding, exclusive breastfeeding, rapid cessation, HIV, AIDS, MTCT, PMTCT, early cessation of breastfeeding, vertical transmission and weaning SOURCES Pubmed, Google Scholar, Snow ball technique, Books, Journals, WHO/UNICEF/UNAIDS websites, theses and BIBSY