“I Feed My Baby, As I Think, It is Good for My Baby”: Beliefs and Cultural Practices of Infant Feeding among HIV Positive Mothers in Mandalay, Myanmar

Abstract

Background: It was estimated that mother to child HIV transmission was 25% on average and there were 304,800 new child HIV infections due to vertical transmission in high HIV prevalent countries in 2010. WHO and medical professionals have recommended Exclusive Breastfeeding (EBF) or Exclusive Formula Feeding/ Exclusive Replacement Feeding (EFF/ERF) for HIV and infant feeding issue considering “HIV free survival” in HIV exposed babies born to HIV positive mothers. Mixed Feeding (MF) with breastfeeding, was strongly associated with increased HIV transmission to the babies while mixed feeding with formula feeding was claimed for increasing infant and under five years old children mortality and morbidity rate. But, infant mixed feeding is still composed of cultural norms, beliefs and practices. This article aimed to explore cultural beliefs and practices of infant mixed feeding practicing HIV positive mothers regarding under six months infant feedings: EFF/ERF, EBF and MF. Methods: This cross sectional qualitative study applied cultural interpretive medical anthropology. In-depth interviews with HIV positive mothers, peer counselors and medical professionals, focus group discussions with HIV positive mothers, and participant observations on HIV positive mothers’ infant feeding practices were conducted from August 2013 to early January 2014 in Mandalay, Myanmar. The data was entered and analyzed using manual data master sheet. Findings: Of 29 HIV positive mothers, 25 mothers practiced mixed feeding to their under six months babies. A total of 24 cultural infant mixed feeing patterns were found. The mothers had strong beliefs on cultural good mother and cultural seniority concepts related to infant health, growth and development, and on local infant illnesses: etiology, diagnosis, curative and preventive practices. Conclusions: Cultural infant mixed feeding practices resulted from HIV positive mothers’ dissatisfied perceptions, disagreement and confusion, of modern medical HIV and infant feeding counseling messages. Those infant mixed feeding patterns were a result of cultural forces of ‘good motherhood’ and ‘cultural seniority’ through ‘lay referral’ practices.