The influence of family members on adherence to exclusive breastfeeding; experiences of women in prevention of mother to child transmision of HIV programme in extension 8 clinic (Mhluzi)

Abstract

Introduction HIV positive post natal women on a PMTCT program who have opted for exclusive breastfeeding are experiencing pressures from families to give solids, water based fluids, traditional medicines, and complimentary medicines as early as the first 48 hours of life of a newborn baby. The early feeding practice is in contradiction with the PMTCT recommended six months of exclusive breastfeeding or formula feeding Aim The aim of the study was to explore the influence of the family on adherence to exclusive breastfeeding among post natal women on PMTCT programme Objectives of the study were: To explore the influence of the family on adherence to exclusive breastfeeding among women on PMTCT Programme in Extension 8 clinic. To explore the ways in which women on PMTCT programme in Extension 8 clinic deal with the family influences on exclusive breastfeeding. Methodology Focus group discussions (FGDs) and in-depth interviews (IDls) were conducted with post natal women enrolled in the PMTCT program of a community health centre at the Steve Tshwete Local Municipality in Mpumalanga. A focus group guide developed by researcher in English and translated to IsiZulu was used to conduct the FGDS and IDls with 40 HIV positive women who opted for exclusive breastfeeding. A total of five FGDs and seven IDls $J were conducted. . Data analysis The data was analyzed using contents analysis which allowed the categories to emerge from the data. Data analysis began with the verbatim transcription of the transcript in IsiZulu which were later translated into English. This was followed by the identification and definition of emerging themes and the development of a code list. The initial application on themes on the transcripts was done manually to identify themes and subthemes, and new themes that emerged during this process were defined and added to the code list,transcriptswererecoded if a new theme emerged or if a theme was redefined. The fmal code list was adapted from seven codes to thirteen codes. The transcripts were then imported to NVivo 9 and the researcher started applying the codes to the remaining transcripts.

Findings The study found that though it was a norm that babies must be given solids, water, traditional, and complementary medicines, most participants adhered to exclusive feeding. Good infant feeding coun~elling, and good knowledge and understanding of MTCT also served as a strong motivation for participants to adhere to their feeding options. The study also found that the family interfered in infant feeding throughout the exclusive breastfeeding life of the babies. Even when families supported exclusive breastfeeding, they still wanted the mother to give solids and water. The data suggest that the concept of exclusive breastfeeding is not well understood by the family and is contextualised as meaning breastfeeding. The data further show that participants had some fears and uncertainties about exclusive breast feeding, and lived in constant fear that they might infect their babies with HIV and that they were starving the babies. In addition, participants had fears of the consequences of delaying and or ignoring cultural practices.

Conclusion:

The study concludes that the family interfered in infant feeding throughout the exclusive breastfeeding life of the babies. They struggled to understand exclusive breastfeeding concept and expected the mother to give the baby solids and water because it was a norm.

Recommendations ~ Given that the family lacks understanding of exclusive breastfeeding, it is recommended that the family be involved in the education and counselling for exclusive infant feeding practices to promote knowledge and understanding ofMTCT ofHIV. Involving the family in PMTCT will also highlight the risks of some of the cultural practices in transmission of HIV to the

baby.