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Breastfeeding: The Hidden Barrier in PMTCT

Posted: May 13, 2014 · Posted by: Lisa Niemann

In Côte d’Ivoire, HAI works to improve the care for HIV-positive women during pregnancy, through birth, and beyond in order to decrease rates of mother-to-child transmission of HIV. With proper care and treatment, it is possible to greatly decrease the likelihood of a woman passing HIV on to her infant. However, successfully preventing transmission requires coordination of care from health providers and the ability of the woman to adhere to treatment.

A Côte d'Ivoirian healthcare worker performing a standard HIV screening on a Pregnant Woman. Photo Credit: Adam Granato

Heather Buesseler, a former HAI practicum student, as well as HAI staff Ahoua Koné and Julia Robinson, Albert Bakor of I-TECH and Kirsten Senturia of the UW Department of Global Health, recently published a study that explored HIV-positive women’s experiences with the health care system as they accessed prenatal care, delivery, and postpartum services.

Her research found that many aspects of care were serving women well.  Women reported positive interactions with health care personnel, good access to drugs and adherence to drug regimens, and a strong will to adhere to protect their own and their infant’s health.

Health care site where pregnant women can come for antepartum and postpartum care. Photo by: Adam Granato. 

However, several barriers related to the women’s ability to adhere to treatment did exist, such as not disclosing of HIV status to their partners and the difficulty of following infant feeding recommendations. This study found that of these, infant feeding was the biggest struggle for women in PMTCT. At the time of the study, Côte d’Ivoire followed the WHO recommendation of breastfeeding exclusively for the first six months, then introducing complimentary foods, and continue breastfeeding through 12 months. They recommended breastfeeding be discontinued when a “nutritionally adequate and safe diet without breast milk can be provided.” 

In Côte d’Ivoire, however, it is culturally accepted to breastfeed an infant until they are one to two years old, so if a woman stops breastfeeding before then may draw attention from friends and family members, who might wonder why she has decided to wean her infant. The cost of formula and alternative foods was also shown to be a barrier to switching away from breast milk, as was the challenge of a reliably clean water source with which to mix the formula.

This study demonstrates some of the successes in addressing barriers to adherence for HIV positive pregnant women in Côte d’Ivoire, but also identifies ongoing challenges with stigma, disclosure, and especially with infant feeding practices. HAI continues to collaborate with the UW and MPH students to illuminate these challenges through research – then work with the MOH to design programs to address these challenges.

You can view the article at the link here.  

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