Marseille 2007
Marseille 2007
Abstract book
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Abstract #458  -  The feasibility of exclusive breastfeeding for HIV positive mothers: a qualitative analysis within the Kesho Bora Study (Nairobi, Kenya)
Session:
  17.3: Challenges for Children (Parallel) on Monday @ 14.00-16.00 in Auditorium/Overflow Chaired by Patrice Engle, Christina Noestlinger
Authors:
  Presenting Author:   Dr Saskia Walentowitz - Univeristy of Berne, Switzerland
 
  Additional Authors:  BA Emmy Kageha, Prof Alice Desclaux,  
Aim:
According to the latest consensus statement, the WHO recommends exclusive breastfeeding for HIV-infected women for the first 6 months of life unless replacement feeding is acceptable, feasible, affordable, sustainable and safe. Perceptions and experiences regarding prolonged exclusive breastfeeding have been explored in a comparative qualitative study on the socio-cultural determinants of HIV-infection through breastmilk in Nairobi, Kenya. Part of the data has been collected from participants in the ANRS 1271 / WHO Kesho Bora Study.
 
Method / Issue:
35 study participants among whom 18 chose to breastfeed exclusively up to 6 months and 17 opted for free formula were interviewed between one to three months, and again between six and nine months after birth. Ethnographic observations were regularly held at the study clinic and during infant feeding counselling sessions. In addition, more than 60 semi-structured interviews including topics on breastfeeding habitus have been held with women (and some men) from various socio-economic levels, as well as with reproductive health professionals.
 
Results / Comments:
In Kenya where (very) early mixed feeding is the norm, compliance to prolonged exclusive breastfeeding is a major challenge for HIV-infected mothers who do not meet AFASS criteria. In the Kesho Bora setting providing continuous high quality care, counselling and AFASS assessment, the majority of the mothers start with breastfeeding cessation prior to 4 months. In the view of the general population as well as among health personnel, prolonged exclusive breastfeeding is unthinkable for multiple reasons. Although breastmilk is considered vital for the childs health and development, an infants diet should be supplemented with various liquids and foods for nutritious, prophylactic and therapeutic purposes. While breastfeeding is considered central to the mother-child bonding, an infant should be introduced to other foods in order to secure its development towards an autonomous person. Regardless of the effective amount of milk a woman produces, a child is said to be unable to survive on breastmilk alone. Moreover, the production of breastmilk is determined by the mothers diet. Therefore a lack of food correlates immediately with the perception of insufficient breastmilk, whereas the equation between breastmilk production and needs becomes impossible after three months. More than just the mother, infant feeding involves the social environment that takes direct action, especially towards children of working mothers who generally leave their sucklings at home. In this context, HIV positive mothers must cope with the dilemma where not breastfeeding and prolonged exclusive breastfeeding strongly contradict the local infant feeding practices.
 
Discussion:
This qualitative analysis underlines the necessity to understand the practical logic of localized infant feeding patterns in order to develop contextualized prevention measures of HIV-transmission through breastmilk. It further shows that breastfeeding must be understood within the whole social and cultural process of reproduction. The study is the starting point of a general anthropological reflection on low exclusive breastfeeding rates worldwide and offers an analytical frame for a comprehensive support of good feeding practices beyond local socio-cultural obstacles.
 
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