Mental health predictors of breastfeeding initiation and continuation among HIV infected and uninfected women in a South African birth cohort study

Breastfeeding is a cost-effective, yet underutilized strategy to promote maternal and infant health in low and middle income countries (LMICs). Breastfeeding remains challenging for mothers living with HIV in LMICs, yet few studies have examined mental health predictors of breastfeeding initiation a...

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Bibliographic Details
Published in:Preventive medicine 2017-09, Vol.102, p.100-111
Main Authors: Thomas, Eileen, Kuo, Caroline, Cohen, Sophie, Hoare, Jacqueline, Koen, Natassja, Barnett, Whitney, Zar, Heather J., Stein, Dan J.
Format: Article
Language:English
Subjects:
Breastfeeding
Exclusive breastfeeding
HIV
Psychosocial
South Africa
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Summary:Breastfeeding is a cost-effective, yet underutilized strategy to promote maternal and infant health in low and middle income countries (LMICs). Breastfeeding remains challenging for mothers living with HIV in LMICs, yet few studies have examined mental health predictors of breastfeeding initiation and continuation. We investigated breastfeeding among mothers by HIV status in South Africa, evaluating predictors of breastfeeding initiation and continuation to identify intervention-targets. Breastfeeding patterns were investigated in a subsample of 899 breastfeeding mothers from the Drakenstein Child Health Study; a prospective birth cohort of 1225 pregnant women, between March 2012 and March 2015 in a peri-urban area. Breastfeeding was assessed at 5 time-points between 6weeks and 24months' infant age. Cox proportional hazard models evaluated breastfeeding initiation and duration. Logistic regression models with breastfeeding non-initiation as the outcome parameter were performed to determine associations with maternal sociodemographic, psychosocial factors and gestational outcomes. More HIV-uninfected mothers initiated breastfeeding (n=685, 97%) than HIV-infected mothers (n=87, 45%). Median duration of exclusive breastfeeding was short (2months), but HIV-infected mothers engaged in exclusive breastfeeding for longer duration than uninfected mothers (3 vs 2months). Despite concerning high rates, mental disorders were not significant predictors of breastfeeding behaviour. Employment and HIV diagnosis during pregnancy predicted a lower likelihood of breastfeeding initiation among HIV-infected mothers, while employment was associated with earlier breastfeeding-discontinuation in HIV-uninfected mothers. Findings indicate that future interventions should target sub-populations such as HIV-infected women because of distinct needs. Workplace interventions appear particularly key for mothers in our study. •Breastfeeding is a cost-effective strategy to promote maternal and infant health.•HIV infected versus HIV uninfected mothers face differential challenges.•Mental health predictors of breastfeeding behaviour were examined.•Despite high rates, mental disorder was not significant predictors.•Tailored interventions are required for all breastfeeding mothers.
ISSN:0091-7435
1096-0260
DOI:10.1016/j.ypmed.2017.07.004