ETHNOGRAPHY OF INFANT FEEDING IN SUB-SAHARAN AFRICA: CASE STUDIES IN THE CONTEXT OF HIV/AIDS AND NEWBORN CARE

Abstract

The three ethnographic case studies described in this dissertation provide a cultural description of breastfeeding behavior with respect to HIV/AIDS and newborn care, and with a focus on early infancy. Study 1: Influences on infant feeding decisions were investigated in-depth interviews with a sample of 22 HIV-positive mothers from Kwa-Zulu Natal, South Africa. Five themes were identified: social stigma of HIV infection; maternal age and family influences on feeding practices; economic circumstances; beliefs about HIV transmission through breastmilk; and beliefs about the quality of breastmilk compared to formula. Mothers knew that breastmilk can infect the infant with HIV, but a dominant theme was that breastmilk protects children and is superior to formula. Study 2: Local feeding practices for the newborn, and how these ?fit? within the repertoire of newborn care giving practices were assessed in Pemba Island, Tanzania. In-depth interviews were conducted with 13 peri-urban mothers and 30 rural mothers. Beliefs underlying neonatal care-giving practices included: a) fear of maternal and/or newborn death at the time of delivery; b) vulnerability of the newborn; c) ritual pollution after childbirth and d) feeding strategies believed to enhance newborn health and survival. From a pile sort exercise conducted with a literate sub-sample, infant feeding was found to be conceptualized as distinct from other newborn care giving practices. Study 3: The 30 rural women from study 2 were provided with advice to improve feeding behavior during pregnancy. Their responses to the advice were assessed postpartum. Breastfeeding newborns was part of cultural expectation and practice, but exclusive breastfeeding was not. In all three communities, breastfeeding is highly valued and is culturally normative. The first study results offer a glimpse of the forces that influence HIV positive women as they attempt to make an informed choice about feeding their infants. Results from the second study suggest that interventions could specifically target feeding without having to affect other domains of newborn care. Results from the third study offer guidance for designing education messages for promoting exclusive breastfeeding during the first few weeks of infant life. Taken together, the three studies provide useful information for breastfeeding promotion activities.