Social Determinants of Breastfeeding Preferences among Black Mothers Living with HIV in Two North American Cities.

Josephine Etowa,Ikenna Mbagwu,Hilary Nare,Egbe Etowa,Jean Hannan

doi:10.3390/ijerph17186893

Abstract

The study is motivated by the need to understand the social determinants of breastfeeding attitudes among HIV-positive African, Caribbean, and Black (ACB) mothers. To address the central issue identified in this study, analysis was conducted with datasets from two North American cities, where unique country-specific guidelines complicate infant feeding discourse, decisions, and practices for HIV-positive mothers. These national infant feeding guidelines in Canada and the US present a source of conflict and tension for ACB mothers as they try to navigate the spaces between contradictory cultural expectations and national guidelines. Analyses in this paper were drawn from a broader mixed methods study guided by a community-based participatory research (CBPR) approach to examine infant feeding practices among HIV-positive Black mothers in three countries. The survey were distributed through Qualtrics and SPSS was used for data cleaning and analysis. Results revealed a direct correlation between social determinants and breastfeeding attitude. Country of residence, relatives’ opinion, healthcare providers’ advice and HIV-related stigma had statistically significant association with breastfeeding attitude. While the two countries’ guidelines, which recommend exclusive formula feeding, are cardinal in preventing vertical transmission, they can also be a source of stress. We recommend due consideration of the cultural contexts of women’s lives in infant feeding guidelines, to ensure inclusion of diverse women.

Highlights

Breastfeeding has been an acceptable method of feeding infants throughout history, not just because it is regarded as being ‘fundamental to womanhood’ and tied to being a good mother [1,2], and for the extensive benefits it confers on both the mother and the infant [3,4]
Documentary analysis laid the foundation for this study, and it adopted an experimental research design to ensure the measurability of outcomes, to determine the prevalence rate of breastfeeding attitudes and its determinants
While the Canadian and US national guidelines, which recommend exclusive formula feeding, are cardinal in prevention of vertical transmission (PMTCT), they can be a source of enormous emotional stress and suffering to HIV-positive mothers as unintended negative consequences of these policies

Summary

Introduction

Breastfeeding has been an acceptable method of feeding infants throughout history, not just because it is regarded as being ‘fundamental to womanhood’ and tied to being a good mother [1,2], and for the extensive benefits it confers on both the mother and the infant [3,4]. In spite of its massive benefits, in the 19th century and early 20th century, the Industrial Revolution and technological advancement aided the creation of feeding bottles and formula feeding, as alternative feeding methods for mothers who were too busy with work and could not breastfeed their babies [5]. Hygienic challenges and techniques for home storage were generally unsafe and presented some drawbacks [6]. During this period, the low breastfeeding rates in the United States correlated with an increased infant mortality rate.

Methods

Discussion

Conclusion