‘If nurses were in our shoes would they breastfeed their own babies?’ A qualitative inquiry on challenges faced by breastfeeding mothers on the PMTCT programme in a rural community in Zimbabwe

Abstract

Background The Prevention of Mother to Child Transmission (PMTCT) of HIV programme in Zimbabwe has had remarkable success despite the country’s economic challenges. The aim of this study was to explore the challenges faced by breastfeeding mothers on the PMTCT programme. Method Narratives from 15 women (age range 19–35 years) were collected at two rural health facilities in Zimbabwe through in-depth interviews over a period of 6 months. Thematic analysis was used to describe breastfeeding mothers’ experiences and challenges of being on the PMTCT programme. Results The findings suggest that breastfeeding women on the PMTCT programme face challenges that include internal, external and institutional stigma and discrimination. Women reported a sense of powerlessness in decision making on following through with the PMTCT programme and were ambivalent regarding disclosure of their HIV status to their partners and significant others. Conclusion HIV and AIDS programmes should pay attention to women’s readiness for interventions. There is need to understand women’s life experiences to ensure informed and targeted programming for PMTCT. Electronic supplementary material The online version of this article (10.1186/s12884-019-2336-1) contains supplementary material, which is available to authorized users.

Barriers and facilitators for early and exclusive breastfeeding in health facilities in Sub-Saharan Africa: a systematic review

“…Of the 56 studies included in this review, 8 (14.3%) reported infrastructural barriers [ 30 – 37 ] while only one study (1.8%) reported facilitators [ 38 ]. Most frequently described barriers to postnatal breastfeeding support were overcrowding and lack of space [ 30 – 32 , 34 – 36 ]. For example, a study from Ghana reported that increases in caesarean deliveries was associated with overcrowding and insufficient equipment, which led to moving new mothers out of delivery quickly to make room for the next woman in labour [ 30 ].…”

“…Lack of privacy, a quiet place to breastfeed, availability of chairs for mothers to sit and breastfeed in and unreliable access to water and electrical power were also infrastructural challenges to breastfeeding at health facilities [ 33 , 35 – 37 ]. For example, a study from Zimbabwe highlighted how health workers asked mothers questions related to their HIV status while other patients were listening, which compromised confidentiality and decreased the likelihood of initiating breastfeeding [ 36 ]. In the one study that described infrastructural facilitators, the researchers in Tanzania reported that wall clocks and cell phone alarms supported regular timing feedings of low birthweight infants [ 38 ].…”

“…Caregiver factors were mentioned by 75.0% (42 of 56) of studies, including 37 studies (66.1%) that described barriers [ 31 , 32 , 34 – 36 , 38 , 43 , 46 , 50 – 52 , 55 , 56 , 58 – 62 , 64 , 66 , 68 – 84 ] and 27 studies (48.2%) that described facilitators [ 32 , 37 , 38 , 43 , 44 , 46 , 48 , 49 , 51 , 55 , 58 , 60 , 61 , 68 , 69 , 71 – 76 , 79 – 82 , 84 , 85 ]. Frequently mentioned barriers included inadequate lactation counselling [ 32 , 34 , 43 , 52 , 72 , 79 ] and misconceptions [ 34 – 36 , 50 , 52 , 55 , 56 , 60 , 62 , 68 , 72 , 74 , 77 , 79 , 83 ], such as breastmilk alone would not meet nutritional needs for the baby, formula was healthier, colostrum was dirty or not real breastmilk, infants required water in hot weather or infants required rest after delivery. Peer pressure by relatives and lack of decision-making power was frequently mentioned as a barrier to effective facility-based breastfeeding [ 36 , 46 , ...…”

“…Frequently mentioned barriers included inadequate lactation counselling [ 32 , 34 , 43 , 52 , 72 , 79 ] and misconceptions [ 34 – 36 , 50 , 52 , 55 , 56 , 60 , 62 , 68 , 72 , 74 , 77 , 79 , 83 ], such as breastmilk alone would not meet nutritional needs for the baby, formula was healthier, colostrum was dirty or not real breastmilk, infants required water in hot weather or infants required rest after delivery. Peer pressure by relatives and lack of decision-making power was frequently mentioned as a barrier to effective facility-based breastfeeding [ 36 , 46 , 52 , 56 , 60 – 62 , 68 , 79 , 80 ]. When counselling was provided, mothers were engaged directly while grandmothers and fathers were rarely included but reported to be influential regarding infant care.…”

“…When counselling was provided, mothers were engaged directly while grandmothers and fathers were rarely included but reported to be influential regarding infant care. A frequently mentioned barrier was fear of HIV transmission and issues around stigma and disclosure of HIV status [ 31 , 36 , 46 , 52 , 55 , 62 , 66 , 70 , 73 , 74 , 79 , 80 , 84 ]. A study from Uganda found that maternal HIV-positive status was associated with twice the odds of delayed initiation to breastfeeding (aOR 2.3; 95% CI 1.3–4.2) and reported that the fear of transmission led to hesitancy, even when the mother was counselled and intended to breastfeed [ 52 ].…”