When the Reality of Breastfeeding Sets in: How HIV‐Infected Mothers' Perceptions About Infant Feeding Messages Change over Time

Exclusive breastfeeding to six months is not widespread despite significant investments to modify current practices. Counseling strategies promoting exclusive breastfeeding are often designed without adequate attention to cultural heterogeneity in maternal perceptions or to changes in those perceptions over the course of early breastfeeding experiences. As researchers and practitioners, we often fail to account for mothers' cognitive processes from the time they receive an infant feeding message to their eventual decisions about what to do with that message, nor do we account for how those processes might change with the experience of breastfeeding. The aim of this study was to measure and identify how HIV‐infected breastfeeding mothers cognitively organize infant feeding messages, and whether this changes from pre‐delivery to five months postpartum. Using focused ethnographic methods (semi‐structured interviews and a pile sorting exercise), we interviewed 30 HIV‐infected mothers in Port‐au‐Prince, Haiti. We asked them to sort and rate 18 infant feeding messages three times (during pregnancy, 0–1 month postpartum and 3–5 months postpartum). We analyzed responses using multidimensional scaling, property fitting analysis and partition analysis. We found relatively low, but measurable, intra‐cultural diversity, as well as general temporal stability in the messages that were grouped together. Specifically, at all three times, mothers clearly differentiated between messages that were pertinent for exclusive breastfeeding from those that were not. However, there were some time‐dependent changes in perceptions with regard to the tightness of clustering (or the similarity between) messages within message groups. At the 0–1 month postpartum visit, mothers more tightly clustered messages compared to other study visits. This might represent a time of cognitive stress. We conclude that mothers share a common cognitive organization of infant feeding messages and that this organization changes over time. Accounting for this variation can help us to develop more context‐sensitive, patient‐centered counseling and improve targeting of infant feeding messages. Support or Funding Information This work was supported by the Division of Nutritional Sciences, the Cornell Human Ecology Alumni Association, the Mario Einaudi Center for International Studies, the Cornell Graduate School, the First Presbyterian Church of Ithaca, and the American Association of University Women (AAUW). 1 The common infant feeding messages used in the pile sorting exercises with 30 HIV‐infected Haitian womenID Infant feeding message1 Exclusively breastfeed for the first six months, without giving any other food or liquids 2 Initiate breastfeeding early for your baby to habituate to the breast 3 Express your milk in a clean vessel if you are going out 4 Breastfeed regularly for your breast milk to be produced/to come 5 After six months, breastfeed and give other foods until 1 year 6 You can breastfeed if you have HIV if you take your medication 7 If your breast is hurt, see the doctor and use your other breast in the interim 8 Exclusively breastfeed for the first six months to protect the baby from getting HIV 9 Breastfeed the baby to protect it from illness/infection, such as diarrhea 10 Exclusively breastfeed because it is more economical 11 Breastfeed for the baby's brain to develop well 12 Breastfeed regularly so that your baby gains more weight 13 Give your baby other foods to prevent it from pulling gas from you 14 Do not breastfeed if you have not eaten well 15 Give the baby “lok” to clean the tar in the baby's gut a 16 Do not breastfeed after six months so that the baby does not get the virus 17 If you have bad blood or you have spent too much time out, do not breastfeed, your milk has spoiled 18 Wash your hands each time you are going to breastfeeda Lok is a commonly used prelacteal in Haiti that is made from castor oil, grated nutmeg, sour orange juice, garlic, unrefined sugar and water (Alvarez and Murray 1981)