Reconceptualising issues around HIV & breastfeeding advice: findings from KwaZulu‐Natal, South Africa

This article is concerned with the dynamics between health care workers and pregnant women, and advice given to women about mother‐to‐child transmission (MTCT) through breastfeeding in KwaZulu‐Natal (KZN). Using ethnographic methods, it explores issues relating to HIV and infant feeding in settings where a period of breastfeeding is expected. The anti‐baby milk action of the 1970s remains an important point of reference, which has profoundly shaped attitudes towards breastfeeding as ‘the culture of health’. For many health professionals in KZN, the breastfeeding lobby, on which the authority of many nurses depends, and its successes, are now perceived to be undermined by AIDS and the ‘AIDS camp’. International data that point to the risks attached to any period of breastfeeding have provoked a range of reactions among health workers in KZN, from suspicion attached to information ‘from outside’, to confusion and outright disbelief. An integral part of this study is the pattern of power relations that pertain between health workers and their patients, and the values they may seek to sustain. Many nurses hold negative attitudes about young, pregnant and largely unmarried mothers, and HIV/AIDS is an additional stigma. Nurses’ professional socialisation, influencing how they construct gender, women with HIV, and ‘motherhood’, has an important bearing on how they interact with vulnerable young women, and on the information and advice they make available to them. These patterns will also shape the ways in which they engage with the new South African and UNAIDS policy guidelines, which emphasise a woman's right to make an informed decision on infant feeding, in what is a rights’ culture. These representations, investments, and practices, are also shaped by earlier identity processes, and are shot through with images of gender, class and ethnicity. How to advise and counsel HIV+ women on how best to feed their babies raises some of the most complex and hotly debated issues in health care ethics today. It is imperative that these issues, including the ideologies and discourses that may accompany changes in breastfeeding practices, and the values they underwrite, be explored from new angles, underpinned by social theory.