Women's autonomy in infant feeding decision-making: A qualitative study in Nairobi, Kenya

Abstract

Background: Exclusive breastfeeding (EBF) is the optimal way to feed young infants. Guidelines recommend that HIV-positive mothers on antiretroviral therapy (ART) should EBF for at least one year to reduce the risk of mother to child transmission of HIV (MTCT). Mothers may face social or logistic barriers making it difficult to EBF. Methods: This qualitative research was nested within a longitudinal study of intensive maternal counseling to increase EBF. HIV-negative and HIV-positive mothers were recruited from four public clinics in Nairobi. Women participated in focus group discussions (FGDs) that explored beliefs about and experiences with infant feeding. Conventional content analysis was used to describe and compare barriers and facilitators influencing HIV-positive and HIV-negative women’s EBF experiences. Results: We conducted 17 FGDs with 80 HIV-positive and 53 HIV-negative women between 2009- 2012. Overall, mothers agreed that breastmilk is good for infants. However, early mixed feeding was a common cultural practice. HIV-positive women perceived that infant feeding methods and durations were their decision. Autonomy in decision-making was facilitated by receiving EBF counseling and family support, especially from male partners. HIV-positive women reported healthier infants. In contrast, HIV-negative women reported less autonomy and more mixed feeding, citing peer pressure. Low milk production was a barrier to EBF, regardless of HIV status, and perceived to represent poor maternal nutrition. Conclusions: Despite challenges, EBF was a preferred practice after counseling, which empowered HIV-positive women to advocate for EBF with spouses and family.