Early cessation of breastfeeding amongst women in South Africa: an area needing urgent attention to improve child health

Abstract

BackgroundBreastfeeding is a critical component of interventions to reduce child mortality. Exclusive breastfeeding practice is extremely low in South Africa and there has been no improvement in this over the past ten years largely due to fears of HIV transmission. Early cessation of breastfeeding has been found to have negative effects on child morbidity and survival in several studies in Africa. This paper reports on determinants of early breastfeeding cessation among women in South Africa.MethodsThis is a sub group analysis of a community-based cluster-randomized trial (PROMISE EBF) promoting exclusive breastfeeding in three South African sites (Paarl in the Western Cape Province, and Umlazi and Rietvlei in KwaZulu-Natal) between 2006 and 2008 (ClinicalTrials.gov no: NCT00397150). Infant feeding recall of 22 food and fluid items was collected at 3, 6, 12 and 24 weeks postpartum. Women’s experiences of breast health problems were also collected at the same time points. 999 women who ever breastfed were included in the analysis. Univariable and multivariable logistic regression analysis adjusting for site, arm and cluster, was performed to determine predictors of stopping breastfeeding by 12 weeks postpartum.ResultsBy 12 weeks postpartum, 20% of HIV-negative women and 40% of HIV-positive women had stopped all breastfeeding. About a third of women introduced other fluids, most commonly formula milk, within the first 3 days after birth. Antenatal intention not to breastfeed and being undecided about how to feed were most strongly associated with stopping breastfeeding by 12 weeks (Adjusted odds ratio, AOR 5.6, 95% CI 3.4 – 9.5 and AOR 4.1, 95% CI 1.6 – 10.8, respectively). Also important was self-reported breast health problems associated with a 3-fold risk of stopping breastfeeding (AOR 3.1, 95%CI 1.7 – 5.7) and the mother having her own income doubled the risk of stopping breastfeeding (AOR 1.9, 95% CI 1.3 – 2.8).ConclusionEarly cessation of breastfeeding is common amongst both HIV-negative and positive women in South Africa. There is an urgent need to improve antenatal breastfeeding counselling taking into account the challenges faced by working women as well as early postnatal lactation support to prevent breast health problems.

Infant feeding knowledge, perceptions and practices among women with and without HIV in Johannesburg, South Africa: a survey in healthcare facilities

“…Even in the early years of the national PMTCT programme, a study done from 2002 to 2003 showed poor infant feeding practices among both women with and without HIV, with less than 10% exclusively breastfeeding at 12 weeks [7]. High rates of formula feeding were also reported among women with HIV, when free infant formula was available [8–10]. In a study done in Cape Town, over 90% of postpartum women with HIV reported ever using infant formula, including a large proportion of women who had also breastfed [8].…”

Iodine status and associations with feeding practices and psychomotor milestone development in six‐month‐old South African infants

“…Infant feeding practices in South Africa are found to be substandard, whereby mixed feeding is the most common practice even before 6 months of age (Doherty et al, 2012, Siziba, Jerling, Hanekom, & Wentzel-Viljoen, 2015. The South African National Health and Nutrition Examination Survey of 2012 reported the exclusive breastfeeding rates for the first 6 months of life to be very low at 7.4% nationwide, despite the high rates (83.0%) of breastfeeding initiation (South Africa HSRC 2013).…”

Mental health predictors of breastfeeding initiation and continuation among HIV infected and uninfected women in a South African birth cohort study

“…In South Africa, exclusive breastfeeding rates, regardless of HIV status, remains low at approximately 32% 17 . Breastfeeding practices among uninfected mothers are slightly better compared to HIV-infected mothers 18,19 , but are still below ideal targets 20 .…”

“…Many studies examining barriers and facilitators of breastfeeding in LMIC, including South Africa has since been generated 19 . Pregnancy and gestational factors such as unplanned pregnancy, nulliparity, caesarean section, infant male gender and low birth weight to be negatively associated with breastfeeding behaviour 14,21,22 .…”