"On our own, we can't manage": experiences with infant feeding recommendations among Malawian mothers living with HIV.
BACKGROUND
Infant feeding in communities with a high prevalence of HIV and AIDS is a potential challenge for mothers who must ultimately decide how to feed their infants within contexts that constrain their choices.


METHODS
We investigated how infant feeding policy recommendations translate into maternal infant feeding decisions and practices using ethnographic research conducted between August 2004 and June 2005 among women participating in a prevention of mother-to-child transmission (PMTCT) program in Lilongwe, Malawi.


RESULTS
Qualitative findings are that maternal ability to adhere to recommendations to breastfeed exclusively for the first six months of infant life was constrained by expectations and psycho-social support. The most salient were women's pre-existing views on breastfeeding, their understanding of the medico-scientific information, and the quality of counselling received. In contrast, maternal decisions to wean were largely influenced by household economic factors and food insecurity.


CONCLUSIONS
We conclude that PMTCT programs delivered in ways which "download" the responsibility of adhering to recommendations to women in the absence of adequate psycho-social and livelihood supports contribute to substantial maternal psychosocial distress in this and, likely, similar settings.
Department of Anthropology, University of Toronto, 19 Russell Street, Toronto, Ontario, M5S 2S2, Canada. jen.levy@utoronto.ca.
Jennifer M
JM
Levy
Aimee L
AL
Webb
Daniel W
DW
Sellen