"We decided together": a qualitative study about women with HIV navigating infant-feeding decisions with the father of their children

Bakita Kasadha; Shema Tariq; Nell Freeman-Romilly; Catherine Pope; Angelina Namiba; Farai Nyatsanza; Lisa Hinton; Tanvi Rai

doi:10.1186/s12884-023-06198-w

"We decided together": a qualitative study about women with HIV navigating infant-feeding decisions with the father of their children

BMC Pregnancy Childbirth. 2024 Jan 6;24(1):41. doi: 10.1186/s12884-023-06198-w.

Authors

Bakita Kasadha¹, Shema Tariq^{2

3}, Nell Freeman-Romilly⁴, Catherine Pope⁵, Angelina Namiba⁶, Farai Nyatsanza⁷, Lisa Hinton⁵, Tanvi Rai⁵

Affiliations

¹ Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. bakita.kasadha@phc.ox.ac.uk.
² Institute for Global Health, University College London, London, UK.
³ Central and North West London NHS Foundation Trust, London, UK.
⁴ Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁵ Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
⁶ 4M Mentor Mothers Network, London, UK.
⁷ Cambridgeshire Community Services NHS Trust, Cambridge, UK.

Abstract

Background: The World Health Organization (WHO) recommends that women with HIV breastfeed for a minimum of one year. In contrast, United Kingdom (UK) guidelines encourage formula feeding, but breastfeeding can be supported under certain circumstances. Infant-feeding decisions often involve personal and social networks. Currently, little research addresses how individuals with HIV in high-income countries navigate infant-feeding decisions with the father of their children.

Methods: Semi-structured remote interviews were conducted with UK-based individuals with a confirmed HIV positive diagnosis who were pregnant or one-year postpartum, and two partners. Using purposive sampling, pregnant and postpartum participants were recruited through HIV NHS clinics and community-based organisations, and where possible, fathers were recruited via them. Data were analysed using thematic analysis and organised using NVivo 12.

Results: Of the 36 women interviewed, 28 were postpartum. The majority were of Black African descent (n = 22) and born outside the UK. The key factors in women navigating HIV and infant-feeding discussions with respect to their baby's father were the latter's: (1) awareness of woman's HIV status; (2) relationship with the woman; (3) confidence in infant-feeding decision; (4) support and opinion about woman's infant-feeding intentions. Most women made a joint decision with biological fathers when in a long-term (> one year) relationship with them. Single women tended not to discuss their infant-feeding decision with the father of their child, often for safety reasons.

Conclusion: Women in ongoing relationships with the father of their child valued their support and opinions regarding infant-feeding. In contrast, single women chose not to involve the father for reasons of privacy and safety. Clinical teams and community-based organisations should support mothers in discussing infant-feeding decisions regardless of relationship status. When appropriate, they should also support discussions with their partners, but remain sensitive to circumstances where this may put women at risk.

Keywords: Breastfeeding; HIV; HIV prevention; Infant-feeding; Mother-to-child transmission; Vertical transmission.

MeSH terms

Breast Feeding*
Child
Fathers
Female
HIV Infections*
Humans
Income
Infant
Male
Pregnancy
Qualitative Research