Rates of exclusive breastfeeding in Malawi remain low despite the acknowledged benefits of exclusive breastfeeding for the infant’s wellbeing and the prevention of mother-to-child transmission of HIV. Creating an environment supportive of exclusive breastfeeding is critical to increase the rate of exclusive breastfeeding among HIV-positive mothers. However, little is known on factors that influence the environment within which HIV-positive mothers in Malawi practise exclusive breastfeeding. Therefore, the exploratory qualitative study on which this article is based was conducted at the Chatinkha maternity unit of Queen Elizabeth Central Hospital in Malawi from April 16, 2009 to May 8, 2009 to explore perceived practice environment related barriers to exclusive breastfeeding among HIV-positive mothers. Data were obtained through indepth interviews with 16 purposively selected breastfeeding HIV-positive mothers between 18 and 35 years old and two focus group discussions with women of unknown HIV status. Semi-structured interview and focus group guides were utilised. Content analysis of data was done. Five main themes emerged regarding factors that may influence the environment within which exclusive breastfeeding was practised: 1) availability of resources; 2) societal norms and cultural practices; 3) mother-baby proximity; 4) health workers’ attitudes and 5) disclosure of the mothers’ HIV status. A multi-sectoral approach to promote exclusive breastfeeding is suggested. This should include community involvement because it is in the community where breastfeeding norms and cultural practices associated with breast-feeding are propagated.
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