Determinants of Adherence to National Infant Feeding Guidelines by Black Mothers Living with HIV

Objective: Worldwide, 160,000 children were newly infected with HIV in 2018; half of these were infected through breastfeed­ing. Infant feeding guidelines are distinct depending on each country’s resources and national or sub-national guidelines. Because of divergent guidelines, the best infant feeding approach to prevent mother-to-child transmission can become unclear. The purpose of this study was to examine the so­ciocultural and psychosocial factors related to adherence to infant feeding guidelines through a city-level, North-South com­parison of Black mothers living with HIV in Nigeria, Canada, and the United States.Design: Using a cross-sectional multi-country survey, a convenience sample of 690 mothers were recruited from June 2016 - December 2019. Socio-cultural and psychosocial factors influencing infant feed­ing practices were measured.Results: Using binary logistic regression, infant feeding attitudes (OR = 1.10), motherhood experiences (OR = 1.08), low hyper-vigilance score (OR = .935), paternal support (OR = 1.10) and percep­tion that the health care provider supported adherence to infant feeding guidelines (OR = 2.43) were associated with guideline ad­herence. Mothers who had cultural beliefs that were inconsistent with infant feeding guidelines and mothers with low incomes (OR = 2.62) were less likely adherent with their country’s guidelines.Conclusion: City-level factors were not found to influence adherence to infant feeding guidelines; however, socio-cultural and psychosocial factors at community, family and individual levels were significant. Policy formulation and targeted interven­tions must be cognizant of cultural expecta­tions of motherhood and mindful of psycho­social determinants of adherence to infant feeding guidelines.Ethn Dis. 2021;31(1):31- 40; doi:10.18865/ed.31.1.31