Experiences of HIV positive women going through artificial infant feeding in an urban public clinic offering services to low income populations in São Paulo, Brazil
B. da Costa Thome1,2, R.C.d.M. Succi1, J. Pfeiffer2
1Federal University of São Paulo - UNIFESP, Pediatric Infectious Diseases, São Paulo, Brazil, 2University of Washington, Global Health - School of Public Health, Seattle, United States
Background: In Brazil,
where breastfeeding is normally promoted, the HIV/AIDS National Program
recommends that HIV positive mothers should not breastfeed their infants,
providing them with artificial milk formula. Despite the positive impact this
policy has had in decreasing HIV Mother to Child Transmission, little is known
about its emotional effects on mothers.
Methods: Using qualitative research methods, this study was conducted at a Center
for Pediatric AIDS Care (CEADIPE), in order to document mothers´ experiences
when advised not to breastfeed, and how health services address their needs and
provide them with adequate support. Open-ended interviews of 24 HIV positive
mothers were conducted and interpreted in light of mothers´ social and cultural
context, including women with and without previous breastfeeding experience.
Results: Although mothers felt non-
breastfeeding as a difficult topic, different patterns of reaction and
coping strategies were identified in the analysis of the interviews. Mothers´
frustrations and acceptance varied according to their age and previous
motherhood and infant feeding experiences, but in general they were more assured
if they felt they had enough information and support from health staff to deal
with artificial feeding, which for this cohort wasn´t a problem since they had
easy access to formula. The prescription of breast milk cessation through
mechanical methods was often described as painful and discriminating. Stigma
represented an important challenge to mothers not breastfeeding since it could
represent the disclosure of their HIV status. Fear was commonly mentioned
regarding babies health status especially when deprived of maternal milk.
Conclusions: Factors that influence mothers´ well being and how they
experience artificial feeding were identified, which can illuminate the points
of intervention where improvement of services could be most productive. The
role of the public sector in order to support mothers with formula milk and
specialized services proved to be crucial.
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