Abstract:
Breastfeeding education and support are critical health worker skills. Confusion surrounding
infant feeding advice linked to the HIV epidemic has reduced the confidence
of health workers to support breastfeeding. High antiretroviral therapy
coverage of breastfeeding women living with HIV, and an Infant Feeding policy supportive
of breastfeeding, now provides an opportunity to improve breastfeeding practices.
Challenges remain in restoring health worker confidence to support
breastfeeding. This qualitative study presents findings from focus group discussions
with mothers of young infants, exploring their experiences of health worker
breastfeeding counselling and support. Analysis followed the thematic framework
approach. Six researchers reviewed the transcripts, coded them independently, then
jointly reviewed the codes, and agreed on a working analytical framework. Although
mothers received antenatal breastfeeding messages, these appeared to focus rigidly
on the importance of exclusivity. Mothers described receiving some practical support with initiation of breastfeeding after delivery, but support and advice for post‐natal
breastfeeding challenges were often incorrect or absent. The support also ignored
the context in which women make infant feeding decisions, including returning to
work and pressures from family members. Despite improved breastfeeding policies,
restoring confidence in health workers to support breastfeeding remains a challenge.
The post‐natal period, when mothers experience breastfeeding difficulties, is particularly
critical, and our findings reinforce the importance of continuity of care between
communities and health facilities. This research has implications for how health
workers are trained to support breastfeeding. Greater attention is needed on developing
skills and confidence in identifying, assessing, and supporting women
experiencing breastfeeding challenges.
