Abstract
As the papers in this thematic series have illustrated, the postnatal prevention of mother to child transmission of HIV (PMTCT) strategy has struggled with lack of local relevance. In an attempt to increase our understanding of the great dissonance between the policy intention and the experiences of the participants in concrete PMTCT programmes, we will in these concluding remarks draw upon writings in institutional ethnography. Through the concept of 'global texts' we reflect upon the scientific and ideological underpinnings of the WHO policy guidelines on HIV and infant feeding, and the influence that this policy has had across multiple local settings. The particular impact of the global postnatal PMTCT policy guidelines on the position of breastfeeding lies at the core of the discussion.
Highlights
We close this thematic series titled ‘HIV and infant feeding: lessons learnt and ways ahead’ by reflecting first, in the present paper, on the lessons learnt during the past decade of PMTCT programme implementation and in the subsequent paper, by briefly discussing ways ahead
The grounded qualitative studies of PMTCT clients and providers presented in this issue reveal the complex and often troubled relationship between such policy guidelines and the ‘local’, and their particular cultural and political underpinnings and historical provenance
Concluding remarks The papers in this issue have focussed on the challenges and failures of previous efforts to manage infant feeding practices by HIV positive mothers and postnatal PMTCT counsellors
Summary
We close this thematic series titled ‘HIV and infant feeding: lessons learnt and ways ahead’ by reflecting first, in the present paper, on the lessons learnt during the past decade of PMTCT programme implementation and in the subsequent paper, by briefly discussing ways ahead. With an attempt to grasp the meaning and significance of the unexpected and disturbing outcomes of previous PMTCT infant feeding guidelines documented in the papers of this issue we will reflect on them as part of a growing body of policy and implementation documents operating on the global arena. The grounded qualitative studies of PMTCT clients and providers presented in this issue reveal the complex and often troubled relationship between such policy guidelines and the ‘local’, and their particular cultural and political underpinnings and historical provenance.
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