Practices, support and stigma related to infant feeding and postpartum engagement in care among women living with HIV in Canada

Figures & data

Figure 1 . Predictive factors of breastfeeding according to timing of HIV diagnosis (Odds ratio), ART: antiretroviral therapy

Table 1 . Risk factors for breastfeeding per live birth before and after HIV diagnosis.

Risk Factors		Delivery After HIV Diagnosis n = 409				Delivery Before HIV Diagnosis n = 1789
		Breastfeeding n = 21	Not Breastfeeding n = 388	Odds Ratios	Adjusted Odds Ratios	Breastfeeding n = 1204	Not Breastfeeding n = 585	Odds Ratios	Adjusted Odds Ratios
Year of delivery median (25–75th centile)		1999 (1996–2006)	2007 (2002–2011)	0.89 (0.83–0.95)	0.88 (0.81–0.96)	1992 (1986–1997)	1989 (1981–1994)	1.03 (1.02–1.04)	1.03 (1.02–1.05)
Province	British Columbia	2 (10%)	107 (28%)	0.23 (0.05–1.00)		356 (30%)	227 (39%)	0.64 (0.47–0.88)
	Quebec	5 (24%)	114 (29%)	0.52 (0.18–1.48)		343 (28%)	153 (26%)	0.69 (0.49–0.98)
	Ontario*	17 (28.6%)	154 (41.1%)			505 (42%)	205 (35%)
Age less than 25 years old at delivery	7 (33%)	75 (19%)	2.39 (0.9–6.3)		688 (57%)	386 (66%)	0.93 (0.77–1.11)
Country of birth other than Canada	15 (71%)	192 (49%)	2.55 (0.98–6.66)		638 (53%)	89 (15%)	5.35 (3.84–7.46)
Ethnicity	African, Caribbean, Black	15 (71%)	133 (34%)	2.67 (0.94–7.55)	1.85 (0.45–7.54)	503 (42%)	28 (5%)	14.24 (8.82–22.98)	4.01 (1.91–8.44)
	Other	1 (5%)	137 (35%)	0.18 (0.02–1.53)	0.15 (0.01–2.07)	334 (28.2%)	231 (39.1%)	1.56 (1.16–2.11)	1.37 (1–1.88)
	White*	5 (24%)	118 (30%)			287 (24.2%)	296 (50.1%)
Not Canadian citizenship	10 (48%)	88 (23%)	3.13 (1.32–7.43)		368 (31%)	35 (6%)	6.28 (3.81–10.37)
Not married, relationship or common-law	17 (81%)	233 (60%)	2.8 (0.93–8.39)		875 (73%)	454 (78%)	0.69 (0.50–0.95)
Unemployed	15 (71%)	294 (76%)	1.25 (0.47–3.28)		961 (80%)	541 (92%)	0.59 (0.44–0.80)
Delivery outside Canada	14 (67%)	28 (7%)	25.65 (9.75–67.46)	16.28 (5.71–46.42)	584 (49%)	38 (6%)	8.67 (5.73–13.14)	4.18 (2.21–7.88)
Education lower than high school	5 (24%)	53 (14%)	1.93 (0.67–5.58)		203 (17%)	213 (36%)	0.33 (0.24–0.45)	0.37 (0.26–0.52)
Unplanned pregnancy	9 (43%)	209 (54%)	0.63 (0.26–1.54)		575 (48%)	396 (68%)	0.59 (0.47–0.74)
Preterm delivery	2 (10%)	84 (22%)	0.38 (0.09–1.67)		146 (12%)	100 (17%)	0.63 (0.49–0.83)
Previous breastfeeding	10 (48%)	96 (25%)	4.15 (1.28–13.47)		616 (51%)	70 (12%)	37.38 (24.8–56.36)
HIV diagnosis during pregnancy	7 (24.1%)	85 (22.7%)	1.38 (0.63–3.03)
Not taking ART before pregnancy	16 (76%)	165 (45.0%)	3.91 (1.40–10.91)
At least one HIV positive child	2 (10%)	9 (2%)	5.42 (1.08–27.31)

*Reference category

Table 2. Care, support and experience regarding infant feeding practice in the CHIWOS cohort (55 women with 66 pregnancies in total).

Variable	N	(%)	Waves
Felt like received support for infant feeding practice used			2+3 (n=66)
Yes	40	(61)
No	12	(18)
NA/No response/DK/PNTA	14	(21)
Satisfaction with Counselling from Health Care Provider Regarding Optimal Infant Feeding Practices			2+3 (n=66)
Received counselling and satisfied	22	(33)
Received counselling but unsatisfied	1	(2)
Did not receive counselling	12	(18)
NA/No response/DK/PNTA	31	(47)
Health Care Provider Discussed Importance of Bonding with Child if not Breastfeeding			2 (n=40)
Yes	21	(53)
No	9	(23)
NA/No response/DK/PNTA	10	(25)
Access to Any Free Formula Programs for HIV-Positive Women			2 (n=40)
Yes	22	(55)
No	8	(20)
NA/No response/DK/PNTA	10	(25)
Concerned with the Impact of not Breastfeeding on her Role and Identity as a Mother			2 (n=40)
Yes	23	(58)
No	7	(18)
NA/No response/DK/PNTA	10	(25)
Experienced Social and Cultural Pressures to Breastfeed			2 (n=40)
Yes	18	(45)
No	12	(30)
NA/No response/DK/PNTA	10	(25)
Concerned About Being Identified as a Woman Living with HIV if not Breastfeed			2 (n=40)
Yes	15	(38)
No	14	(35)
NA/No response/DK/PNTA	11	(28)
Was offered a Medication for Lactation Inhibition			3 (n=26)
Yes	17	(65)
No	6	(23)
Not applicable	3	(12)

NA/No response/DK/PNTA: not applicable, no response, don’t know or prefer not to answer.

Figure 2 . HIV cascade of care of women of the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) who were within one year after delivery at any one of the study waves (n = 71). CHIWOS: W1. Wave 1 (2013–2015), W2. Wave 2 (2015–2017), W3. Wave 3 (2017–2018). ART: antiretroviral therapy

Table

	Wave 1 (2013–2015)	Wave 2 (2015–2017)	Wave 3 (2017–2018)
Objective 1: Breastfeeding practice
Did you breastfeed your baby, even if only for a short time? Yes/No	X
Objective 2: Care and support, Stigma/experience
Receive any counselling from your health care provider regarding optimal infant feeding practices Yes/No		X	X
Satisfied with the information provided Yes/No		X	X
Healthcare provider discuss the importance of bonding with your child if you’re not breastfeeding Yes/No		X
Offered a medication for lactation inhibition Yes/No			X
Access any free formula programs for HIV-positive women Yes/No		X
Received support for the infant feeding practice she used Yes/No		X	X
Concern with the impact of not breastfeeding on her role and identity as a mother Yes/No		X
Experience social and cultural pressures to breastfeed Yes/No		X
Concerned about being identified as a woman living with HIV if she didn’t breastfeed Yes/No		X
Objective 3: Postpartum cascade of care
Undetectable viral load Yes/No	X	X	X
ART Yes/No	X	X	X
Access to HIV Medical Care in the Past Year Yes/No	X	X	X
At least 2 visits to the clinic in the past year Yes/No	X	X	X