Why breast practice is so hard for HIV-positive moms
Their decision to choose formula instead is driven by fear of transmitting HIV to their babies, new research reveals
When HIV-positive mother Nombasa Dumile gave birth to her daughter and son, now 13 and five, she did everything in her power to ensure they were healthy.
Even though there was little chance of the Gugulethu, Cape Town woman transmitting the virus to her children, since she was on treatment and was virally suppressed, she admits her anxiety prevented her from breastfeeding them.
According to national infant feeding guidelines and the World Health Organisation, women who are HIV-positive and on antiretrovirals should exclusively breastfeed their babies for six months and continue doing so for 18 months after the introduction of solids.
But Dumile, who is an HIV activist and a mentor for HIV-positive mothers, opted for formula.
“I couldn’t bring myself to do it. I was not brave enough, even after counselling. I didn’t want any chance of them contracting HIV. For me, the guilt of giving them formula milk was way better than the guilt that I would have had if they had contracted HIV,” she said.
According to new research published in the International Breastfeeding Journal, Dumile is far from alone.
Scientists from Johns Hopkins Bloomberg School of Public Health in the US and a Johannesburg NGO, Witkoppen Health and Welfare Centre, found that pregnant women living with HIV are less likely to breastfeed compared with their HIV-negative counterparts.
Most HIV-positive women who chose formula feeding said their decision was driven by their fear of transmitting HIV to their babies. Some said the lack of breastfeeding role models added to their uncertainty, and others were discouraged by inconsistent messages from healthcare providers about the safety of breastfeeding.
While almost all HIV-negative expectant mothers planned to breastfeed, only 71% of HIV-positive moms did so. During the first postnatal visit, 93% of HIV-negative moms had initiated breastfeeding compared with only two-thirds of HIV-positive mothers. By six months, only 37% of HIV-positive moms were still breastfeeding.
Researchers noted that many women living with HIV feared pressure from family and community members. Some even worried that their choice of feeding method may reveal their HIV status. Many were also anxious about continuing breastfeeding after introducing solids, because they felt this may expose their babies to HIV.
Lead researcher Nora West said: “The choice to initiate formula or breastfeed beyond six months is a complicated process influenced by the healthcare provider counselling, fear of HIV transmission, individual economic realities, social pressure and stigma.”
West said as countries such as SA rolled out updates to infant feeding guidelines, women who lived with HIV were entitled to receive uniform and unambiguous messages.