Early cessation of breastfeeding to prevent postnatal transmission of HIV: a recommendation in need of guidance
Article first published online: 30 JUL 2008
©2008 The Author(s)/Journal Compilation ©2008 Foundation Acta Pædiatrica/Acta Pædiatrica
Volume 97, Issue 12, pages 1663–1668, December 2008
How to Cite
De Paoli, M. M., Mkwanazi, N. B., Richter, L. M. and Rollins, N. (2008), Early cessation of breastfeeding to prevent postnatal transmission of HIV: a recommendation in need of guidance. Acta Paediatrica, 97: 1663–1668. doi: 10.1111/j.1651-2227.2008.00956.x
- Issue published online: 6 NOV 2008
- Article first published online: 30 JUL 2008
- Received 26 March 2008; revised 19 May 2008; accepted 30 June 2008.
- Infant feeding;
- Mother-to-child transmission of HIV;
- Rapid cessation;
- South Africa;
Aim: Early and rapid cessation of breastfeeding has been recommended by WHO to reduce mother-to-child transmission of HIV. This study assessed how HIV-infected mothers planned and experienced breastfeeding cessation as part of an HIV prevention strategy and how counsellors facilitated this process.
Methods: A qualitative study was conducted among HIV-infected mothers and counsellors from local clinics and an intervention research project in Durban, South Africa.
Results: Mothers enrolled in the research setting reported many success stories in contrast to mothers attending routine services. Consistent counselling and ongoing support from counsellors facilitated this, though specific advice on how to stop breastfeeding and introduce complementary feeds was inadequate amongst both sets of counsellors. Few mothers had a plan for what they were actually going to do on the day when they had decided to stop breastfeeding. Their primary motivation for wanting to rapidly stop breastfeeding, even with the difficulties involved, was to avoid infecting their child with HIV. Both counsellors and HIV-infected mothers expressed concern about practical issues, including social consequences, associated with early cessation. Mothers who had stopped breastfeeding offered some, albeit limited, recommendations to assist and guide other women.
Conclusion: The experiences of HIV-infected mothers planning for and stopping breastfeeding early illustrate the complexity of this recommendation and demonstrate that counsellors are ill-prepared to support mothers accomplish this safely. Guidance that acknowledges the cultural context and psychological stresses is urgently needed to direct policy, training and service delivery.