title: Free formula milk in the prevention of mother-to-child transmission programme: voices of a peri-urban community in South Africa on policy change.
abstract: BACKGROUND
  In 2001, South Africa began implementing the Prevention of Mother-to-Child Transmission of HIV (PMTCT) programme. This programme included distribution of free formula milk for infants up to 6 months of age at all public health facilities. Effective from 1 January 2011, KwaZulu-Natal became the first province to phase out free formula milk from its PMTCT programme. On 23 August 2011, the South African National Department of Health adopted promotion of exclusive breastfeeding as the national infant feeding strategy and made a decision to withdraw free formula milk from the PMTCT programme.
  
  
  OBJECTIVE
  To explore the perceptions and understanding of households at community level on the policy decision to phase out free formula milk from the PMTCT programme in South Africa.
  
  
  METHODS
  An exploratory qualitative study was conducted amongst women enrolled in a community randomized trial known as Good Start III. Focus group discussions were held with grandmothers, fathers and teenage mothers; and in-depth interviews were performed with HIV-positive and HIV-negative mothers. Data were analysed using thematic analysis.
  
  
  RESULTS
  Identified themes included: (1) variations in awareness and lack of understanding of the basis for the policy change, (2) abuse of and dysfunctional policy as perceived reasons for policy change and (3) proposed strategies for communicating the policy change.
  
  
  CONCLUSIONS
  There is an urgent need to develop a multifaceted communication strategy clearly articulating the reasons for the infant feeding policy change and promoting the new breastfeeding strategy. The communication strategy should take into account inputs from the community. With a supportive environment and one national infant feeding strategy, South Africa has an opportunity to reverse years of poor infant feeding practices and to improve the health of all children in the country.
authors.affiliation: Health Systems Research Unit, Medical Research Council, 460 Ridge Road, PO Box 70380, Overport 4067, South Africa. E-mail: petrida.ijumba@mrc.ac.za.
authors.forename: Petrida
authors.initials: P
authors.lastname: Ijumba
authors.forename: Tanya
authors.initials: T
authors.lastname: Doherty
authors.forename: Debra
authors.initials: D
authors.lastname: Jackson
authors.forename: Mark
authors.initials: M
authors.lastname: Tomlinson
authors.forename: David
authors.initials: D
authors.lastname: Sanders
authors.forename: Lars-Åke
authors.initials: LÅ
authors.lastname: Persson
mesh_terms: D000293:Adolescent; D005249:Fees and Charges; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000635:transmission*; D006291:Health Policy; D006801:Humans; D007223:Infant; D041943:Infant Formula / Q000191:economics; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D036301:Qualitative Research; D013019:South Africa; D014505:Urban Population
keywords: Formula feeding; HIV; community perceptions; focus group discussions; policy change; qualitative research