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Counseling and choosing between infant-feeding options: Overall limits and local interpretations by health care providers and women living with HIV in resource-poor countries (Burkina Faso, Cambodia, Cameroon)

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  • Desclaux, Alice
  • Alfieri, Chiara

Abstract

As part of prevention of HIV mother-to-child transmission (PMTCT) strategies, HIV-positive women are asked to choose between two options regarding infant feeding: replacement feeding or exclusive breastfeeding with early weaning. Health services must offer women counseling, guidance, and support to enable them to make an informed choice. This article aims to shed light on the content of counseling and its adaptation to local situations, including women's perceptions, in three resource-poor countries with different infant feeding patterns (Burkina Faso, Cambodia, and Cameroon). The qualitative study included observations in health facilities and interviews with HIV-positive mothers and health workers. The results show that counseling practices vary, including prescriptive counseling proposing only one option to all women, an option based on the mother's economic level assessed by health care providers, and the choice between options. While health workers consider economic aspects first, women mostly consider social aspects related to the risk of being stigmatized as a "bad mother'" or as HIV-positive. Overall trends identify some limits to counseling effectiveness when considering women's perceptions and needs, such as: the content of information provided by health care providers, duration and timing of counseling, discrepancies between information provided during counseling and from the health system, and ranking of preventive options by health workers. Women's agency for feeding choices is related to local practices and local authorities' abilities to provide more or less comprehensive counseling based on the organization of the health and aid system. Local practices also depend on institutions' interpretations of international recommendations based on public health considerations regarding standard of care and women's and the health system's respective responsibilities. Beyond structural constraints that hinder the adoption of preventive infant feeding patterns, addressing these issues may help improve counseling practices.

Suggested Citation

  • Desclaux, Alice & Alfieri, Chiara, 2009. "Counseling and choosing between infant-feeding options: Overall limits and local interpretations by health care providers and women living with HIV in resource-poor countries (Burkina Faso, Cambodia, ," Social Science & Medicine, Elsevier, vol. 69(6), pages 821-829, September.
  • Handle: RePEc:eee:socmed:v:69:y:2009:i:6:p:821-829
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    Citations

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    Cited by:

    1. Våga, Bodil Bø & Moland, Karen Marie & Evjen-Olsen, Bjørg & Blystad, Astrid, 2014. "Reflections on informed choice in resource-poor settings: The case of infant feeding counselling in PMTCT programmes in Tanzania," Social Science & Medicine, Elsevier, vol. 105(C), pages 22-29.
    2. Tijou Traoré, Annick & Querre, Madina & Brou, Hermann & Leroy, Valériane & Desclaux, Alice & Desgrées-du-Loû, Annabel, 2009. "Couples, PMTCT programs and infant feeding decision-making in Ivory Coast," Social Science & Medicine, Elsevier, vol. 69(6), pages 830-837, September.
    3. Richards, Esther & Theobald, Sally & George, Asha & Kim, Julia C. & Rudert, Christiane & Jehan, Kate & Tolhurst, Rachel, 2013. "Going beyond the surface: Gendered intra-household bargaining as a social determinant of child health and nutrition in low and middle income countries," Social Science & Medicine, Elsevier, vol. 95(C), pages 24-33.
    4. Prakash Shakya & Mika Kondo Kunieda & Momoko Koyama & Sarju Sing Rai & Moe Miyaguchi & Sumi Dhakal & Su Sandy & Bruno Fokas Sunguya & Masamine Jimba, 2017. "Effectiveness of community-based peer support for mothers to improve their breastfeeding practices: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 12(5), pages 1-24, May.

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