Work

Perspectives of Wife‐Husband Pairs on Their Roles in Infant and Young Child Feeding Decision‐Making in the Context of Malawi's Prevention of Mother‐to‐Child HIV Transmission Program

Year: 2016

Type: article

Abstract: Studies have examined the role of male involvement in HIV counseling and testing within prevention of mother‐to‐child transmission (PMTCT) programs, but there is no corresponding data on male involvement in infant and young child feeding (IYCF) decision‐making and its relation to adherence to HIV and infant feeding guidelines. Adherence to IYCF guidelines remains important for limiting HIV transmission through breast milk and improving child survival. We explored wives’ and husbands’ perceptions of husbands’ roles in feeding decision‐making and practice in the context of Malawi's Option B+ PMTCT program through in‐depth interviews conducted in the catchment areas of 2 urban and 2 rural government clinics in Lilongwe District. Participants were 15 wife‐husband pairs (interviewed separately), where the wife was ≥ 18 years, HIV‐positive, and had a child < 24 months. The interviews were analyzed using thematic content analysis. Husbands were generally less well‐informed about IYCF recommendations than their wives, who were advised on IYCF during antenatal and PMTCT clinic visits. Most husbands and wives agreed that the wife was largely responsible for IYCF decision‐making and few husbands were involved in decisions about complementary feeding. Some husbands participated in decisions about when to stop breastfeeding the child because of their fears about the child becoming HIV infected, even if the wife was on antiretroviral therapy. In couples where the husband advised the wife on feeding, the wife usually said that she followed his wishes. Both wives and husbands wanted to avoid disagreements about IYCF because they were worried that such disagreements would harm the child's health and well being. For wives and husbands, the most important role of husbands in relation to IYCF was to purchase food or provide money for food for the child. Wives appreciated it when their husbands offered verbal support to encourage them to continue with the recommended IYCF practices. Wives whose husbands were supportive found it easier to follow breastfeeding recommendations, but adequate complementary feeding remained a challenge in the face of household food insecurity. In conclusion, Malawian husbands and wives reported highly gendered roles in relation to IYCF decision‐making in the context of HIV, but some women flagged their interest in having verbal, in addition to monetary, support from their husbands for IYCF practices. To address this gap, strategies should be tested for getting messages on IYCF to husbands through male‐friendly radio and community‐based programs or by encouraging them to participate in PMTCT visits with their wives. Support or Funding Information NIH BIRCWH K12 program, UNC CFAR developmental award

Source: The FASEB Journal

DOI: 10.1096/fasebj.30.1_supplement.1149.12