Maternal and Child Health Journal

, Volume 20, Issue 12, pp 2599–2606 | Cite as

Intimate Partner Violence Against HIV-Positive Women is Associated with Sub-Optimal Infant Feeding Practices in Lusaka, Zambia



Objectives The aim of this study is to determine how intimate partner violence against HIV-positive women affects safe infant feeding practices in Lusaka, Zambia. Methods A cross-sectional face-to-face survey was conducted with 320 married postpartum women at a large public health center in Lusaka, Zambia, in 2014. Variables were measured using previously validated instruments from the Demographic and Health Survey. Data were analyzed using simple and multivariate logistic regression in Stata 12. Results Thirty-seven percent of women report early mixed infant feeding prior to six months. Women who experienced intimate partner violence have 2.8 higher adjusted odds of early mixed infant feeding (p < 0.001). Women who experienced emotional violence, specifically, have 1.9 higher adjusted odds of early mixed infant feeding (p < 0.05), while women who experienced sexual violence have 2.3 higher adjusted odds (p < 0.01). There is also a dose–response relationship between IPV and early mixed infant feeding (p < 0.05). Lastly, disclosing one’s HIV-positive status to the husband is associated with at least 67 % lower adjusted odds of early mixed feeding (p < 0.05). Conclusions Intimate partner violence against HIV-positive women, in particular emotional and sexual violence, increases the likelihood of early mixed infant feeding, putting infants at greater risk for both mother-to-child transmission of HIV and other infant morbidities. Intimate partner violence should thus be given increased attention within the context of infant feeding and HIV in sub-Saharan Africa.


Intimate partner violence Domestic violence Mixed infant feeding Prevention of mother-to-child transmission HIV and infant feeding Sub-Saharan Africa Zambia Exclusive breastfeeding 


  1. Bahl, R., Frost, C., Kirkwood, B. R., Edmond, K., Martines, J., Bhandari, N., et al. (2005). Infant feeding patterns and risks of death and hospitalization in the first half of infancy: Multicentre cohort study. Bulletin of the World Health Organization, 83(6), 418–426.PubMedPubMedCentralGoogle Scholar
  2. Coovadia, H. M., Rollins, N. C., Bland, R. M., Little, K., Coutsoudis, A., Bennish, M. L., et al. (2007). Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: An intervention cohort study. Lancet, 369(9567), 1107–1116. doi:10.1016/S0140-6736(07)60283-9.CrossRefPubMedGoogle Scholar
  3. Coutsoudis, A., Pillay, K., Kuhn, L., Spooner, E., Tsai, W. Y., & Coovadia, H. M. (2001). Method of feeding and transmission of HIV-1 from mothers to children by 15 months of age: Prospective cohort study from Durban, South Africa. AIDS, 15(3), 379–387.CrossRefPubMedGoogle Scholar
  4. CSO and Macro International Inc. (2009). Zambia Demographic and Health Survey 2007. Calverton, Maryland, USA: Central Statistical Office (CSO), Ministry of Health (MOH), Tropical Diseases Research Centre (TDRC), University of Zambia, & Macro International Inc.Google Scholar
  5. Doherty, T., Chopra, M., Jackson, D., Goga, A., Colvin, M., & Persson, L. A. (2007). Effectiveness of the WHO/UNICEF guidelines on infant feeding for HIV-positive women: Results from a prospective cohort study in South Africa. AIDS, 21(13), 1791–1797. doi:10.1097/QAD.0b013e32827b1462.CrossRefPubMedGoogle Scholar
  6. Doherty, T., Chopra, M., Nkonki, L., Jackson, D., & Persson, L. A. (2006). A longitudinal qualitative study of infant-feeding decision making and practices among HIV-positive women in South Africa. Journal of Nutrition, 136(9), 2421–2426.PubMedGoogle Scholar
  7. Ellsberg, M., Jansen, H. A., Heise, L., Watts, C. H., & Garcia-Moreno, C. (2008). Intimate partner violence and women’s physical and mental health in the WHO multi-country study on women’s health and domestic violence: An observational study. The Lancet, 371(9619), 1165–1172. doi:10.1016/S0140-6736(08)60522-X.CrossRefGoogle Scholar
  8. Fadnes, L. T., Engebretsen, I. M., Moland, K. M., Nankunda, J., Tumwine, J. K., & Tylleskar, T. (2010). Infant feeding counselling in Uganda in a changing environment with focus on the general population and HIV-positive mothers—A mixed method approach. BMC Health Services Research, 10, 260. doi:10.1186/1472-6963-10-260.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Farquhar, C., Mbori-Ngacha, D. A., Bosire, R. K., Nduati, R. W., Kreiss, J. K., & John, G. C. (2001). Partner notification by HIV-1 seropositive pregnant women: association with infant feeding decisions. AIDS, 15(6), 815–817.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavioral Research Methods, 39(2), 175–191.CrossRefGoogle Scholar
  11. Filmer, D., & Pritchett, L. (2001). Estimating wealth effect without expenditure data or tears: An application to educational enrollments in states of India. Demography, 38, 115–132.PubMedGoogle Scholar
  12. Iliff, P. J., Piwoz, E. G., Tavengwa, N. V., Zunguza, C. D., Marinda, E. T., Nathoo, K. J., et al. (2005). Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival. AIDS, 19(7), 699–708.CrossRefPubMedGoogle Scholar
  13. Karamagi, C. A., Tumwine, J. K., Tylleskar, T., & Heggenhougen, K. (2007). Intimate partner violence and infant morbidity: Evidence of an association from a population-based study in eastern Uganda in 2003. BMC Pediatrics, 7, 34. doi:10.1186/1471-2431-7-34.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Kendall-Tackett, K. A. (2007). Violence against women and the perinatal period: The impact of lifetime violence and abuse on pregnancy, postpartum, and breastfeeding. Trauma, Violence, & Abuse, 8(3), 344–353.CrossRefGoogle Scholar
  15. Kimani-Murage, E. W., Wekesah, F., Wanjohi, M., Kyobutungi, C., Ezeh, A. C., Musoke, R. N., et al. (2014). Factors affecting actualisation of the WHO breastfeeding recommendations in urban poor settings in Kenya. Matern Child Nutr,. doi:10.1111/mcn.12161.PubMedGoogle Scholar
  16. Klingelhafer, S. K. (2007). Sexual abuse and breastfeeding. Journal of Human Lactation, 23(2), 194–197.CrossRefPubMedGoogle Scholar
  17. Kumar, D., Goel, N. K., Mittal, P. C., & Misra, P. (2006). Influence of infant-feeding practices on nutritional status of under-five children. Indian Journal of Pediatrics, 73(5), 417–421.CrossRefPubMedGoogle Scholar
  18. Lawrence, R. A., & Lawrence, R. A. (1985). Breastfeeding, a guide for the medical profession (2nd ed.). St. Louis: Mosby.Google Scholar
  19. Levendosky, A. A., Huth-Bocks, A. C., Shapiro, D. L., & Semel, M. A. (2003). The impact of domestic violence on the maternal child relationship and preschool-age children’s functioning. Journal of Family Psychology, 17(3), 275–287.CrossRefPubMedGoogle Scholar
  20. Madiba, S., & Letsoalo, R. (2013). HIV disclosure to partners and family among women enrolled in prevention of mother to child transmission of HIV program: Implications for infant feeding in poor resourced communities in South Africa. Global Journal of Health Science, 5(4), 1–13. doi:10.5539/gjhs.v5n4p1.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Maman, S., Mbwambo, J., Hogan, N. M., Kilonzo, G. P., & Sweat, M. (2001). Women’s barriers to HIV-1 testing and disclosure: Challenges for HIV-1 voluntary counselling and testing. AIDS Care, 13(5), 595–603. doi:10.1080/09540120120063223.CrossRefPubMedGoogle Scholar
  22. Misch, E. S., & Yount, K. M. (2014). Intimate partner violence and breastfeeding in Africa. Maternal and Child Health Journal, 18(3), 688–697. doi:10.1007/s10995-013-1294-x.CrossRefPubMedGoogle Scholar
  23. Omari, A. A., Luo, C., Kankasa, C., Bhat, G. J., & Bunn, J. (2003). Infant-feeding practices of mothers of known HIV status in Lusaka, Zambia. Health Policy Plan, 18(2), 156–162.CrossRefPubMedGoogle Scholar
  24. Onono, M. A., Cohen, C. R., Jerop, M., Bukusi, E. A., & Turan, J. M. (2014). HIV serostatus and disclosure: Implications for infant feeding practice in rural south Nyanza, Kenya. BMC Public Health, 14, 390. doi:10.1186/1471-2458-14-390.CrossRefPubMedPubMedCentralGoogle Scholar
  25. MacQuarrie, K. L., Winter, R., & Kishor, S. (2014). Spousal violence in Sub-Saharan Africa: Structure, forms, and levels. Paper presented at the Population Association of America Annual Meeting, Boston, MA.Google Scholar
  26. Raghunathan, T. E., Lepkowski, J. M., Hoewyk, J. V., & Solenberger, P. (2001). A multivariate technique for multiply imputing missing values using a sequence of regression models. Survey Methodology, 27, 85–95.Google Scholar
  27. Sibeko, L., Coutsoudis, A., Nzuza, S., & Gray-Donald, K. (2009). Mothers’ infant feeding experiences: Constraints and supports for optimal feeding in an HIV-impacted urban community in South Africa. Public Health Nutrition, 12(11), 1983–1990. doi:10.1017/S1368980009005199.CrossRefPubMedGoogle Scholar
  28. Silverman, J. G., Decker, M. R., Reed, E., & Raj, A. (2006). Intimate partner violence around the time of pregnancy: Association with breastfeeding behavior. Journal of Women’s Health (Larchmt), 15(8), 934–940. doi:10.1089/jwh.2006.15.934.CrossRefGoogle Scholar
  29. StataCorp. (2009). Stata 11 multiple-imputation reference manual. College Station, TX: Stata Press.Google Scholar
  30. Torpey, K., Kasonde, P., Kabaso, M., Weaver, M. A., Bryan, G., Mukonka, V., et al. (2010). Reducing pediatric HIV infection: estimating mother-to-child transmission rates in a program setting in Zambia. Journal of Aquired Immune Deficiency Syndrome, 54(4), 415–422. doi:10.1097/QAI.0b013e3181e36616.CrossRefGoogle Scholar
  31. Tuthill, E., McGrath, J., & Young, S. (2014). Commonalities and differences in infant feeding attitudes and practices in the context of HIV in sub-Saharan Africa: A metasynthesis. AIDS Care, 26(2), 214–225. doi:10.1080/09540121.2013.813625.CrossRefPubMedGoogle Scholar
  32. van Buuren, S., Brand, J. P. L., Groothuis-Oudshoorn, C. G. M., & Rubin, D. B. (2006). Fully conditional specification in multivariate imputation. Journal of Statistical Computation and Simulation, 76, 1049–1064.CrossRefGoogle Scholar
  33. WHO. (2010). Guidelines on HIV and infant feeding: Principles and recommendations for infant feeding in the context of HIV and a summary of evidence Geneva, Switzerland: WHO, UNAIDS, UNFPA, UNICEF.Google Scholar
  34. ZMOH. (2010). PMTCT 2010 National Protocol Guidelines: Integrated Prevention of other-to-Child Transmission of HIV. In M. Bweupe, L. Chitembo, S. Maswenyeho, E. Murless, J. Mwale, B. Tambatamba, C. Vwalika, & R. Mbewe (Eds.) Zambia Ministry of Health.Google Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department Health and Behavioral SciencesUniversity of Colorado DenverDenverUSA

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