Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Debbie Humpries

Second Advisor

Rafael Perez-Escamilla


INTRODUCTION: Exclusive breastfeeding has been shown to provide many benefits that can be life saving for the infant and mother in low resource settings7. Although the potential effects of breastfeeding appear large, exclusive breastfeeding rates remain low in this area of the world, and are even lower among the HIV population8-10. It is important to understand what influences HIV + mothers to exclusively breastfeed, as well as formula feed and adhere to ARV (antiretroviral) medication while breast feeding in order to make comprehensive policy recommendations that are as culturally sensitive and practical as possible. The objective of this review is to understand the positive determinants that influence recommended early infant feeding practices such as exclusive breastfeeding and formula feeding among HIV + mothers in SSA and adherence to ARVS when made available.

METHOD: A realist approach was chosen in order to determine what other factors can complement Prevention of Mother to Child Transmission (PMTCT) programs and the 2010 WHO Guidelines on HIV and Infant Feeding upon the decisions HIV + mothers make in regards to infant feeding and how causal mechanisms can be shaped and constrained by social context. The literature search was iterative and ongoing throughout the project. A total of 23 articles were included for further analysis.

PRELIMINARY RESULTS: In terms of using ARV medication while breastfeeding, some determinants include: having self-efficacy, fear of MTCT, and having a good relationship with PMTCT counselors. For exclusively formula feeding, some determinants include: disclosure of status to family and support, being independent/ having flexibility in everyday routine, and being financially stable. For exclusively breast-feeding, some determinants include: fulfilling the role of a good mother, belief in breast milk having nutritious benefits, and making the choice antepartum.

CONCLUSIONS: In many sub-Saharan societies, exclusive breastfeeding is considered by far the best feeding option for HIV + mothers. Strengthening and generalizing promotion of exclusive breastfeeding by first identifying the determinants that help to generate positive adherence at a policy and then community based level should be a major public-health priority both for the infant’s HIV-free survival and the mother’s welfare.


This is an Open Access Thesis.

Open Access

This Article is Open Access