Breastfeeding practices and attitudes relevant to the vertical transmission of HIV in rural south-west Uganda

Breastfeeding has been associated with a doubling of the risk of HIV transm ission. In developed countries, it is recommended that HIV-positive women d o not breastfeed, but this is not a feasible option in most of Africa. It i s therefore important to know the extent to which breastfeeding practices a re amenable to change. To study this, we carried out 24 focus group discuss ions with 208 women attending maternity clinics in three rural sites in rur al south-west Uganda. Breastfeeding starts from a few minutes to a few days after delivery; most women reported starting after 2 days. The main reason for delay is lack of milk or that the breasts are 'blocked'. Most women th ought that this del:ay was good for the baby, or at least not harmful. Almo st all women reported giving the child a soup made of boiled mushrooms befo re starting to breastfeed. Once they have started breastfeeding, various su pplementary foods are gradually introduced at 4-6 months. Women thought tha t ideally breastfeeding should last for 2-3 years, but in practice most sto pped after 18 months. The father and his female relatives generally decide when the child should be weaned. The women thought that commercial milk for mula foods were good but could not use them because they are too expensive and anyway unavailable in rural areas. Most women were unaware that HN coul d be passed to the child through breastfeeding. Various practices identifie d as potentially risky are common in this population. Artificial feeding is not a viable option in this area, and although women were prepared to make sacrifices to prevent vertical transmission of HIV, practices are deeply i ngrained in traditional culture and will need to be addressed in future int erventions. Male partners will also need to be involved.