[pronut-hiv] WHEN BREASTFEEDING BECOMES A CHOICE

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WHEN BREASTFEEDING BECOMES A CHOICE

Implementing informed choice regarding infant feeding in a national
programme to prevent mother-to-child transmisson of HIV in India

Report on a qualitative study of the counselling, decision making and
implementation of informed choice regarding infant feeding for
HIV-positive women in urban India, April 2002

Stina Almroth, Ph.D.
UNICEF, New Delhi, India
 
In March 2000, the National AIDS Control Organisation (NACO) in India
with support from UNICEF initiated a Feasibility Study of its  national
programme to prevent parent-to-child transmission (PPTCT) of HIV. As in
many PPTCT projects elsewhere, informed choice was expected to guide
women's infant feeding decisions. A qualitative study in 2001 was
conducted to examine to what extent it had been possible to implement
the informed choice concept in the Indian context. 
	Informed choice counselling was assessed from the perspective of
the counsellors, themselves, women clients who made and implemented
their choices and their family members who were also involved in the
decision-making process. The study methodology was based on in-depth
interviews with 18 counsellors, 54 HIV-positive women and 34 family
members.
	The study findings demonstrated a counselling bias toward
artificial feeding as evidenced by the high proportion of women who
chose artificial feeding.  Although it was promoted that the infant
feeding choice should be a woman's informed decision, it was found that
counsellors had actually understood that artificial feeding was the
preferred alternative for achieving the project aim of reducing
parent-to-child transmission. This was further confirmed when women
reported that they had been given this advice. As a consequence, study
results showed that 81% of the women interviewed had chosen artificial
feeding, and family members tended to support their decision. The study
also found that while acceptable, artificial feeding was not necessarily
affordable, feasible nor sustainable for all of the women, or safe for
all infants.
	In conclusion, the study highlights the need for training and
capacity building to improve counselling on infant feeding, as well as
supportive project policies related to training content. It also
underscores the need to assess the effects of different modes of infant
feeding, taking into account not only rates of HIV-transmission, but
also the overall health outcomes for the children and their mothers.