Breast milk as the "water that supports and preserves life"--socio-cultural constructions of breastfeeding and their implications for the prevention of mother to child transmission of HIV in sub-Saharan Africa

From Liminality to Vitality: Infant Feeding Beliefs Among Refugee Mothers From Vietnam and Myanmar

Infant feeding in traditional (non-White societies) is imbued within beliefs surrounding the human body and food. This article, framed within the liminality theory, demonstrates perspectives of 38 Vietnamese and Myanmarese refugee mothers. Situated within the postmodern methodological framework, innovative methods of in-depth interviewing and drawing were used to gather participant's subjectivities. As birthing renders the new mother and infant weak, the findings mirror a "liminality to vitality" nurturing continuum, acknowledging the (a) essentialism of bodily breast milk, (b) rituals that strengthen mothers for lactation, (c) lactation-inducing food, and (d) culturally symbolic non-milk food that promote an independence for nourishment other than from the maternal body. Health care professionals are called to value the importance of bodily vitality in birthing and clinical maternal-child health/nutrition spheres so that culturally specific services and consultations are rendered. Our findings also offer a platform to developing models of care for families from Vietnamese and four ethnic Myanmarese communities.

Sociocultural factors influencing infant-feeding choices among African immigrant women living with HIV: A synthesis of the literature

BACKGROUND AND PURPOSE

The World Health Organizations (WHO) strategy is to eliminate pediatric HIV. HIV prevention guidelines in high-income countries recommend mothers living with HIV avoid breastfeeding. Yet, breastfeeding is promoted as the normal and unequalled method of feeding infants. This creates a paradox for mothers coming from cultures where breastfeeding is an expectation and formula feeding suggests illness. Therefore, the purpose of this literature review is to examine the context influencing infant feeding among African immigrant women living with HIV to develop interventions to reduce the risk of HIV mother-to-child transmission.

METHODS

Using the PEN-3 cultural model as a guide, we selected 45 empirical studies between 2001 and 2016 using 5 electronic databases on the sociocultural factors influencing infant-feeding choices and practices among African women from HIV endemic countries.

CONCLUSIONS

Findings are congruent with the importance of culture when developing guidelines. Our review provides support that culture-centered interventions are crucial toward achieving the WHO's strategy to eliminate pediatric HIV.

IMPLICATIONS FOR PRACTICE

Understanding the sociocultural determinants of infant-feeding choices is critical to the development of prevention initiatives to eliminate pediatric HIV.

HIV disclosure and nondisclosure among migrant women from sub-Saharan Africa living in Switzerland

No study to date has focused specifically on the reasons for and against disclosure of HIV-positive status among sub-Saharan migrant women. Thirty HIV-positive women from 11 sub-Saharan countries living in French-speaking Switzerland participated in semi-structured individual interviews. The reasons women reported for disclosure or nondisclosure of their HIV serostatus were classified into three categories: social, medical, and ethical. The women identified the stigma associated with HIV as a major social reason for nondisclosure. However, this study identifies new trends related to disclosure for medical and ethical reasons. Being undetectable played an important role in the life of sub-Saharan migrant women, and analysis revealed their medical reasons for both disclosure and nondisclosure. Disclosure to new sexual partners occurred when women had a more positive perception about HIV and when they believed themselves to be in a long-term relationship. Women reported nondisclosure to family members when they did not need help outside the support provided by the medical and social fields. The results on ethical reasons suggested that challenging stigma was a reason for disclosure. Since the women' perceptions on HIV changed when they came to see it as a chronic disease, disclosure occurred in an attempt to normalize life with HIV in their communities in migration and to challenge racism and discrimination. Our findings can help health providers better understand the communication needs of sub-Saharan migrant women with respect to HIV/AIDS and sexuality and offer them adequate disclosure advice that takes into account migration and gender issues.

Comparing local perspectives on women's health with statistics on maternal mortality: an ethnobotanical study in Bénin and Gabon

BACKGROUND

According to the World Health Organization (WHO), reproductive health problems are the leading cause of morbidity and mortality for women in Africa. In spite of this scenario and the importance of plants in African health care, limited research has been conducted linking maternal health and plant-based medicine. The objective of our research was to examine how closely Beninese and Gabonese women's health perspectives, medicinal plant knowledge, and plant use practices reflect the statistical causes of maternal mortality.

METHODS

In Bénin (2011) and Gabon (2012), we conducted 87 ethnobotanical questionnaires with the corresponding collection of 800 botanical specimens. We used free-listing analysis, citation frequency and species counts to determine women's top health concerns. We also interviewed 18 biomedical healthcare providers in national hospitals and local clinics.

RESULTS

Informants' perceptions of the main causes of maternal suffering included malaria, infertility, and menstruation and pregnancy concerns. Women were knowledgeable on plants to treat the top causes of maternal morbidity, but knew more plants for conditions such as anemia, infertility, breast milk production, and the maintenance of menstruation and pregnancy. The biomedical staff recognized the role of traditional medicine in their patients' lives and expressed concern for herbal remedies to facilitate birth, but were restricted by national policies on advising on medicinal plant use.

CONCLUSIONS

Plants serve as an entry point to understanding Beninese and Gabonese women's perceptions of common health concerns and local health management strategies. Plant use practices in both countries did not closely parallel the top statistical causes of maternal mortality, but highlighted key issues such as menstruation and infertility as salient health concerns for women. More research is needed on the role of plants in women's gynecological healthcare.

Commonalities and differences in infant feeding attitudes and practices in the context of HIV in sub-Saharan Africa: a metasynthesis

Exclusive breastfeeding (EBF) has been identified as a key intervention to promote infant health and to reduce the vertical transmission of HIV. Despite this knowledge and increased resources to promote EBF, the practice in sub-Saharan Africa (SSA) remains low among HIV+ women. Although a number of qualitative studies have been conducted throughout SSA, the influences on and consequences of infant feeding choices of HIV+ mothers' findings have not been regarded systematically. Therefore, our objective was to identify overarching themes, commonalities, and differences in infant feeding choices among qualitative studies with HIV+ mothers in SSA. Sixteen qualitative studies of infant feeding practices in the context of HIV were identified. Noblit and Hare's seven-step metasynthesis methodology was used to analyze the experiences of HIV+ women and those who provide infant feeding services/counseling. Data were available from approximately 920 participants (i.e., 750 HIV+ mothers, 109 health-care providers, and 62 family members) across 13 SSA countries from 2000 to 2011. From these data, five themes emerged within which 3-4 overarching key metaphors were identified. The consistency of key metaphors across a variety of geographic, economic, and cultural settings suggest the importance of approaching infant feeding holistically, within the context of maternal knowledge, health-care support, family resources, and cultural expectations. EBF campaigns in SSA are more likely to successfully support optimal health for infants and a safe supportive environment for their mothers when the impact of infant feeding decisions are evaluated across these themes.

Perceptions of caregivers about health and nutritional problems and feeding practices of infants: a qualitative study on exclusive breast-feeding in Kwale, Kenya

Background

Despite the significant positive effect of exclusive breast-feeding on child health, only 32% of children under 6 months old were exclusively breast-fed in Kenya in 2008. The aim of this study was to explore perceptions and feeding practices of caregivers of children under 6 months old with special attention to the caregivers’ indigenous knowledge, perceptions about the health and nutritional problems of their infants, and care-seeking behaviors that affect feeding practices.

Methods

The study was exploratory and used an inductive approach. In all, 32 key informants, including mothers, mothers-in-law, and traditional healers, were interviewed in-depth. The number of participants in free-listing of perceived health problems of babies, in ranking of the perceived severity of these health problems, and in free-listing of food and drink given to children under 6 months old were 29, 28, and 32, respectively. Additionally, 28 babies under 6 months old were observed at home with regard to feeding practices. Data obtained using these methods were triangulated to formulate an ethnomedical explanatory model for mothers who do not practice exclusive breast-feeding.

Results

The informants stated that various types of food, drink, and medicine were given to infants under 6 months old. Direct observation also confirmed that 2- to 3-month-old babies were given porridge, water, juice, herbal medicine, and over-the-counter medicine. Mothers’ perceptions of insufficient breast milk production and a lack of proper knowledge about the value of breast milk were identified in key informant interviews, free-listing, and ranking as important factors associating with the use of food and drink other than breast milk; in addition, perceived ill health of babies appears to be associated with suboptimal practice of exclusive breast-feeding. Caregivers used various folk and popular medicines from the drugstore, their own backyard or garden, and traditional healers so that the mother or child would not be exposed to perceived risks during the vulnerable period after birth.

Conclusions

Mothers should be advised during their antenatal and postnatal care about exclusive breast-feeding. This should be done not as a single vertical message, but in relation to their concerns about the health and nutritional problems of their babies.

Incorporating cultural beliefs in promoting exclusive breastfeeding

INTRODUCTION

Since 2003, the World Health Organization has recommended exclusive breastfeeding for the first 6 months of life. In the Northwest region of Cameroon approximately 90% of women initiate breastfeeding, yet only 34% of these women exclusively breastfeed for the recommended six months.

AIM

To determine influences on women's exclusive breastfeeding practices.

METHODS

Semi-structured interviews were conducted with six women and six men followed by focus group discussions with three groups of women and three groups of men in the Kumbo West Health District, Northwest region, Cameroon. All participants were selected using theoretical sampling to assure triangulation.

RESULTS

Three themes emerged that influence exclusive breastfeeding practices: woman's readiness to exclusively breastfeed; cultural influences towards exclusive breastfeeding; and perceived constraints to exclusive breastfeeding.

CONCLUSION

These emergent themes were used to create a theoretical framework that is useful for developing a breastfeeding health education intervention in non-Western settings.

Breast or bottle? HIV-positive women's responses to global health policy on infant feeding in India

This article describes how local responses to global health initiatives on infant feeding for HIV-positive mothers reflect and transform sociocultural values in Tamil Nadu, India. Drawing from ethnographic research conducted from 2002 to 2008, the article compares guidelines for counseling HIV-positive mothers established by UNICEF and WHO with decision-making processes and perceptions of HIV-positive mothers. In addition to the financial considerations, three factors are identified as impinging on this decision: (1) a strong sociocultural value in favor of breastfeeding linked to historical traditions and contemporary state and international development discourses, (2) constructions of class identity, (3) the influence of a rights-based discourse in HIV/AIDS advocacy. This wide range of factors points to the difficulty of implementing the international protocols. This is the first study of its kind to closely examine the complex determinants in HIV-positive women's decisions and evaluations of infant feeding methods in India.

Situational analysis of infant and young child nutrition policies and programmatic activities in Burkina Faso

Progress towards reducing mortality and malnutrition among children < 5 years of age has been less than needed to achieve related Millennium Development Goals. Therefore, several international agencies joined to 'Reposition children's right to adequate nutrition in the Sahel', starting with an analysis of current activities related to infant and young child nutrition (IYCN). The objectives of the present paper are to compare relevant national policies, training materials, programmes, and monitoring and evaluation activities with internationally accepted IYCN recommendations. These findings are available to assist countries in identifying inconsistencies and filling gaps in current programming. Between August and November 2008, key informants responsible for conducting IYCN-related activities in Burkina Faso were interviewed, and 153 documents were examined on the following themes: optimal breastfeeding and complementary feeding practices, prevention of micronutrient deficiencies, screening and treatment of acute malnutrition, prevention of mother-to-child transmission of HIV, food security and hygienic practices. National policy documents addressed nearly all of the key IYCN topics, specifically or generally. Formative research has identified some local barriers and beliefs related to general breastfeeding and complementary feeding practices, and other formative research addressed about half of the IYCN topics included in this review. However, there was little evidence that this formative research was being utilized in developing training materials and designing programme interventions. Nevertheless, the training materials that were reviewed do provide specific guidance for nearly all of the key IYCN topics. Although many of the IYCN programmes are intended for national coverage, we could only confirm with available reports that programme coverage extended to certain regions. Some programme monitoring and evaluation were conducted, but few of these provided information on whether the specific IYCN programme components were implemented as designed. Most surveys that were identified reported on general nutrition status indicators, but did not provide the detail necessary for programme impact evaluations. The policy framework is well established for optimal IYCN practices, but greater resources and capacity building are needed to: (i) conduct necessary research and adapt training materials and programme protocols to local needs; (ii) improve, carry out, and document monitoring and evaluation that highlight effective and ineffective programme components; and (iii) apply these findings in developing, expanding, and improving effective programmes.

A qualitative investigation into knowledge, beliefs, and practices surrounding mastitis in sub-Saharan Africa: what implications for vertical transmission of HIV?

BACKGROUND

Mastitis constitutes an important risk factor in HIV vertical transmission. Very little, however, is known on how women in sub-Saharan Africa conceptualise health problems related to breastfeeding, such as mastitis, and how they act when sick. We aimed at filling this gap in knowledge, by documenting the indigenous nosography of mastitis, health seeking behaviour, and remedies for prophylaxis and treatment in rural sub-Saharan Africa.

METHODS

The study was conducted in the Nouna Health District, rural Burkina Faso. We employed a combination of in-depth individual interviews and focus group discussions reaching both women and guérisseuers. All material was transcribed, translated, and analysed inductively, applying data and analyst triangulation.

RESULTS

Respondents perceived breast problems related to lactation to be highly prevalent and described a sequence of symptoms which resembles the biomedical understanding of pathologies related to breastfeeding, ranging from breast engorgement (stasis) to inflammation (mastitis) and infection (breast abscess). The aetiology of disease, however, differed from biomedical notions as both women and guerisseurs distinguished between "natural" and "unnatural" causes of health problems related to breastfeeding. To prevent and treat such pathologies, women used a combination of traditional and biomedical therapies, depending on the perceived cause of illness. In general, however, a marked preference for traditional systems of care was observed.

CONCLUSION

Health problems related to breastfeeding are perceived to be very common in rural Burkina Faso. Further epidemiological research to assess the actual prevalence of such pathologies is urgently needed to inform the design of adequate control measures, especially given the impact of mastitis on HIV vertical transmission. Our investigation into local illness concepts and health care seeking behaviour is useful to ensure that such measures be culturally sensitive. Further research into the efficacy of local customs and traditional healing methods and their effect on viral load in breast milk is also urgently needed.