Premium
Early cessation of breastfeeding to prevent postnatal transmission of HIV: a recommendation in need of guidance
Author(s) -
De Paoli Marina M,
Mkwanazi Ntombizodumo B,
Richter Linda M,
Rollins Nigel
Publication year - 2008
Publication title -
acta pædiatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/j.1651-2227.2008.00956.x
Subject(s) - breastfeeding , medicine , intervention (counseling) , context (archaeology) , human immunodeficiency virus (hiv) , family medicine , nursing , transmission (telecommunications) , qualitative research , social support , pediatrics , psychology , psychotherapist , paleontology , social science , biology , engineering , sociology , electrical engineering
Aim: Early and rapid cessation of breastfeeding has been recommended by WHO to reduce mother‐to‐child transmission of HIV. This study assessed how HIV‐infected mothers planned and experienced breastfeeding cessation as part of an HIV prevention strategy and how counsellors facilitated this process. Methods: A qualitative study was conducted among HIV‐infected mothers and counsellors from local clinics and an intervention research project in Durban, South Africa. Results: Mothers enrolled in the research setting reported many success stories in contrast to mothers attending routine services. Consistent counselling and ongoing support from counsellors facilitated this, though specific advice on how to stop breastfeeding and introduce complementary feeds was inadequate amongst both sets of counsellors. Few mothers had a plan for what they were actually going to do on the day when they had decided to stop breastfeeding. Their primary motivation for wanting to rapidly stop breastfeeding, even with the difficulties involved, was to avoid infecting their child with HIV. Both counsellors and HIV‐infected mothers expressed concern about practical issues, including social consequences, associated with early cessation. Mothers who had stopped breastfeeding offered some, albeit limited, recommendations to assist and guide other women. Conclusion: The experiences of HIV‐infected mothers planning for and stopping breastfeeding early illustrate the complexity of this recommendation and demonstrate that counsellors are ill‐prepared to support mothers accomplish this safely. Guidance that acknowledges the cultural context and psychological stresses is urgently needed to direct policy, training and service delivery.