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Sex Transm Infect doi:10.1136/sextrans-2015-052224
  • Behaviour
  • Original article

“It pains me because as a woman you have to breastfeed your baby”: decision-making about infant feeding among African women living with HIV in the UK

Open Access
  1. Alexandra Pillen2
  1. 1School of Health Sciences, City University London, London, UK
  2. 2Department of Anthropology, University College London, London, UK
  3. 3MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, UK
  4. 4Centre for the Study of Sexual Health and HIV, Homerton University Hospital NHS Foundation Trust, London, UK
  5. 5Harrison Wing, Guy's and St Thomas’ NHS Foundation Trust, London, UK
  6. 6Greenway Centre, Newham University Hospital, London, UK
  1. Correspondence to: Dr Shema Tariq, Research Department of Infection and Population Health, University College London, Mortimer Market Centre, Off Capper Street, London WC1E 6JB, UK; s.tariq{at}ucl.ac.uk
  • Received 30 June 2015
  • Revised 30 October 2015
  • Accepted 6 December 2015
  • Published Online First 12 January 2016

Abstract

Objectives UK guidance advises HIV-positive women to abstain from breast feeding. Although this eliminates the risk of postnatal vertical transmission of HIV, the impact of replacement feeding on mothers is often overlooked. This qualitative study examines, for the first time in the UK, decision-making about infant feeding among African women living with HIV.

Methods Between 2010 and 2011, we conducted semistructured interviews with 23 HIV-positive African women who were pregnant or had recently given birth. We recruited participants from three HIV antenatal clinics in London.

Results Women highlighted the cultural importance of breast feeding in African communities and the social pressure to breast feed, also describing fears that replacement feeding would signify their HIV status. Participants had significant concerns about physical and psychological effects of replacement feeding on their child and felt their identity as good mothers was compromised by not breast feeding. However, almost all chose to refrain from breast feeding, driven by the desire to minimise vertical transmission risk. Participants’ resilience was strengthened by financial assistance with replacement feeding, examples of healthy formula-fed children and support from partners, family, peers and professionals.

Conclusions The decision to avoid breast feeding came at considerable emotional cost to participants. Professionals should be aware of the difficulties encountered by HIV-positive women in refraining from breast feeding, especially those from migrant African communities where breast feeding is culturally normative. Appropriate financial and emotional support increases women's capacity to adhere to their infant-feeding decisions and may reduce the emotional impact.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/