Lack of HIV RNA test result is a barrier to breastfeeding among women living with HIV in Botswana

Background Botswana updated its antiretroviral treatment (ART) guidelines in May 2016 to support breastfeeding for women living with HIV (WLHIV) on ART who have documented HIV RNA suppression during pregnancy. Methods From September 2016 to March 2019, we evaluated feeding method at discharge among WLHIV at eight government maternity wards in Botswana within the Tsepamo Study. We validated the recorded feeding method on the obstetric record using the prevention of mother-to-child transmission of HIV (PMTCT) counsellor report, infant formula dispensing log or through direct observation. Available HIV RNA results were recorded from the obstetric record, and from outpatient HIV records (starting February 2018). In a subset of participants, we used electronic laboratory records to verify whether an HIV RNA test had occurred. Univariable and multivariable logistic regression analyses were performed to identify factors associated with infant feeding choice. Results Among 13,354 WLHIV who had a validated feeding method at discharge, 5303 (39.7%) chose to breastfeed and 8051 (60.3%) chose to formula feed. Women who had a documented HIV RNA result in the obstetric record available to healthcare providers at delivery were more likely to breastfeed (50.8%) compared to women who did not have a documented HIV RNA result (35.4%) (aOR 0.59; 95% CI 0.54, 0.65). Among women with documented HIV RNA, 2711 (94.6%) were virally suppressed (< 400 copies/mL). Breastfeeding occurred in a substantial proportion of women who did not meet criteria, including 46 (30.1%) of 153 women with HIV RNA > 400 copies/mL, and 134 (27.4%) of 489 women with no reported ART use. A sub-analysis of electronic laboratory records among 150 women without a recorded result on the obstetric record revealed that 93 (62%) women had an HIV RNA test during pregnancy. Conclusions In a setting of long-standing use of suppressive ART, with majority of WLHIV on ART from the time of conception, requiring documentation of HIV RNA suppression in the obstetric record to inform infant feeding decisions is a barrier to breastfeeding but unlikely to prevent a substantial amount of HIV transmission.

Breastfeeding in Context: African American Women’s Normative Referents, Salient Identities, and Perceived Social Norms

The purpose of this study was to describe social norms and salient social identities related to breastfeeding intentions among African American mothers in Washington, D.C. Five focus groups were held with 30 mothers who gave birth to a child between 2016 and 2019. Two coders conducted pragmatic thematic analysis. This study demonstrated that women hold different identities relevant to making infant feeding decisions, with mother being primary and race/ethnicity, age, and relationship status factoring into how they define themselves. Mothers drew their perceptions of what is common and accepted from family, friends, the “Black community,” and what they perceived visually in their geographic area and heard from their health care providers. Mothers believed breastfeeding to be increasing in popularity and acceptability in African American communities in Washington, D.C., but not yet the most common or accepted mode of feeding, with some variability by socioeconomic status group. Implications for public health communication and social marketing are discussed.

Maternal Opinions on Breastfeeding, Introducing Solids, and Postpartum Weight Loss

Objectives: Early cessation of breastfeeding, inappropriate introduction of solids, and postpartum weight retention are associated with negative health outcomes for mother and infant. The purpose of this study was to understand timing of and factors that influence infant feeding decisions and barriers that women face when breastfeeding, introducing solids, and losing weight postpartum to inform future interventions.Methods: Eleven women who had recently delivered (infant age 3-10 months) were recruited from a Kansas City Metro pediatric office. All women were currently breastfeeding or had previous breastfeeding experience. Women completed a feeding survey and participated in a group interview to obtain information regarding breastfeeding, introducing solids, and postpartum weight loss. A content and text analysis were performed to summarize the data.Results: Predominant emerging themes were: (1) Inadequate knowledge for caring for self and infant (2) Desired knowledge from a Healthcare Provider (3) Feeding decisions were made before pregnancy and preparation took place in the second/third trimesters (4) Unmet breastfeeding goals (5) Clear guidelines on introducing solids are lacking (6) ) Those that achieve pre-pregnancy weight have a different body shape and weight distribution (7) and Lack of time and energy make postpartum weight loss hard. Conclusions: Overall, women do not feel they have adequate information to successfully breastfeed, introduce solids, or lose weight postpartum. They would like basic and practical information on both caring for and feeding themselves and their infant. They would like this information provided to them both during pregnancy and during well child visits.

Women Living With HIV in High Income Countries and the Deeper Meaning of Breastfeeding Avoidance: A Metasynthesis

Background: Recommendations to avoid breastfeeding for women living with HIV in high income countries has resulted in a gap in the literature on how healthcare professionals can provide the highest standard of lactation counseling. Research aims: (1) Describe social and emotional experiences of infant feeding for women living with HIV in high income countries; (2) raise ethical considerations surrounding the clinical recommendation in high income countries to avoid breastfeeding. Methods: A systematic literature search was conducted between January 1, 2008 and June 20, 2019. A total of 900 papers were screened and six met the inclusion criteria: (a) the sample was drawn from a high-income country regardless of the nativity of participants; (b) some or all participants were women living with HIV. Metasynthesis, according to Noblit and Hare (1988), was used to synthesize the experiences of women living with HIV in high-income countries and their experiences in infant feeding decisions. Results: Participants in this sample suffered a substantial emotional burden associated with infant feeding experiences potentially leading to risk of internalized stigma, suggesting that infant feeding considerations may contribute to HIV stigma in unique ways. Four overarching themes were identified expressing the meaning of avoidance of breastfeeding: maternal self-worth, deculturalization, surveillance, and intersectionality. Conclusion: Women in high-income countries living with HIV deserve the highest standard of lactation care and counseling available. Healthcare professionals in high-income countries are ethically obligated to provide evidenced-based lactation care and counseling to women living with HIV.

Should we talk about the ‘benefits’ of breastfeeding? The significance of the default in representations of infant feeding

Breastfeeding advocates have criticised the phrase ‘breast is best’ as mistakenly representing breastfeeding as a departure from the norm rather than the default for infant feeding. Breastfeeding mothers have an interest in representing breastfeeding as the default, for example, to counteract criticism of breastfeeding outside the home. This connects to an increasing trend to frame feeding babies formula as harmful, which can be seen in research papers, public policy and information presented to parents and prospective parents. (1) Whether we frame infant-feeding decisions in terms of harming or benefit, protection or risk matters because these distinctions are generally morally significant and thus (2) holding that those who decide to use formula ‘harm’, ‘risk harm’ to their babies or describing formula feeding as ‘dangerous’ is likely to contribute to guilt associated with formula feeding and thus to undermine the well-being of vulnerable women. It may undermine attempts to improve breastfeeding rates by leading women to reject information about health outcomes surrounding infant-feeding decisions. However, (3) these distinctions do not apply easily to infant-feeding decisions, in part because of difficulties in determining whether we should treat breastfeeding as the normative baseline for infant feeding. I show that neither the descriptive ‘facts of the matter’ nor moral or pragmatic considerations provide an easy answer before discussing how to respond to these considerations.

“I’m Doing the Best That I Can for Her”: Infant-Feeding Decisions of Mothers Receiving Medication-Assisted Treatment for an Opioid Use Disorder

Background: Several professional health organizations have made statements endorsing the safety of breastfeeding for women taking medication-assisted treatment for an opioid use disorder. Yet, breastfeeding initiation rates for this population are approximately 50% lower than the general United States’ population. Furthermore, little is known about what influences the infant-feeding decisions of these women. Research aim: This study aimed to describe what influences the infant-feeding decisions of women taking medication-assisted treatment for an opioid use disorder. Methods: Qualitative description was used. We conducted semistructured, individual interviews with mothers ( N = 8) who were receiving medication-assisted treatment during the postpartum period. We analyzed our data using thematic analysis. Results: We identified two themes: (a) what I heard about breastfeeding, and (b) doing what I feel is best for my baby. What I heard about breastfeeding reflects the information and misinformation that women received about breastfeeding. Doing what I feel is best for my baby describes the inner conflict that the women experienced. Most of the women in this study desired to breastfeed; however, all women reported that the social stigma surrounding methadone use strongly influenced their infant-feeding decision. Conclusion: This study sheds new light on what influences the infant-feeding decisions of women taking medication-assisted treatment and represents an initial step toward the development of targeted interventions to improve breastfeeding rates for this unique population.

Infant feeding decisions and behaviours among low-income smoke-exposed women: timing and change during pregnancy

ObjectiveThe present study aimed to describe change in feeding intentions and predictors of breast-feeding intentions during the course of pregnancy.DesignAnalysis of prospectively collected data from a larger randomized controlled trial of a health education intervention to reduce environmental smoke exposure among women during and after pregnancy.SettingParticipants were recruited from prenatal clinics, but all further communication occurred with participating women living in the community.SubjectsLow-income, adult women (n399) were interviewed during the 16th and 32nd week of pregnancy to ascertain prenatal feeding intentions and breast-feeding knowledge, attitudes and self-efficacy. Characteristics of women by infant feeding intention were assessed along with differences in intention from 16 to 32 weeks of pregnancy and feeding behaviours after delivery. Differences in psychosocial variables between women of different intention for infant feeding were measured. Women in each category of feeding intention were assessed for changes in psychosocial factors by eventual infant feeding behaviour.ResultsFeeding intention early in pregnancy was strongly, but not consistently, associated with feeding intention late in pregnancy, feeding initiation and later feeding patterns. Over one-third of women who were undecided at 16 weeks’ gestation or earlier initiated breast-feeding. Increases in knowledge and improvement in time, social factors and social support barriers were found among those who exclusively breast-fed.ConclusionsResults indicate that feeding decisions may change during pregnancy. Determining when women make feeding decisions during their pregnancy warrants more research. Interventions to increase breast-feeding intentions should target knowledge, self-efficacy and barriers.