Infant feeding practices in Soweto, South Africa: Implications for healthcare providers.

BACKGROUND: The 2011 Tshwane Declaration for the Promotion of Breastfeeding in South Africa ended the country's longstanding support for promoting either exclusive breastfeeding (EBF) or exclusive formula feeding for HIV-positive mothers. However, South Africa's EBF rate is only 32%.

OBJECTIVES: To describe multilevel factors associated with different infant feeding practices among HIV-positive and negative mothers of infants aged <6 months in an HIV-endemic community.

METHODS: A cross-sectional survey was administered to 298 HIV-positive and negative mothers accessing care in one of five community health clinics in Soweto, Johannesburg, between September 2015 and May 2016. Infant feeding practices and associated factors were explored through descriptive and multivariate analysis.

RESULTS: Excluding HIV-positive mothers who chose formula feeding (n=97), breastfeeding initiation was almost universal (99.5%). Caesarean section (CS) was the most common reason mothers delayed breastfeeding. HIV-positive mothers were significantly more likely to report prolonged EBF (and formula feeding) practices than their HIV-negative counterparts. Breastfeeding mothers were significantly more likely to be unemployed than mothers who formula fed. Mixed feeding was common.

CONCLUSIONS: EBF remains strongly associated with HIV status as opposed to infant health and development. Breastfeeding support for working mothers is needed. While breastfeeding increased following the Declaration, more should be done in the health setting to communicate the risks of mixed feeding in the first 6 months. The high rate of CSs reported by mothers, linked to late initiation of breastfeeding, also needs the medical community's attention.