Infant feeding is estimated to be responsible for 5%-20% of the burden of HIV transmission from mother to child. HIV positive women who cannot afford safe formula feeding are advised to practise exclusive breastfeeding (EBF) followed by prompt weaning. We conducted a qualitative study using observations and in-depth individual interviews to explore patterns of EBF as well as which factors motivate or hinder women to practice EBF. HIV positive women who intended to practice EBF from urban Malawi were purposively selected and interviewed. All women were well informed and had high knowledge on HIV as well as on EBF but much less knowledge on basic facts about breastfeeding. Despite their intentions less than half of the interviewed women managed to practice EBF and the barriers were explained by perceived lack of milk, lack of control over the feeding situation, felt and enacted stigma as well as poor counselling. Women who succeeded were older, had the explicit support of their husband and lived without the presence of their mother-in-law. Weaning at the age of 6 months was reported to be as difficult for the women as EBF. Intention itself is not a sufficient determinant of successful EBF unless a number of enabling factors come together. Prolonged breastfeeding is the cultural norm in Malawi and programs must be sensitive to social expectations to mothers and involve mothers-in-law and fathers in counselling of mothers who intend to practice EBF (Afr. J. Reprod. Health 2010; 14[3]: 213-222).

 

 

Résumé

On appelle nos enfants les bébés « nevirapines » : Une étude qualitative sur l‟Allaitement Maternel Exclusif chez les mères séropositives au Malawi. On estime que l‟allaitement est responsable de 5% à 20% de la charge de la transmission du VIH de la mère à l‟enfant. Les femmes séropositives qui n‟ont pas les moyens d‟acheter l‟aliment lacté artificiel pour nourrir leurs enfants sont conseillées de pratiquer l‟allaitement maternel exclusif (AME) suivi du sevrage sans délai. Nous avons mené une étude qualitative à l‟aide des observations et des interviews en profondeur  individuels pour explorer les modèles de l‟AME et les facteurs qui les encouragent ou qui les empêchent de le faire. Les femmes séropositives qui venaient du Malawi urbain et qui avaient l‟intention de pratiquer l‟AME ont été délibérément sélectionnées et interrogées. Toutes les femmes ont été bien informées et avaient une bonne connaissance du VIH aussi bien que de l‟AME, mais elles possèdent beaucoup moins de connaissance quant aux données fondamentales concernant l‟allaitement. Malgré leurs intentions, moins de la moitié des femmes interrogées ont réussi à pratiquer l‟AME et elles ont expliqué que les obstacles comprenaient le manque perçu de lait, le manque de contrôle à l‟égard de la condition de l‟alimentation, la stigmatisation éprouvée et représentée aussi bien que le mauvais conseil. Les femmes qui ont réussi étaient les plus vieilles et celles qui avaient le soutien tacite de leurs maris et qui vivaient sans la présence de leurs belles-mères. On a déclaré que le sevrage à l‟âge de six mois était aussi difficile que l‟AME pour les femmes.  L‟intention elle-même n‟est pas un déterminant suffisant d‟un AME sauf si un nombre des facteurs son mis en place.  L‟allaitement prolongé est la norme au Malawi et il faut que les programmes soient sensibles aux attentes des mères et qu‟ils associent les belles-mères et les pères au conseil des mères qui ont l‟intention de pratiquer l‟AME (Afr. J. Reprod. Health 2010; 14[3]: 213-222).

 

 

Key words: Breastfeeding, exclusive breastfeeding, weaning, HIV/AIDS, Malawi.

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