Social Determinants of Breastfeeding Preferences among Black Mothers Living with HIV in Two North American Cities

Abstract

The study is motivated by the need to understand the social determinants of breastfeeding attitudes among HIV-positive African, Caribbean, and Black (ACB) mothers. To address the central issue identified in this study, analysis was conducted with datasets from two North American cities, where unique country-specific guidelines complicate infant feeding discourse, decisions, and practices for HIV-positive mothers. These national infant feeding guidelines in Canada and the US present a source of conflict and tension for ACB mothers as they try to navigate the spaces between contradictory cultural expectations and national guidelines. Analyses in this paper were drawn from a broader mixed methods study guided by a community-based participatory research (CBPR) approach to examine infant feeding practices among HIV-positive Black mothers in three countries. The survey were distributed through Qualtrics and SPSS was used for data cleaning and analysis. Results revealed a direct correlation between social determinants and breastfeeding attitude. Country of residence, relatives’ opinion, healthcare providers’ advice and HIV-related stigma had statistically significant association with breastfeeding attitude. While the two countries’ guidelines, which recommend exclusive formula feeding, are cardinal in preventing vertical transmission, they can also be a source of stress. We recommend due consideration of the cultural contexts of women’s lives in infant feeding guidelines, to ensure inclusion of diverse women.

“Discrimination is harder to live with than the disease”: an interview study of the perceptions and experiences of sexual and reproductive health and rights among women living with HIV in Sweden

“… 31 Other scholars argue that while infant-feeding guidelines opposing breastfeeding are crucial for preventing vertical transmission, they can also be a source of concerns and challenges for women LWH in the context of “breast is best” and the era of U = U. 10 , 11 , 33 Some women LWH may choose to breastfeed despite these guidelines for individual, social and cultural reasons or for fear of unintentional sharing of their HIV status, which could lead to stigma. 33 Previous research recommends considering the diversity of women LWH and provides evidence about the risks and benefits of breastfeeding to support clinical guidance and enable an informed decision.…”

“… 10 , 11 , 33 Some women LWH may choose to breastfeed despite these guidelines for individual, social and cultural reasons or for fear of unintentional sharing of their HIV status, which could lead to stigma. 33 Previous research recommends considering the diversity of women LWH and provides evidence about the risks and benefits of breastfeeding to support clinical guidance and enable an informed decision. 11 , 33 …”

Factors that affect feeding infants with HIV mothers

“…The role of health workers is very influential on the behavior of HIV-positive mothers in food selection (Etowa et al, 2020;Labbok, 2001). Research shows that there is a need to improve the communication skills of health workers to provide appropriate counselling for HIV mothers because, despite information that encourages exclusive breastfeeding in HIV-infected babies, HIV-positive mothers continue to struggle to understand the information that influences their desire to change feeding behavior (Hazemba et al, 2016b).…”

When law and science part ways: the criminalization of breastfeeding by women living with HIV

“…It is increasingly acknowledged that some parents living with HIV choose to breastfeed, even where formula is available. [37][38][39][40][41]…”