Attitudes towards exclusive breastfeeding and other infant feeding options--a study from Abidjan, Cote d'Ivoire

The HIV/AIDS-pandemic causes many problems for the most affected societies and their health care systems. One of these is the 'parent to child transmission' (PTCT) through breastmilk and its prevention (PPTCT). As economic and hygienic conditions do not always assure safe replacement feeding in developing countries, a WHO/UNAIDS/UNICEF-expert panel proposed methods to reduce the risk of PTCT but to use breastmilk for infant feeding. The study presented here aimed at identifying the expected acceptance of such a concept by addressing the attitudes of women in Abidjan, Ivory Coast. Interviews were performed with 150 mothers and 60 pregnant women. The vast majority regarded breastfeeding as the appropriate method of infant feeding, although the idea of exclusive breastfeeding was not well accepted. Water, especially, was felt to be a necessary supplement. In case of a suggested HIV-infection of the mother, 74 per cent of the women voted for weaning after 3 months. Eighty-three per cent accepted the exclusive use of breastmilk substitutes from birth. Seventy-six per cent were ready to boil their milk for pasteurization. Only 37 per cent considered a wet-nurse to breastfeed their child. As mixed breastfeeding implies a highest risk of PTCT of HIV, the most favoured option-exclusive breastfeeding and early weaning-requires some effort to convince women that breastmilk is a sufficient source of nutrients, fluid and energy for their child and that this feeding should preferably be practised up to 6 months of age. For affluent women, breastmilk substitutes can also be considered as a means of PPTCT in overall resource-poor countries. For the majority of women, there is no real alternative to breastfeeding and to the use of breastmilk for which appropriate technologies of PPTCT are to be developed with respect to national, local and household specifications.