Safer Infant Feeding Practices Research Articles

Mothers’ Experiences During the 2022 Infant Formula Shortage in Washington D.C.

IntroductionAn unprecedented shortage of infant formula occurred in the United States (U.S.) in 2022 and posed widespread challenges to infant feeding nationwide. The purpose of this study is to investigate mothers’ experiences during the 2022 infant formula shortage and its perceived impacts on infants’ diet and health.MethodsMothers (n = 45) of infants under 8 months old from Washington D.C. were invited to participate in a virtual study meeting during the summer of 2022. Mothers completed surveys regarding their demographics, infants’ anthropometrics, infant feeding practices, information they have received about infant feeding, and knowledge about infant feeding practices. They then participated in a qualitative interview about their experiences during the infant formula shortage.ResultsOverarching themes were: the shortage (1) had adverse impacts on mothers’ mental and emotional health; (2) had significant financial and intangible costs; (3) led to changes in infant feeding practices; (4) social and family networks were helpful in navigating the shortage; and (5) mothers felt fortunate to have resources to breastfeed and/or obtain formula.DiscussionThe infant formula shortage adversely impacted mothers’ mental and emotional health, and was costly, in terms of financial and intangible costs. Findings demonstrate the need to develop clinical and policy approaches to support mothers in feeding their infants and provide education about safe infant feeding practices.

Understanding the Intersections of IPV and HIV and Their Impact on Infant Feeding Practices among Black Women: A Narrative Literature Review

Intimate partner violence (IPV), particularly sexual and emotional violence, against Black mothers who acquire human immunodeficiency virus (HIV) during childbearing age is a significant health and social concern requiring targeted interventions and precautions. IPV against women increases the chances of early mixed feeding, placing infants at high risk of mother-to-child transmission of HIV and increasing infant morbidities. Although violence complicates many Black mothers’ lives, limited research evidence exists about the critical intersections of violence, HIV, and motherhood. Women’s fear associated with IPV makes them less likely to disclose their positive HIV status to their partners, which subsequently prevents them from applying the guidelines for safe infant feeding practices. This review aims to explore the critical intersections between IPV and HIV and their impact on the infant feeding practices of Black mothers living with HIV. Furthermore, the theme of IPV and how it overlaps with other factors such as HIV-positive status and gender dynamics to compromise the motherhood experience is also the focus of this narrative review of existing literature. Understanding the intersection of IPV and other factors influencing infant feeding practices among women living with HIV will help inform programming and policy interventions for HIV-positive Black women who may experience IPV during the perinatal period.

The “Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)” Project – executive summary

The public health community has come to appreciate that a deeper understanding of the biology of human milk is essential to address ongoing and emerging questions about infant feeding practices. The critical pieces of that understanding are that 1) human milk is a complex biological system, a matrix of many interacting parts that is more than the sum of those parts, and 2) human milk production needs to be studied as an ecology that consists of inputs from the lactating parent, their breastfed baby, and their respective environments. The “Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)” Project was designed to examine this ecology as well as its functional implications for both the parent and infant and to explore ways in which this emerging knowledge can be expanded via a targeted research agenda and translated to support the community’s efforts to ensure safe, efficacious, and context-specific infant feeding practices in the United States and globally. The five working groups of the BEGIN Project addressed the following themes: 1) parental inputs to human milk production and composition; 2) the components of human milk and the interactions of those components within this complex biological system; 3) infant inputs to the matrix, emphasizing the bidirectional relationships associated with the breastfeeding dyad; 4) the application of existing and new technologies and methodologies to study human milk as a complex biological system; and 5) approaches to translation and implementation of new knowledge to support safe and efficacious infant feeding practices.

Attitudes on breast feeding among persons with HIV who have given birth and their perceptions of coercion during counseling on safe infant feeding practices

ABSTRACT Persons with HIV can receive mixed messages about the safety of breastfeeding. We sought to assess if they felt coerced to formula feed when counseled about practices to reduce HIV transmission. Persons with HIV who had given birth were eligible to complete a survey to describe their experiences with infant feeding counseling and if they felt coerced to formula feed. An Iowa Infant Feeding Attitude Scale (IIFAS) assessed attitudes towards breastfeeding. Qualitative analyses were performed on narrative responses. One hundred surveys were collected from sites in Georgia, North Carolina, Pennsylvania, and South Carolina. The mean IIFAS score (n, 85) was 47 (SD 9.2), suggesting relatively favorable attitudes toward breastfeeding. Thirteen persons reported feeling coerced to formula feed. When controlling for choosing to give any breast milk, persons with any college education were more likely to report feeling coerced (aOR 9.8 [95% CI 1.8–52.5]). Qualitative analyses revealed three themes: perceiving breastfeeding as unsafe, engaging in shared decision-making, and resisting advice to formula feed. Persons with HIV desire to be counseled about safe infant feeding practices and have their questions answered without judgement. We highlight experiences of persons with HIV that reflect a need for a nuanced approach to infant feeding counseling.

Knowledge mobilization tool to promote, protect, and support breastfeeding during COVID-19.

SettingThis knowledge mobilization project was conceptualized to increase awareness among breastfeeding mothers and the general public on safe infant feeding practices during the COVID-19 pandemic by addressing myths and misconceptions associated with breastfeeding practices, guiding breastfeeding mothers to make informed decisions around child feeding practices, and offering meaningful guidance in simple language through a short online animated video.InterventionThis project was undertaken in four phases. During phase 1, an informal discussion was held with the breastfeeding mothers, service providers, and community partner in identifying issues surrounding lactation counselling facilities during the COVID-19 pandemic. During phase 2, recommendations from 23 organizations with regard to breastfeeding during COVID-19 were reviewed and analyzed. During phase 3, using evidence from reliable sources, a 5-minute animated e-resource on breastfeeding during COVID-19 was conceptualized and developed. During phase 4, the e-resource was disseminated to the breastfeeding mothers, general public, post-secondary institutions, and organizations providing services to breastfeeding mothers in Canada.OutcomesThis evidence-based e-resource facilitated addressing misconceptions around breastfeeding during COVID-19 and raising public awareness on safe infant feeding practices during this pandemic. Overall, the video was described as an informative, user-friendly, useful, and easily accessible resource by breastfeeding mothers who were in self-isolation with little access to healthcare services during the pandemic.ImplicationsThis project highlighted the importance of patient engagement and collaboration with the community partner in protecting breastfeeding during the COVID-19 pandemic. It further illustrated how informational e-resources can protect breastfeeding in situations where breastfeeding mothers’ access to healthcare services is compromised.

Determinants of infant feeding practices among mothers living with HIV attending prevention of mother to child transmission Clinic at Kiambu Level 4 hospital, Kenya: a cross-sectional study

BackgroundHuman immunodeficiency virus infection and acquired immune deficiency syndrome is global pandemic with around 150,000 children infected with HIV in 2015. In Kenya, it is estimated that 11,000 children who are under 15 years old were infected. Safe infant feeding practices are the major important determinants of the prevention of mother to child transmission. The decision to breastfeed or not is considered a very tough choice for mothers living with HIV. This study assessed the infant feeding practices and its determinants among mothers living with HIV with infants 0–12 months old.MethodsThis was a mixed methods cross-sectional study adopting qualitative and quantitative data collection procedures. A sample of 180 systematically selected mothers living with HIV with infants 0–12 months old attending prevention of mother to child transmission clinic participated in the study.ResultsExclusive breastfeeding rate was 71.4%, mixed feeding (18.2%) and replacement feeding (10.4%). Complementary feeding with continued breastfeeding rate was 63.1%. Similarly, qualitative results showed that exclusive breastfeeding was the most preferred feeding method by mothers living with HIV. Age (Adjusted Odds Ratio (AOR) 0.19; (95% Confidence Interval (CI) 0.41, 0.85; p = 0.030) and infant feeding practice knowledge (AOR 0.20; 95% CI 0.06, 0.64; p = 0.007) were determinants of exclusive breastfeeding. Education AOR 0.17; 95% CI 0.03, 0.85; p = 0.002) and occupation (AOR 3.91; 95% CI 1.24, 12.32; p = 0.020) were determinants of complementary feeding with continued breastfeeding.ConclusionExclusive breastfeeding is attainable in this population. However, poor infant feeding practice knowledge led to non-adherence to safe infant feeding practices such as exclusive breastfeeding. Socio-demographic factors such as age, education and occupation were established as determinants of infant feeding practices among mothers living with HIV. Ministry of Health should come up with strategies on infant feeding counseling that are aligned to a local context, to allow mothers to understand the importance of recommended infant feeding options for HIV-exposed infants.

Incidence, prevalence and associated factors of mother-to-child transmission of HIV, among children exposed to maternal HIV, in Belgaum district, Karnataka, India

BackgroundIndia lacks data on the incidence of Paediatric HIV. In 2010, the Indian Council of Medical Research commissioned a task force study to estimate the paediatric HIV burden in Belgaum district, Karnataka, India. We estimated the HIV incidence, prevalence and associated risk factors of mother to child transmission of HIV among children exposed to maternal HIV by age 24 months.MethodsWe included Belgaum resident pregnant women who tested HIV positive between January 1st, 2011 and May 31st, 2013 and who provided consent. Their babies were tested for HIV at three time intervals using DNA PCR dry blood spot (DBS) method at 6–10 weeks and 6–9 months, and using Antibody tests at 18–24 months of age. We estimated cumulative incidence using survival analysis that considered censoring of cases and prevalence rates of HIV by age 24 months. Using competing-risk survival regression model, we examined the correlates of transmission of HIV among babies exposed to maternal HIV.ResultsAmong 487 children of HIV positive mothers recruited in the study, the cumulative incidence rate by 24 months of age was 4.8 per 1000 person months [95% CI: 3.5–6.6]. The HIV prevalence rate among babies exposed to maternal HIV until 24 months was 7.8% [95% CI: 5.7–10.7]. Mother’s age above 30 years, and breastfeeding duration of more than six months were factors that significantly increased the HIV transmission; adjusted hazard ratio (AHR) 6.98 [95% CI: 1.73–28.16] and 5.28 [95% CI, 1.75–15.90], respectively. The risk of MTCT was significantly reduced if both mother and baby had received Nevirapine at delivery [AHR 0.25; 95%CI: 0.10–0.61] and if either mother or baby had been given Nevirapine at delivery [AHR 0.12; 95%CI: 0.03–0.49].ConclusionThe study findings suggest that mother’s age above 30 years and breastfeeding beyond 26 weeks is associated with higher rates of HIV transmission from mother to child. It confirms the benefits of providing anti-retrovirals (Nevirapine) in reducing mother to child transmission of HIV. Effective strategies to promote safe infant feeding practices, including avoidance of mixed feeding beyond 26 weeks among HIV infected mothers, is critical to reduce incidence of paediatric HIV in India.

The impact of approaches in improving male partner involvement in the prevention of mother-to-child transmission of HIV on the uptake of safe infant feeding practices by HIV positive women in sub-Saharan Africa. A systematic review and meta-analysis.

BackgroundThe low level of male partner involvement in Prevention of Mother to Child Transmission of HIV services such as safe infant feeding practices poses a serious challenge to the implementation of guidelines on safe infant feeding and may undermine efforts towards elimination of mother to child transmission of HIV in sub Saharan Africa(SSA). We conducted a systematic review and meta-analysis to identify the approaches that have been utilized to improve male partner involvement in PMTCT services as well as their impact on the uptake of safe infant feeding practices by HIV positive mothers in SSA.MethodsIn this systematic review and meta-analysis, Ovid Medline, Embase, PsycINFO, Cochrane library, ClinicalTrials.gov, Web of Science and Current Controlled Trials were searched. Only studies performed in SSA that reported an approach that specifically involved male partners and its impact on the uptake of safe infant feeding practices (irrespective of the language and date of publication) were included. Odds ratios were extracted or calculated from studies and combined in a meta-analysis using the statistical package Stata version 11.0. Forest plots were generated using the random effect model.ResultsFrom an initial 2416 non-duplicate articles, 06 articles were included in the systematic review and meta-analysis. The overall pooled unadjusted OR was 3.08[95%CI: 2.58–3.68], while the effect sizes for interventions aimed at promoting male partner involvement such as verbal encouragement, complex community intervention and enhanced psychosocial interventions were 1.93[95%CI: 1.34–2.79], 3.45[95%CI: 2.79–4.25] and 5.14[95%CI: 2.42–10.90] respectively. Using only adjusted odd ratios, the pooled adjusted OR = 1.78[95%CI: 1.35–2.34]. The I2 = 60.1% p = 0.057 using adjusted ORs.ConclusionInterventions aimed at promoting male partner involvement such as enhanced psychosocial interventions, verbal encouragement and complex community interventions increase the uptake of safe infant feeding options. The heterogeneity was moderate among studies. More studies including randomised trials that will recruit larger, representative samples of patients are needed in the future.Prospero registration number: 42016032673

Infant feeding knowledge, perceptions and practices among women with and without HIV in Johannesburg, South Africa: a survey in healthcare facilities.

BackgroundSouth Africa has a history of low breastfeeding rates among women with and without Human Immunodeficiency Virus (HIV). In this study, we assessed infant feeding knowledge, perceptions and practices among pregnant and postpartum women with and without HIV, in the context of changes in infant feeding and Prevention of Mother-to-Child Transmission of HIV (PMTCT) guidelines.MethodsThis was a cross-sectional survey conducted from April 2014 to March 2015 in 10 healthcare facilities in Johannesburg, South Africa. A total of 190 pregnant and 180 postpartum women (74 and 67, respectively, were HIV positive) were interviewed using a semi-structured questionnaire. Multiple regression analyses assessed factors associated with an intention to exclusively breastfeed, and exclusive breastfeeding of infants less than six months of age.ResultsWomen with HIV had better overall knowledge on safe infant feeding practices, both in general and in the context of HIV infection. There were however gaps in knowledge among women with and without HIV. Information from healthcare facilities was the main source of information for all groups of women in the study. A greater percentage of women without HIV 80.9% (93/115), reported an intention to exclusively breastfeed, compared to 64.9% (48/74) of women with HIV, p = 0.014. Not having HIV was positively associated with a reported intention to breastfeed, Adjusted Odds Ratio (AOR) 3.60, 95% CI 1.50, 8.62. Other factors associated with a reported intention to exclusively breastfeed were prior breastfeeding experience and higher knowledge scores on safe infant feeding practices in the context of HIV infection. Among postpartum women, higher scores on general knowledge of safe infant feeding practices were positively associated with reported exclusive breastfeeding, AOR 2.18, 95% CI 1.52, 3.12. Most women perceived that it was difficult to exclusively breastfeed and that cultural factors were a barrier to exclusive breastfeeding.ConclusionsWhile a greater proportion of women are electing to breastfeed, HIV infection and cultural factors remain an important influence on safe infant feeding practices. Healthcare workers are the main source of information, and highlight the need for accurate and consistent messaging for both women with and without HIV.

Intimate Partner Violence Against HIV-Positive Women is Associated with Sub-Optimal Infant Feeding Practices in Lusaka, Zambia.

Objectives The aim of this study is to determine how intimate partner violence against HIV-positive women affects safe infant feeding practices in Lusaka, Zambia. Methods A cross-sectional face-to-face survey was conducted with 320 married postpartum women at a large public health center in Lusaka, Zambia, in 2014. Variables were measured using previously validated instrumentsfrom the Demographic and Health Survey. Data were analyzed using simple and multivariate logistic regression in Stata 12. Results Thirty-seven percent of women report early mixed infant feedingprior to six months. Women who experienced intimate partner violence have 2.8 higher adjusted odds of early mixed infant feeding (p<0.001). Women who experienced emotional violence, specifically, have 1.9 higher adjusted odds of early mixed infant feeding (p<0.05), while women who experienced sexual violence have 2.3 higher adjusted odds (p<0.01). There is also a dose-response relationship between IPV and early mixed infant feeding(p < 0.05). Lastly, disclosing one's HIV-positive status to the husband is associated with at least 67% lower adjusted odds of early mixed feeding (p<0.05). Conclusions Intimate partner violence against HIV-positive women, in particular emotional and sexual violence, increases the likelihood of early mixed infantfeeding, putting infants at greater risk for both mother-to-child transmission of HIV and other infant morbidities. Intimate partner violence should thusbe given increased attention within the context of infant feeding and HIV in sub-Saharan Africa.

Factors Influencing Infant Feeding Choices of HIV Positive Mothers in Southwestern, Nigeria

Breastfeeding is a socio-culturally acceptable, universal way of feeding infant during the first year of life and a key determinant of child survival and development. Semi-structured interviewer-administered questionnaire was used in the cross-sectional survey to obtain data from 600 HIV positive mothers to assess practices regarding infant feeding choices and factors influencing these choice(s) by mothers enrolled in Prevention of Mother -to -Child Transmission (PMTCT) of HIV clinics in Oyo State, Southwestern, Nigeria. Majority of the mothers (86.0%) was married and aged 31.0 ± 5.7 years. Slightly above half (53.0%) had ≤ 2 children and more than two-third had disclosed their HIV status to their spouses. About two-third (61.0%) were traders with 75.0% earning monthly income ≤ ₦18,000.00k. Half of the mothers had ≥ 3 antenatal care visits and 85.0% had infant feeding counselling. Infant feeding choices among the mothers were Exclusive Breast Feeding (EBF) (61.0%), Exclusive Replacement Feeding (ERF) (26.0%) and Mixed Feeding (MF) (13.0%). The choice of EBF, ERF and MF were influenced by fear of stigmatisation (55.0%), disclosure of HIV status to spouse (67.0%) and neighbours’ advice (66.0%) respectively. Predictors of EBF were; monthly income [AOR = 2.6, C.I. =1.45-4.59], infant feeding counselling [AOR = 2.7, C.I. = 1.62-6.94)] and fear of stigmatisation [AOR = 7. 2, C.I. = 2.11-23.60]. Predictors of ERF were; being a civil servant [AOR = 5.7, C.I. = 2.51-16.42], desire to reduce the risk of transmission of HIV [AOR = 2.5, C.I. =1.03-11.83] and disclosure of HIV status to spouses [AOR=5.0, C.I. =3.81-23.01]. Predictors of MF were; parity < 3 [AOR = 3.4, C.I. =1.72-6.96], receiving neighbours’ advice [AOR = 4.6, C.I. = 3.72-56.21] and infant illness [AOR = 6.8, C.I. = 4.0 -35.10]. Although a high proportion of mothers practiced exclusive breastfeeding for fear of stigmatization, mixed feeding is still being practiced due to neighbours’ advice. Family members’ education on safer infant feeding practices and behavioural change programmes in the context of HIV is advocated.

Promoting safe infant feeding practices - the importance of structural, social and contextual factors in Southern Africa.

There has been significant progress towards the goal of eliminating vertical transmission of HIV by 2015. However, a question that remains is how we can most effectively prevent late postnatal transmission of HIV through infant feeding. Guidelines published by the World Health Organization in 2010 have been widely adopted. These guidelines place strong emphasis on exclusive breastfeeding, in some countries over-turning a prior emphasis on formula feeding. Where available, provision of antiretroviral treatment for HIV-positive mothers or prophylaxis for infants offers additional protection against vertical transmission through infant feeding. However, merely changing guidelines is not sufficient to change practice, particularly with regard to culturally sanctioned forms of feeding, such as mixed feeding. This commentary highlights structural, social and contextual barriers to effective implementation of the guidelines and suggests ways to address some of these barriers.

What will it take to achieve virtual elimination of mother-to-child transmission of HIV? An assessment of current progress and future needs

BackgroundThe number of HIV-positive pregnant women receiving antiretroviral drugs (ARVs) to prevent mother-to-child transmission (MTCT) of HIV has increased rapidly.ObjectiveTo estimate the reduction in new child HIV infections resulting from...

Infant feeding in emergencies

This article addresses the range of issues that arise when an area is struck by disasters of natural and human origin, and considers how infant feeding practices are affected in a compromised environment. Strategies to enable mothers to continue to feed infants safely are considered, along with the role of emergency workers, health-care providers and the media in influencing how women choose to feed their infants in disaster zones. The article focuses on promoting safe infant feeding practices by highlighting the risks posed by unsanitary conditions, and the benefits of supporting, promoting and protecting breastfeeding, particularly in compromised environments.

Review Of Presentation Of Mother –To – Child Transmission Of HIV.

The total number of AIDS death since the epidemic started is estimated at 21.8 million worldwide, of which 4.3 million were in children. Most of these children will have acquired their infection as a result of mother to child transmission (MTCT). This is a growing problem. Over 90% of women who are HIV positive are of the child bearing age- yet to start or complete their families. This risk of MTCT can occur during pregnancy – via the placenta and through the breast milk. Factors that will increase the risk of MTCT include: maternal viral load, maternal immune deficiency, placental abruption, invasive ante and intra- partum procedures, mode of delivery and breast feeding. Prevention of MTCT of HIV will involve; (1) Prevention of transmission from an HIV infected mother to her infant. (2) Prevention of unintended pregnancies in HIV infected women. (3) Prevention of new infections in pregnant women and their partners. And (4) Provision of treatment, care and support to women infected with HIV, their infants and families. These could be achieved through the use of the anti-retroviral (ARV) drugs- HAART (Highly Active Anti-Retroviral Therapy) or combination of two drugs. Use of safer obstetric practices- Elective caesarean section is preferred but vaginal delivery could be conducted with precaution to reduce risk of transmission especially in women with low viral load. Use of safer infant feeding practices- HIV positive women who opt to breast feed must do so for a short duration and stop if breast inflammation or abscesses occur. Use of condoms especially female condom is recommended to prevent new infections and HIV positive mothers are advised to abstain from sex during antenatal periods to avoid new infections. In conculsion, prevention of MTCT will depend on the vigorous implementation of these guidelines Keywords : v Tropical Journal of Medical Research Vol. 10 (2) 2006: pp. 16-21

Review of prevention of mother –to – child transmission of HIV

Background: The total number of AIDS death since the epidemic started is estimated at 21.8 million worldwide, of which 4.3 million were in children. Most of these children will have acquired their infection as a result of mother to child transmission (MTCT). This is a growing problem because greater than 90% of women who are HIV positive are of the child bearing age- yet to start or complete their families. The risk of MTCT is generally estimated at between 15 and 40%. Methods: Review of available literature to highlights current practices in prevention of MTCT in HIV/AIDS. Results: MTCT can occur during pregnancy – via the placenta, during labour and delivery – through contact of maternal fluids with the baby and during breast feeding – through the breast milk. Factors that will increase the risk of MTCT include: maternal viral load, maternal immune deficiency, placental abruption, invasive ante and intra- partum procedures, mode of delivery and breast feeding. Prevention of MTCT of HIV will involve; (1) Prevention of transmission from an HIV infected mother to her infant. (2) Prevention of unintended pregnancies in HIV infected women. (3) Prevention of new infections in pregnant women and their partners. And (4) Provision of treatment, care and support to women infected with HIV, their infants and families. These could be achieved through the use of the anti-retroviral (ARV) drugs- HAART (Highly Active Anti-Retroviral Therapy) or combination of two drugs. Use of safer obstetric practices- Elective caesarean section is preferred but vaginal delivery could be conducted with precaution to reduce risk of transmission especially in women with low viral load. Use of safer infant feeding practices- HIV positive women who opt to breast feed must do so for a short duration and stop if breast inflammation or abscesses occur. Use of condoms especially female condom is recommended to prevent new infections and HIV positive mothers are advised to abstain from sex during antenatal periods to avoid new infections. Conclusion: Prevention of MTCT will depend on the vigorous implementation of these guidelines Keywords : Prevention, Mother –to –Child Transmission, HIV Tropical Journal of Medical Research Vol. 11 (1) 2007: pp. 19-25

Infant feeding practices among HIV-positive mothers

The study examined infant feeding practices adopted by HIV positive mothers in three health care facilities in Swaziland. Data was obtained using structured interviews; descriptive analysis was used. Results revealed that exclusive breastfeeding, mixed feeding and breastmilk substitutes were used by mothers. Reasons for not breastfeeding were: avoidance of transmitting HIV infection to infants; inconsistent messages from health care professionals; formula milk was perceived to be nutritious for infants at risk of acquiring HIV infection; and employment away from home. Mothers who breastfed exclusively were following advice by midwives about the health benefits of breastfeeding even if the mothers were HIV positive. Lack of financial resources was cited as a deterrent to offering alternative feeds when mothers were avoiding mother to child transmission (MTCT) of HIV from breast milk. Recommendations directed to midwives are to offer quality infant feeding information and support to all mothers irrespective of the HIV status; and to use acceptable, feasible, affordable, sustainable and safe (AFASS) criterion when advising about the ideal infant feeding practice. General recommendations indicate a need for extensive research on safe infant feeding practices among HIV-exposed infants, in view of conflicting findings related to interventions for reducing MTCT of HIV postnatally. The culture of breastfeeding among women should be protected, promoted and preserved at all levels.