Abstract

BackgroundIn resource-poor settings, HIV positive mothers are recommended to choose between 'Exclusive breastfeeding' (EBF) or 'Exclusive replacement feeding' (ERF). Acceptability, Feasibility, Affordability, Sustainability and Safety (AFASS) has been the World Health Organization (WHO)'s a priori criteria for ERF the last ten years. 'AFASS' has become a mere acronym among many workers in the field of prevention of mother-to-child transmission of HIV, PMTCT. Thereby, non-breastfeeding has been suggested irrespective of social norms. EBF for the first half of infancy is associated with huge health benefits for children in areas where infant mortality is high. But, even if EBF has been recommended for a decade, few mothers are practicing it. We set out to understand fathers' and mothers' infant feeding perceptions and the degree to which EBF and ERF were 'AFASS.'MethodsEight focus groups with 81 informants provided information for inductive content analysis. Four groups were held by men among men and four groups by women among women in Mbale District, Eastern Uganda.ResultsTwo study questions emerged: How are the different feeding options understood and accepted? And, what are men's and women's responsibilities related to infant feeding? A mother's commitment to breastfeed and the husband's commitment to provide for the family came out strongly. Not breastfeeding a newborn was seen as dangerous and as unacceptable, except in cases of maternal illness. Men argued that not breastfeeding could entail sanctions by kin or in court. But, in general, both men and women regarded EBF as 'not enough' or even 'harmful.' Among men, not giving supplements to breast milk was associated with poverty and men's failure as providers. Women emphasised lack of time, exhaustion, poverty and hunger as factors for limited breast milk production. Although women had attended antenatal teaching they expressed a need to know more. Most men felt left out from health education.ConclusionBreastfeeding was the expected way to feed the baby, but even with existing knowledge among mothers, EBF was generally perceived as impossible. ERF was overall negatively sanctioned. Greater culture-sensitivity in programs promoting safer infant feeding in general and in HIV-contexts in particular is urgently needed, and male involvement is imperative.Trial RegistrationThe study was part of formative studies for the ongoing study PROMISE EBF registered at http://clinicaltrials.gov (NCT00397150).

Highlights

  • In resource-poor settings, HIV positive mothers are recommended to choose between ‘Exclusive breastfeeding’ (EBF) or ‘Exclusive replacement feeding’ (ERF)

  • This study explored how exclusively breastfeed (EBF) and exclusively replacement feed (ERF) were perceived among parents in communities in Eastern Uganda

  • The results presented here are based on a total of eight focus groups discussions (FGD) among men and women in four sub-counties in Mbale District during October and November 2003

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Summary

Introduction

In resource-poor settings, HIV positive mothers are recommended to choose between ‘Exclusive breastfeeding’ (EBF) or ‘Exclusive replacement feeding’ (ERF). ‘AFASS’ has become a mere acronym among many workers in the field of prevention of mother-to-child transmission of HIV, PMTCT. We set out to understand fathers’ and mothers’ infant feeding perceptions and the degree to which EBF and ERF were ‘AFASS.’. Recent studies suggest a growing awareness of the importance of partner HIV-testing and disclosure during pregnancies [1,2], and involvement of the father in prevention of mother-to-child transmission (PMTCT) programmes [3,4,5,6]. HIV positive women are usually counselled on infant feeding options alone and have been left with the challenge of choosing the best or most appropriate infant feeding alternative. The discrepancies between how women are informed to feed their infants in the antenatal clinic and what is socially preferable in their communities represent major challenges [8]

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