"For someone to be called a father? You should participate in going to the clinic and looking after your child": a qualitative study on men's involvement in infant feeding in Kenya

Abstract

Background: Exclusive breastfeeding is a high impact strategy for infant development and survival. Guidelines recommend exclusive breastfeeding for six months for HIV-positive mothers on antiretroviral treatment to reduce mother-to-child transmission of HIV. Male partner attitudes and actions can influence a mother’s decision to exclusively breastfeed and the duration of exclusive breastfeeding. This qualitative study evaluates male partner views on their role in infant feeding and identifies factors impeding their involvement. Methods: This study was nested in a longitudinal study evaluating counseling for HIV-positive Kenyan women to increase exclusive breastfeeding rates. Male partners of female participants were recruited from clinics in Nairobi for focus group discussions. Male partner beliefs and experiences related to exclusive breastfeeding were identified using conventional content analysis. Results: Five focus group discussions with 31 male partners were conducted between 2010-2012. Data from these focus groups brought to light that within the Kenyan context, gender heavily influences perceptions surrounding men’s involvement in infant feeding. Many men expressed an interest in being involved with infant feeding practices, and more broadly care of the child, but they identified barriers to being involved many of which are tied to cultural constructs of masculinity and gendered divisions of labor and spaces. Male partners felt excluded at the clinic by health care workers and female clinic attendees who treated as a space for only women and children. They were less likely to return after an initial visit, losing the opportunity for exclusive breastfeeding education and to support the mother and child. Conclusion: Men viewed involvement in infant feeding as a wide range of activities ranging from providing financial support up to being involved in direct care tasks. It is important to capitalize on male partner interest to be involved, but in a way that keeps the context in mind and incorporates and impacts various socio-ecological factors. Supporting alternative ideas of masculinity that include involvement in infant feeding practices and care of the child, along with promoting inclusive clinic spaces for male partners may improve an HIV-positive woman’s decision to exclusively breastfeed and the duration of her exclusive breastfeeding.