Featured news from NHIVNA
HIV-related news from NAM
For African women in the UK, formula feeding has a high social and personal cost
Roger Pebody, 2013-04-23 08:10:00
Although most African women living with HIV in the UK do comply with medical recommendations to avoid breastfeeding, doing so comes at a high social and personal cost, according to qualitative research presented to the British HIV Association conference last week. There are considerable structural, cultural and personal barriers to formula feeding, reported Dr Shema Tariq of City University.
Whereas women living with HIV in resource-limited settings are advised to breastfeed their babies (because of the unavailability of clean water supplies), the advice in resource-rich settings is to bottle-feed with powdered milk formula. This reduces the risk of passing on HIV to the child, although in the context of antiretroviral therapy and an undetectable viral load, there are questions about how risky breastfeeding would be.
Furthermore, health information for the general population in the UK – which women living with HIV are frequently exposed to – usually states that ‘breast is best’.
Women who have grown up in African countries and have migrated to the UK or other western countries must therefore grapple with conflicting messages and expectations. Women frequently maintain significant social connections with other African people, both in the diaspora and their country of origin.
Very little research has explored the impact of infant feeding decisions on migrant mothers living in resource-rich settings (although a Canadian study was presented last year). Researchers in London therefore conducted in-depth qualitative interviews with 23 African women living with HIV who were pregnant or had recently given birth. In addition, six professionals (clinicians, midwives, voluntary sector workers) were interviewed.
With one exception, all the women were exclusively bottle-feeding or intended to. However women had to overcome a number of barriers in order to do so.
“That’s what really make me feel sad because our culture in Africa you’re supposed to breastfeed.”
There was a widespread expectation – from both the women themselves and from other members of their communities – that breastfeeding was an essential aspect of being a woman and a mother. There could be considerable pressure from other people to breastfeed. This didn’t just come from friends or relatives. If the baby cried, strangers on a bus could even forcibly suggest that he or she should be put to the breast.
Women feared that formula feeding would lead to unwanted disclosure of their HIV status. This could include disclosure to the baby’s father.
Most of the interviewees were extremely poor and formula milk was very expensive for them. Although BHIVA recommend that free formula milk and feeding equipment be supplied in this situation, resources were not always available.
When bottle-feeding, women frequently felt that they were missing out on bonding with their baby, and felt a sense of personal loss. Moreover many were anxious about their child’s health, concerned that he or she would miss out on the health benefits of breastfeeding that are extolled in mainstream health information for mothers.
Moreover, in order to avoid unwanted disclosure and stigmatisation, many women isolated themselves and stayed away from social interactions.
In order to face these challenges, Dr Tariq says that women required considerable resilience. The most important of the resources that they drew upon was the knowledge that they were safeguarding their baby.
“The most important thing is my child not having it [HIV], you understand? If there’s anything that’ll make them not have it, why wouldn’t I do it?”
Although many of the fathers were absent or semi-absent, when they were present and supportive, this was extremely important. Knowing other mothers who had given birth to HIV-negative babies was also valuable.
Women deployed creative excuses to explain why they weren’t breastfeeding, for example saying that they had mastitis or had recently taken antibiotics. When provided, free formula milk and feeding equipment were of considerable help.
Source:1
