Psychosocial and community perspectives on alternatives to breastfeeding

In developing countries, what advice to give HIV-positive mothers on infant feeding options remains a vexing public health issue. This paper reviews data on infant feeding practices in sub-Saharan Africa, the cultural context of breastfeeding, and the still meager literature of decision-making by HIV-positive mothers, following impartial counseling. Although prolonged breastfeeding is common, weaning foods typically are introduced early. A minority of women practice the recommended exclusive breastfeeding for 4-6 months. Breastfeeding taboos, expecially regarding colostrum, are common. The usual reason for introduction of weaning foods is to ensure that the baby has enough food. Exclusive formula feeding is perceived as stigmatizing, but acceptable with husband support. The main perceived barrier to formula is cost. Health workers may be less effective in conveying the risk of formula compared to the risk of HIV transmission in breast milk. Studies presently available regarding these issues are few and involve small samples. More studies are planned, and some are under way. By offering actual feeding choices to HIV-positive women, observing what choices they make, and monitoring the outcomes of these choices, we will be better placed to give advice.