Doherty Tanya, Horwood Christiane, Haskins Lyn, Magasana Vuyolwethu, Goga Ameena, Feucht Ute, Sanders David, Tylleskar Thorkild, Kauchali Shuaib, Dhansay Muhammad Ali, Rollins Nigel, Kroon Max, Engebretsen Ingunn M S
Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
School of Public Health, University of the Western Cape, Cape Town, South Africa.
Matern Child Nutr. 2020 Jan;16(1):e12877. doi: 10.1111/mcn.12877. Epub 2019 Aug 12.
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.
母乳喂养教育与支持是卫生工作者的关键技能。与艾滋病疫情相关的婴儿喂养建议存在混乱,降低了卫生工作者支持母乳喂养的信心。对感染艾滋病毒的母乳喂养妇女的抗逆转录病毒疗法覆盖率很高,以及一项支持母乳喂养的婴儿喂养政策,现在提供了改善母乳喂养做法的机会。在恢复卫生工作者支持母乳喂养的信心方面仍然存在挑战。这项定性研究展示了与婴儿母亲进行焦点小组讨论的结果,探讨了她们接受卫生工作者母乳喂养咨询与支持的经历。分析采用主题框架法。六位研究人员审查了文字记录,独立进行编码,然后共同审查编码,并就一个有效的分析框架达成一致。尽管母亲们在产前收到了母乳喂养信息,但这些信息似乎严格聚焦于纯母乳喂养的重要性。母亲们描述在产后开始母乳喂养时得到了一些实际支持,但对于产后母乳喂养挑战的支持和建议往往不正确或缺失。这种支持也忽视了妇女做出婴儿喂养决定的背景,包括重返工作岗位和来自家庭成员的压力。尽管母乳喂养政策有所改善,但恢复卫生工作者支持母乳喂养的信心仍然是一项挑战。在母亲们经历母乳喂养困难的产后时期尤为关键,我们的研究结果强化了社区与卫生机构之间持续护理的重要性。这项研究对卫生工作者如何接受支持母乳喂养的培训具有启示意义。需要更加关注培养识别、评估和支持面临母乳喂养挑战的妇女的技能和信心。