Attitudes on breast feeding among persons with HIV who have given birth and their perceptions of coercion during counseling on safe infant feeding practices

ABSTRACT

Persons with HIV can receive mixed messages about the safety of breastfeeding. We sought to assess if they felt coerced to formula feed when counseled about practices to reduce HIV transmission. Persons with HIV who had given birth were eligible to complete a survey to describe their experiences with infant feeding counseling and if they felt coerced to formula feed. An Iowa Infant Feeding Attitude Scale (IIFAS) assessed attitudes towards breastfeeding. Qualitative analyses were performed on narrative responses. One hundred surveys were collected from sites in Georgia, North Carolina, Pennsylvania, and South Carolina. The mean IIFAS score (n, 85) was 47 (SD 9.2), suggesting relatively favorable attitudes toward breastfeeding. Thirteen persons reported feeling coerced to formula feed. When controlling for choosing to give any breast milk, persons with any college education were more likely to report feeling coerced (aOR 9.8 [95% CI 1.8–52.5]). Qualitative analyses revealed three themes: perceiving breastfeeding as unsafe, engaging in shared decision-making, and resisting advice to formula feed. Persons with HIV desire to be counseled about safe infant feeding practices and have their questions answered without judgement. We highlight experiences of persons with HIV that reflect a need for a nuanced approach to infant feeding counseling.

KEYWORDS:

• Infant feeding
• formula
• breast milk
• HIV
• coercion
• counseling
• shared-decision making

Acknowledgements

Turner Byers, MUSC College of Medicine summer student research assistant, no funding to report. Raija Haughn and Shira Finke, College of Charleston summer undergraduate research assistants, CofC Dean’s discretionary funds.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was supported by (1) the College of Charleston’s Office of Undergraduate Research and Creative Activities Summer Undergraduate Research with Faculty Program and the School of Humanities and Social Sciences Dean’s Discretionary Funds and (2) the South Carolina Translational Research Institute voucher. The voucher is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Grant Number UL1 TR001450. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funds were allocated to summer student research assistant salaries and study participant gift cards.