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Realities and challenges of breastfeeding policy in the context of HIV: a qualitative study on community perspectives on facilitators and barriers related to breastfeeding among HIV positive mothers in Baringo County, Kenya

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posted on 25.05.2021, 08:05 authored by Betty Mogesi Samburu, Judith Kimiywe, Sera Lewise Young, Frederick Murunga Wekesah, Milka Njeri Wanjohi, Peter Muriuki, Nyovani Janet Madise, Paula GriffithsPaula Griffiths, Elizabeth W. Kimani-Murage
Background: Although recent policies have sought to increase the rates of exclusive breastfeeding (EBF) and continued breastfeeding for HIV exposed infants, few programs have considered the multiple social and cultural barriers to the practice. Therefore, to generate evidence for exclusive and continued breastfeeding policies in Kenya, we examined community perspectives on the facilitators and barriers in adherence to EBF for the HIV positive mothers.
Methods: Qualitative research was conducted in Koibatek, a sub-County in Baringo County Kenya, in August 2014 among 205 respondents. A total of 14 focus group discussions (n = 177), 14 In-depth Interviews and 16 key informant interviews were conducted. Transcribed data was analyzed thematically. NVivo version 10.0 computer qualitative software program was used to manage and facilitate the analysis.
Results: Facilitators to exclusive breastfeeding were perceived to include counselling at the health facility, desire to have a healthy baby, use of antiretroviral drugs and health benefits associated with breastmilk. Barriers to EBF included poor dissemination of policies, knowledge gap, misinterpretation of EBF, inadequate counselling, attitude of mother and health workers due to fear of vertical HIV transmission, stigma related to misconception and misinformation that EBF is only compulsory for HIV positive mothers, stigma related to HIV and disclosure, social pressure, lack of male involvement, cultural practices and traditions, employment, food insecurity.
Conclusions: There are multiple facilitators and barriers of optimal breastfeeding that needs a holistic approach to interventions aimed at achieving elimination of mother to child transmission. Extension of infant feeding support in the context of HIV to the community while building on existing interventions such as the Baby Friendly Community Initiative is key to providing confidential support services for the additional needs faced by HIV positive mothers.


NIH and the USAID through the Partnership for Enhanced Engagement in Research (PEER) Health Program, administered by the National Academy of Sciences (NAS) to Kenyatta University and the African Population and Health Research Center (Grant # PGA2000003677/8)

Wellcome Trust Fellow during the conceptualization and design of the study and initial data collection (Grant # 097146/Z/11/Z)

Wellcome Trust International Engagement Fellow (Grant # 208791/Z/17/Z)

British Academy mid-career fellowship during the conduct of the study (Ref: MD120048).



  • Sport, Exercise and Health Sciences

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International Breastfeeding Journal








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This is an Open Access Article. It is published by BMJ under the Creative Commons Attribution 4.0 Unported Licence (CC BY). Full details of this licence are available at:

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Prof Paula Griffiths. Deposit date: 24 May 2021

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