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Early cessation of breastfeeding to prevent postnatal transmission of HIV: a recommendation in need of guidance.
Acta Paediatr 2008; 97(12):1663-8AP

Abstract

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.

Authors+Show Affiliations

Fafo Institute for Applied International Studies, Norway. marina.de.paoli@fafo.noNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18671688

Citation

de Paoli, Marina M., et al. "Early Cessation of Breastfeeding to Prevent Postnatal Transmission of HIV: a Recommendation in Need of Guidance." Acta Paediatrica (Oslo, Norway : 1992), vol. 97, no. 12, 2008, pp. 1663-8.
de Paoli MM, Mkwanazi NB, Richter LM, et al. Early cessation of breastfeeding to prevent postnatal transmission of HIV: a recommendation in need of guidance. Acta Paediatr. 2008;97(12):1663-8.
de Paoli, M. M., Mkwanazi, N. B., Richter, L. M., & Rollins, N. (2008). Early cessation of breastfeeding to prevent postnatal transmission of HIV: a recommendation in need of guidance. Acta Paediatrica (Oslo, Norway : 1992), 97(12), pp. 1663-8. doi:10.1111/j.1651-2227.2008.00956.x.
de Paoli MM, et al. Early Cessation of Breastfeeding to Prevent Postnatal Transmission of HIV: a Recommendation in Need of Guidance. Acta Paediatr. 2008;97(12):1663-8. PubMed PMID: 18671688.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early cessation of breastfeeding to prevent postnatal transmission of HIV: a recommendation in need of guidance. AU - de Paoli,Marina M, AU - Mkwanazi,Ntombizodumo B, AU - Richter,Linda M, AU - Rollins,Nigel, Y1 - 2008/07/30/ PY - 2008/8/2/pubmed PY - 2009/2/21/medline PY - 2008/8/2/entrez SP - 1663 EP - 8 JF - Acta paediatrica (Oslo, Norway : 1992) JO - Acta Paediatr. VL - 97 IS - 12 N2 - 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. SN - 1651-2227 UR - https://www.unboundmedicine.com/medline/citation/18671688/Early_cessation_of_breastfeeding_to_prevent_postnatal_transmission_of_HIV:_a_recommendation_in_need_of_guidance_ L2 - https://doi.org/10.1111/j.1651-2227.2008.00956.x DB - PRIME DP - Unbound Medicine ER -