Background: In 2001, South Africa began implementing the Prevention of Mother-to-Child
Transmission of HIV (PMTCT) programme. This programme included distribution
of free formula milk for infants up to 6 months of age at all public health
facilities. Effective from 1 January 2011, KwaZulu-Natal became the first
province to phase out free formula milk from its PMTCT programme. On 23
August 2011, the South African National Department of Health adopted
promotion of exclusive breastfeeding as the national infant feeding strategy
and made a decision to withdraw free formula milk from the PMTCT
programme.
Objective: To explore the perceptions and understanding of households at community level
on the policy decision to phase out free formula milk from the PMTCT
programme in South Africa.
Methods: An exploratory qualitative study was conducted amongst women enrolled in a
community randomized trial known as Good Start III. Focus group discussions
were held with grandmothers, fathers and teenage mothers; and in-depth
interviews were performed with HIV-positive and HIV-negative mothers. Data
were analysed using thematic analysis.
Results: Identified themes included: (1) variations in awareness and lack of understanding
of the basis for the policy change, (2) abuse of and dysfunctional policy
as perceived reasons for policy change and (3) proposed strategies for
communicating the policy change.
Conclusion: There is an urgent need to develop a multifaceted communication strategy
clearly articulating the reasons for the infant feeding policy change and
promoting the new breastfeeding strategy. The communication strategy should
take into account inputs from the community. With a supportive environment
and one national infant feeding strategy, South Africa has an opportunity to
reverse years of poor infant feeding practices and to improve the health of all
children in the country.