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Counseling and choosing between infant-feeding options: overall limits and local interpretations by health care providers and women living with HIV in resource-poor countries (Burkina Faso, Cambodia, Cameroon).
Soc Sci Med 2009; 69(6):821-9SS

Abstract

As part of prevention of HIV mother-to-child transmission (PMTCT) strategies, HIV-positive women are asked to choose between two options regarding infant feeding: replacement feeding or exclusive breastfeeding with early weaning. Health services must offer women counseling, guidance, and support to enable them to make an informed choice. This article aims to shed light on the content of counseling and its adaptation to local situations, including women's perceptions, in three resource-poor countries with different infant feeding patterns (Burkina Faso, Cambodia, and Cameroon). The qualitative study included observations in health facilities and interviews with HIV-positive mothers and health workers. The results show that counseling practices vary, including prescriptive counseling proposing only one option to all women, an option based on the mother's economic level assessed by health care providers, and the choice between options. While health workers consider economic aspects first, women mostly consider social aspects related to the risk of being stigmatized as a "bad mother'" or as HIV-positive. Overall trends identify some limits to counseling effectiveness when considering women's perceptions and needs, such as: the content of information provided by health care providers, duration and timing of counseling, discrepancies between information provided during counseling and from the health system, and ranking of preventive options by health workers. Women's agency for feeding choices is related to local practices and local authorities' abilities to provide more or less comprehensive counseling based on the organization of the health and aid system. Local practices also depend on institutions' interpretations of international recommendations based on public health considerations regarding standard of care and women's and the health system's respective responsibilities. Beyond structural constraints that hinder the adoption of preventive infant feeding patterns, addressing these issues may help improve counseling practices.

Authors+Show Affiliations

Institut de Recherche pour le Développement (UMR 145), BP 1386, Dakar, Sénégal. adesclaux@free.frNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

19559512

Citation

Desclaux, Alice, and Chiara Alfieri. "Counseling and Choosing Between Infant-feeding Options: Overall Limits and Local Interpretations By Health Care Providers and Women Living With HIV in Resource-poor Countries (Burkina Faso, Cambodia, Cameroon)." Social Science & Medicine (1982), vol. 69, no. 6, 2009, pp. 821-9.
Desclaux A, Alfieri C. Counseling and choosing between infant-feeding options: overall limits and local interpretations by health care providers and women living with HIV in resource-poor countries (Burkina Faso, Cambodia, Cameroon). Soc Sci Med. 2009;69(6):821-9.
Desclaux, A., & Alfieri, C. (2009). Counseling and choosing between infant-feeding options: overall limits and local interpretations by health care providers and women living with HIV in resource-poor countries (Burkina Faso, Cambodia, Cameroon). Social Science & Medicine (1982), 69(6), pp. 821-9. doi:10.1016/j.socscimed.2009.06.007.
Desclaux A, Alfieri C. Counseling and Choosing Between Infant-feeding Options: Overall Limits and Local Interpretations By Health Care Providers and Women Living With HIV in Resource-poor Countries (Burkina Faso, Cambodia, Cameroon). Soc Sci Med. 2009;69(6):821-9. PubMed PMID: 19559512.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Counseling and choosing between infant-feeding options: overall limits and local interpretations by health care providers and women living with HIV in resource-poor countries (Burkina Faso, Cambodia, Cameroon). AU - Desclaux,Alice, AU - Alfieri,Chiara, Y1 - 2009/06/24/ PY - 2008/03/31/received PY - 2009/6/30/entrez PY - 2009/6/30/pubmed PY - 2009/11/3/medline SP - 821 EP - 9 JF - Social science & medicine (1982) JO - Soc Sci Med VL - 69 IS - 6 N2 - As part of prevention of HIV mother-to-child transmission (PMTCT) strategies, HIV-positive women are asked to choose between two options regarding infant feeding: replacement feeding or exclusive breastfeeding with early weaning. Health services must offer women counseling, guidance, and support to enable them to make an informed choice. This article aims to shed light on the content of counseling and its adaptation to local situations, including women's perceptions, in three resource-poor countries with different infant feeding patterns (Burkina Faso, Cambodia, and Cameroon). The qualitative study included observations in health facilities and interviews with HIV-positive mothers and health workers. The results show that counseling practices vary, including prescriptive counseling proposing only one option to all women, an option based on the mother's economic level assessed by health care providers, and the choice between options. While health workers consider economic aspects first, women mostly consider social aspects related to the risk of being stigmatized as a "bad mother'" or as HIV-positive. Overall trends identify some limits to counseling effectiveness when considering women's perceptions and needs, such as: the content of information provided by health care providers, duration and timing of counseling, discrepancies between information provided during counseling and from the health system, and ranking of preventive options by health workers. Women's agency for feeding choices is related to local practices and local authorities' abilities to provide more or less comprehensive counseling based on the organization of the health and aid system. Local practices also depend on institutions' interpretations of international recommendations based on public health considerations regarding standard of care and women's and the health system's respective responsibilities. Beyond structural constraints that hinder the adoption of preventive infant feeding patterns, addressing these issues may help improve counseling practices. SN - 1873-5347 UR - https://www.unboundmedicine.com/medline/citation/19559512/Counseling_and_choosing_between_infant_feeding_options:_overall_limits_and_local_interpretations_by_health_care_providers_and_women_living_with_HIV_in_resource_poor_countries__Burkina_Faso_Cambodia_Cameroon__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0277-9536(09)00364-5 DB - PRIME DP - Unbound Medicine ER -