The Stigma of Exclusive Breastfeeding Among Both HIV-Positive and HIV-Negative Women in Nairobi, Kenya

Abstract

Stigma related to HIV poses a formidable barrier to EBF in HIV-endemic regions. There is an urgent need to widely target all women with EBF information and support EBF practices regardless of maternal HIV infection status. The lessons learned from this study indicate that vertical programs can hinder promotion of infant health interventions and therefore negatively affect child survival.

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

“…Our finding of better knowledge among women with HIV is consistent with findings from other studies as there has been a greater emphasis on counselling and educating women with HIV on safe infant feeding practices and exclusive breastfeeding [26]. A perception has been created that women without HIV do not have to adhere to safe feeding practices, and that exclusive breastfeeding is a recommendation only for women with HIV, for prevention of HIV transmission [26]. This is of concern, as poor infant feeding practices are associated with increased infant morbidity and mortality, independent of HIV infection [24, 34].…”

“…Data from an established Option B+ PMTCT programme in Malawi however highlighted that most infant feeding counselling still occurs during pregnancy and delivery, with minimal counselling during the postpartum period [32]. Our finding of better knowledge among women with HIV is consistent with findings from other studies as there has been a greater emphasis on counselling and educating women with HIV on safe infant feeding practices and exclusive breastfeeding [26]. A perception has been created that women without HIV do not have to adhere to safe feeding practices, and that exclusive breastfeeding is a recommendation only for women with HIV, for prevention of HIV transmission [26].…”

“…A South African cohort study also found that women with HIV were more likely to exclusively breastfeed than women without HIV [7]. This could be a reflection of the misconception that only women with HIV need to practice exclusive breastfeeding, to prevent HIV transmission, and is optional for women without HIV [26]. In most sub-Saharan countries, including South Africa, mixed feeding is the norm and adherence to exclusive breastfeeding raises suspicions of HIV infection, and to avoid the stigma, women with and without HIV may elect to ‘mix feed’ [26–28].…”

“…This could be a reflection of the misconception that only women with HIV need to practice exclusive breastfeeding, to prevent HIV transmission, and is optional for women without HIV [26]. In most sub-Saharan countries, including South Africa, mixed feeding is the norm and adherence to exclusive breastfeeding raises suspicions of HIV infection, and to avoid the stigma, women with and without HIV may elect to ‘mix feed’ [26–28]. This is somewhat a contradiction given that, as discussed earlier, there is a perception that formula feeding is also associated with having HIV [22, 23].…”

The Impact of Culture on Breastfeeding Rates

“…Just such an article is the study of Odeny and colleagues from Kenya in this month's issue of Breastfeeding Medicine. 1 As we know, current recommendations for mothers in the developing world who are HIV positive are to combine retroviral therapy and exclusively breastfeeding of the infant. 2 This regimen has the best chance of reducing the postpartum HIV transmission rate from the mother to the infant, better than partial breastfeeding or formula feeding.…”