Postpartum
Gaps in Research
- 1.
- HIV-positive mothers, fathers, grandmother and the larger community need clear, consistent, non-contradictory and nonjudgmental counseling on infant feeding practices. Health care providers need training based on accurate information.
- 2.
- Further efforts are needed to identify and treat mastitis in order to reduce HIV transmission in HIV-positive women who are breastfeeding.
- 3.
- Accurate testing techniques for infants may inform infant feeding.
- 4.
- Stigma reduction interventions are needed so that HIV-positive women can choose replacement feeding, breastfeeding and weaning schedules.
- 5.
- Additional efforts are needed to provide postpartum women with contraception information and methods so they may space or prevent their next pregnancy.
- 6.
- Further efforts are needed to educate families about HIV transmission so that infants are not abandoned.
- 7.
- WHO/UNICEF recommendations on the meaning of “acceptable, sustainable, safe and feasible” should be clarified so it can be translated effectively in programmatic settings.
1. HIV-positive mothers, fathers, grandmothers and the larger community need clear, consistent, non-contradictory and nonjudgmental counseling on infant feeding practices. Health care providers need training based on accurate information. Studies found that health care providers gave HIV-positive women conflicting information and that simplified structured counseling tools are needed. Studies found that women reported that providers accused them of killing their infants if they breastfed. Women lack access to infant formula but have been told by providers that it is the only way for their infant to survive. Women were told that breastfeeding is a mode of HIV transmission and exclusive breastfeeding is a mode of prevention. Women fear HIV more than diarrheal disease, even though more deaths occur from diarrheal disease. Women were not given choices. Women did not give providers accurate information on how they were feeding their infant for fear of being denied health care. Women lacked autonomy to decide infant feeding, which was decided by male partners or grandmothers.
Gap noted, for example, in Burkina Faso, Cambodia and Cameroon (Desclaux and Alfieri, 2009), Malawi, Kenya and Zambia (Chopra et al., 2009), Malawi (Kerr et al., 2008), Lesotho (Towle and Lende, 2008), Botswana, Kenya, Malawi and Uganda (Chopra and Rollins, 2008 and Coutosidis et al., 2002 cited in Chopra and Rollins, 2008), and Cameroon (Kakute et al., 2005).
Desclaux, A. and C. Alfieri. 2009. “Counseling and Choosing between Infant-Feeding Options: Overall Limits and Local Interpretations by Health Care Providers and Women Living with HIV in Resource-Poor Countries (Burkina Faso, Cambodia, Cameroon).” Social Science and Medicine 69: 821-829.
2. Further efforts are needed to identify and treat mastitis in order to reduce HIV transmission in HIV-positive women who are breastfeeding. Studies found that maternal HIV infection was correlated with mastitis and the potential for vertical transmission, but treatment for mastitis did not reduce the HIV viral load in breastmilk.
Gap noted, for example, in Zambia (Kasonka et al., 2006), Tanzania (Kantarci et al., 2007) and Malawi (Nussenblatt et al., 2006).
Kasonka, L., M. Makasa, T. Marshall, M. Chisenga, M. Sinkala, C. Chintu, C. Kaseba, F. Kasolo, R. Gitau, A. Tomkins, S. Murray and S. Fiteau. 2006. “Risk Factors for Subclinical Mastitis among HIV-infected and Uninfected Women in Lusaka, Zambia.” Pediatric and Perinatal Epidemiology 20: 379-391.
3. Accurate testing techniques for infants may inform infant feeding. Studies note that rapid scale up of early infant diagnosis is needed in low- resource settings in order to access treatment and care as soon as possible. [For WHO guidance on HIV testing in infants see: [ http://www.who.int/hiv/topi cs/vct/toolkit/additional_resources/children/en/][36]]
Gap noted, for example, in Tanzania (Finnegan et al., 2009: 216); Kenya (Inwani et al., 2009: 492); South Africa (Rollins et al., 2009:1855); Vietnam (Sohn et al., 2009); West Africa (Msellati, 2009:809).
Finnegan, J., K. Nobel and R. Lodha. 2009. “Evidence Behind the WHO Guidelines: Hosptial Care for Children: What is the Role of HIV Antigen Testing in Infants under 12 Months Old?” Journal of Tropical Pediatrics 55 (4): 216-218.
4. Stigma reduction interventions are needed so that HIV-positive women can choose replacement feeding, breastfeeding and weaning schedules. Studies found that HIV-positive women feared that if they used infant formula or abruptly weaned, they would be stigmatized for their HIV-positive serostatus.
Gap noted, for example, in Malawi, (Chinkonde et al., 2009), Ethiopia (Gaga et al., 2008), Malawi (Thorsen et al., 2008 and Banda et al., 2008), and South Africa (Doherty et al., 2006).
Chinkonde, J., J. Sundby and F. Martinson. 2009. “The Prevention of Mother-to-Child HIV Transmission Programme in Lilongwe, Malawi: Why Do So Many Women Drop Out?” Reproductive Health Matters 17 (33): 143-151.
5. Additional efforts are needed to provide postpartum women with contraception information and methods so they may space or prevent their next pregnancy. Studies found that women were not given contraceptive counseling or contraceptives postpartum and that transport costs restricted their ability to gain access to their contraceptive method of choice. Studies also found an unmet need for postpartum contraception among HIV-positive women. Studies found that sexuality and condom use need to be addressed when sexual activity resumes postpartum. Family planning services are most often not provided postpartum in PMTCT programs.
Gap noted, for example, in South Africa (Moodley et al., 2008a), Kenya (Chersich et al., 2008b), Côte d’Ivoire (Brou et al., 2008), Kenya and Zambia (Thea et al., 2006).
Moodley, D., I. Msweli, A. Groves, E. Smith and S. Maman. 2008a. “Missed Opportunities to Prevent Unintended Pregnancy in Durban, South Africa.” Abstract TUPE0838. XVII International AIDS Conference. Mexico City, Mexico. August 3-8.
6. Further efforts are needed to educate families about HIV transmission so that infants are not abandoned. A study found that families forced HIV- positive women to abandon their infants due to erroneous fears that the infants could transmit HIV.
Gap noted, for example, in Russia.
Zabina, H., D. Kissin, E. Pervysheva, A. Mytil, O. Dudchenko, and S. Hillis. 2009. “Abandonment of Infants by HIV-positive Women in Russia and Prevention Measures.” Reproductive Health Matters 17 (3): 162-170.
7. WHO/UNICEF recommendations on the meaning of “acceptable, sustainable, safe and feasible” should be clarified so it can be translated effectively in programmatic settings. A study found that confusing and contradictory advice was given by providers on when to feed with infant formula.
Gap noted, for example, in South Africa,.
Doherty, T., M. Chopra, L. Nkonki, D. Jackson and T. Greiner. 2006. “Effect of the HIV Epidemic on Infant Feeding in South Africa: ‘When They See Me Coming with the Tins They Laugh at Me.’” Bulletin of the World Health Organization 84 (2): 90-96.