TY - JOUR
T1 - Realities and challenges of breastfeeding policy in the context of HIV
T2 - a qualitative study on community perspectives on facilitators and barriers related to breastfeeding among HIV positive mothers in Baringo County, Kenya
AU - Samburu, Betty Mogesi
AU - Kimiywe, Judith
AU - Young, Sera Lewise
AU - Wekesah, Frederick Murunga
AU - Wanjohi, Milka Njeri
AU - Muriuki, Peter
AU - Madise, Nyovani Janet
AU - Griffiths, Paula L.
AU - Kimani-Murage, Elizabeth W.
N1 - Funding Information:
This study was funded by the NIH and the USAID through the Partnership for Enhanced Engagement in Research (PEER) Health Program, administered by the National Academy of Sciences (NAS) to Kenyatta University and the African Population and Health Research Center (Grant # PGA2000003677/8). EWK-M was a Wellcome Trust Fellow during the conceptualization and design of the study and initial data collection (Grant # 097146/Z/11/Z) and is currently a Wellcome Trust International Engagement Fellow (Grant # 208791/Z/17/Z). PG was supported by a British Academy mid-career fellowship during the conduct of the study (Ref: MD120048).
Funding Information:
We thank mothers who shared their priceless time and interviewers for their full commitment. We also thank other community members for their contribution to the study. We acknowledge the Unit of Nutrition and Dietetics, Ministry of Health; UNICEF; and other nutrition stakeholders in Kenya, for their suggestions that guided the design and the implementation of the project. The Baringo County and the Koibatek sub-County Health Management Teams including Dr. Vincent Yator (Formerly sub-County health coordinator), Miriam Chebii (sub-County nutrition officer) and William Ngotie (sub-County community strategy focal person). We are indebted to APHRC?s research team including Dr. Catherine Kyobutungi for technical support. We also acknowledge the data transcriber through the support of APHRC.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/12
Y1 - 2021/12
N2 - Background: Although recent policies have sought to increase the rates of exclusive breastfeeding (EBF) and continued breastfeeding for HIV exposed infants, few programs have considered the multiple social and cultural barriers to the practice. Therefore, to generate evidence for exclusive and continued breastfeeding policies in Kenya, we examined community perspectives on the facilitators and barriers in adherence to EBF for the HIV positive mothers. Methods: Qualitative research was conducted in Koibatek, a sub-County in Baringo County Kenya, in August 2014 among 205 respondents. A total of 14 focus group discussions (n = 177), 14 In-depth Interviews and 16 key informant interviews were conducted. Transcribed data was analyzed thematically. NVivo version 10.0 computer qualitative software program was used to manage and facilitate the analysis. Results: Facilitators to exclusive breastfeeding were perceived to include counselling at the health facility, desire to have a healthy baby, use of antiretroviral drugs and health benefits associated with breastmilk. Barriers to EBF included poor dissemination of policies, knowledge gap, misinterpretation of EBF, inadequate counselling, attitude of mother and health workers due to fear of vertical HIV transmission, stigma related to misconception and misinformation that EBF is only compulsory for HIV positive mothers, stigma related to HIV and disclosure, social pressure, lack of male involvement, cultural practices and traditions, employment, food insecurity. Conclusions: There are multiple facilitators and barriers of optimal breastfeeding that needs a holistic approach to interventions aimed at achieving elimination of mother to child transmission. Extension of infant feeding support in the context of HIV to the community while building on existing interventions such as the Baby Friendly Community Initiative is key to providing confidential support services for the additional needs faced by HIV positive mothers.
AB - Background: Although recent policies have sought to increase the rates of exclusive breastfeeding (EBF) and continued breastfeeding for HIV exposed infants, few programs have considered the multiple social and cultural barriers to the practice. Therefore, to generate evidence for exclusive and continued breastfeeding policies in Kenya, we examined community perspectives on the facilitators and barriers in adherence to EBF for the HIV positive mothers. Methods: Qualitative research was conducted in Koibatek, a sub-County in Baringo County Kenya, in August 2014 among 205 respondents. A total of 14 focus group discussions (n = 177), 14 In-depth Interviews and 16 key informant interviews were conducted. Transcribed data was analyzed thematically. NVivo version 10.0 computer qualitative software program was used to manage and facilitate the analysis. Results: Facilitators to exclusive breastfeeding were perceived to include counselling at the health facility, desire to have a healthy baby, use of antiretroviral drugs and health benefits associated with breastmilk. Barriers to EBF included poor dissemination of policies, knowledge gap, misinterpretation of EBF, inadequate counselling, attitude of mother and health workers due to fear of vertical HIV transmission, stigma related to misconception and misinformation that EBF is only compulsory for HIV positive mothers, stigma related to HIV and disclosure, social pressure, lack of male involvement, cultural practices and traditions, employment, food insecurity. Conclusions: There are multiple facilitators and barriers of optimal breastfeeding that needs a holistic approach to interventions aimed at achieving elimination of mother to child transmission. Extension of infant feeding support in the context of HIV to the community while building on existing interventions such as the Baby Friendly Community Initiative is key to providing confidential support services for the additional needs faced by HIV positive mothers.
KW - Barriers
KW - Continued breastfeeding
KW - Exclusive breastfeeding
KW - Facilitators
KW - HIV
KW - Kenya
KW - Policy
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U2 - 10.1186/s13006-021-00385-1
DO - 10.1186/s13006-021-00385-1
M3 - Article
C2 - 33964950
AN - SCOPUS:85105587378
SN - 1746-4358
VL - 16
JO - International breastfeeding journal
JF - International breastfeeding journal
IS - 1
M1 - 39
ER -
