Commonalities and differences in infant feeding attitudes and practices in the context of HIV in sub-Saharan Africa: a metasynthesis

AIDS Care. 2014 Feb;26(2):214-25. doi: 10.1080/09540121.2013.813625. Epub 2013 Jul 23.


Exclusive breastfeeding (EBF) has been identified as a key intervention to promote infant health and to reduce the vertical transmission of HIV. Despite this knowledge and increased resources to promote EBF, the practice in sub-Saharan Africa (SSA) remains low among HIV+ women. Although a number of qualitative studies have been conducted throughout SSA, the influences on and consequences of infant feeding choices of HIV+ mothers' findings have not been regarded systematically. Therefore, our objective was to identify overarching themes, commonalities, and differences in infant feeding choices among qualitative studies with HIV+ mothers in SSA. Sixteen qualitative studies of infant feeding practices in the context of HIV were identified. Noblit and Hare's seven-step metasynthesis methodology was used to analyze the experiences of HIV+ women and those who provide infant feeding services/counseling. Data were available from approximately 920 participants (i.e., 750 HIV+ mothers, 109 health-care providers, and 62 family members) across 13 SSA countries from 2000 to 2011. From these data, five themes emerged within which 3-4 overarching key metaphors were identified. The consistency of key metaphors across a variety of geographic, economic, and cultural settings suggest the importance of approaching infant feeding holistically, within the context of maternal knowledge, health-care support, family resources, and cultural expectations. EBF campaigns in SSA are more likely to successfully support optimal health for infants and a safe supportive environment for their mothers when the impact of infant feeding decisions are evaluated across these themes.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Africa South of the Sahara
  • Bottle Feeding*
  • Breast Feeding / psychology
  • Breast Feeding / statistics & numerical data*
  • Counseling
  • Female
  • HIV Seropositivity / transmission*
  • Health Knowledge, Attitudes, Practice
  • Health Promotion
  • Humans
  • Infant
  • Infant Formula
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical / prevention & control*
  • Male
  • Milk, Human*
  • Mothers* / psychology
  • Mothers* / statistics & numerical data
  • Peer Group
  • Pregnancy
  • Qualitative Research
  • Social Perception