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Financial and Food Insecurity are Primary Challenges to Breastfeeding for Women Living with HIV in Western Kenya: A Longitudinal Qualitative Investigation

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Abstract

Exclusive breastfeeding for the first 6 months and continued breastfeeding for 24 months or longer is recommended for all mothers world-wide, including women living with HIV (WLWH). Given evidence of suboptimal infant feeding and the need to understand context specific barriers, we explored experiences of perinatal WLWH in Kisumu, Kenya. We applied a longitudinal qualitative approach (4 in-depth interviews) with 30 women from pregnancy to 14–18 months postpartum. Cross-sectional profiling led to a narrative description of infant feeding across time. The majority of women breastfed exclusively for 6 months and weaned by 18 months. Severe financial and food insecurity were primary challenges as women worked through when/how to breastfeed or stop breastfeeding in the setting of multiple competing priorities/pressures across time. Financial and food support and increased support for breastfeeding beyond 18 months have the potential to reduce women’s stress and uncertainty associated with infant feeding as well as optimize infant health and nutrition in this setting.

Resumen

Se recomienda la lactancia materna exclusiva durante los primeros 6 meses y la continuación de la lactancia durante 24 meses o más para todas las madres en todo el mundo, incluidas las mujeres que viven con el VIH (WLWH). Debido a la evidencia de alimentación infantil subóptima y la necesidad de comprender las barreras específicas del contexto, exploramos las experiencias de WLWH perinatal en Kisumu, Kenia. Aplicamos un enfoque cualitativo longitudinal (4 entrevistas en profundidad) con 30 mujeres desde el embarazo hasta los 14-18 meses posparto. El perfil transversal resultó en una descripción narrativa de la alimentación infantil a través del tiempo. La mayoría de las mujeres amamantaron exclusivamente durante 6 meses y dejó de amamantar a los 18 meses. La grave inseguridad financiera y alimentaria fueron los principales desafíos cuando las mujeres analizaban cuándo y cómo amamantar o dejar de amamantar en el contexto de múltiples prioridades y presiones en competencia a través del tiempo. El apoyo financiero y alimentario y un mayor apoyo para la lactancia más allá de los 18 meses tienen el potencial de reducir el estrés y la incertidumbre de las mujeres asociados con la alimentación infantil, así como optimizar la salud y la nutrición infantil en este entorno.

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Acknowledgements

We would like to thank the sub-county hospital staff for supporting our study as well as the participants who kindly shared their experiences with us. We would also like to thank Kenya Medical Research Institute (KEMRI) for providing ethical oversight and logistical support to conduct this research in Kenya.

Funding

ELT was supported by UCSF Center for AIDS Prevention Studies, Center for AIDS Research and by the National Institutes of Health under Grants K23MH116807 (ELT), K24DA037034 (SDW).

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Authors and Affiliations

  1. Department of Community Health Systems, School of Nursing, University of California, 2 Koret Way, San Francisco, CA, 94143, USA

    Emily L. Tuthill, Ann E. Maltby & Carol Dawson-Rose

  2. Global Programs for Research and Training - Kenya, University of California, San Francisco, CA, USA

    Belinda C. Odhiambo

  3. Kenya Medical Research Institute- Center for Microbiology Research, Nairobi, Kenya

    Eliud Akama

  4. Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA

    Craig R. Cohen

  5. Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA

    Sheri D. Weiser

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  1. Emily L. Tuthill
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Contributions

ET conceived of the idea; analyzed data and wrote manuscript; AM analyzed data and drafted manuscript; BO collected the data, assisted with analysis and drafting of manuscript; EA contributed to drafting of manuscript; CD contributed to the review of manuscript, CC contributed to the research design and review of manuscript; SW contributed to the research question, and finalization of manuscript.

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Correspondence to Emily L. Tuthill.

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Tuthill, E.L., Maltby, A.E., Odhiambo, B.C. et al. Financial and Food Insecurity are Primary Challenges to Breastfeeding for Women Living with HIV in Western Kenya: A Longitudinal Qualitative Investigation. AIDS Behav 27, 3258–3271 (2023). https://doi.org/10.1007/s10461-023-04046-8

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