Who is empowering who: Unlocking maternal knowledge in breastfeeding promotion

Despite evidence supporting efficacy of exclusive breastfeeding (EBF) in minimizing vertical transmission of HIV, while maximizing child survival, breastfeeding by HIV-infected women has received much opposition. In sub-Saharan Africa, the epicenter of the epidemic, HIV seemed to provide an opportunity for revitalization of the infant formula market, thinly veiled as a necessary and ethically responsible action. Social and cultural contextual considerations were minimal as were vulnerabilities resulting from poverty. However, formula proved to be both unsustainable and dangerous. The resulting confusion and dilemma played a significant role in undermining maternal confidence, in a mother’s ability to nourish and nurture her infant using traditional methods and in so doing, challenged her identity of motherhood. Accordingly, the promotion of safe breastfeeding practices to meet the needs of infected women desperate for inexpensive, safe and sustainable strategies is met with many challenges. In a South African resource poor setting, using mixed methods, input from mothers and other stakeholders was utilized to assess the acceptability and feasibility of one such strategy. Our findings indicate that use of knowledge generated by participating mothers as a pathway for promoting EBF and home heat-treated manually expressed breastmilk, challenged traditional assumptions of the meaning of empowerment. Furthermore, we discovered that mothers were already engaged in numerous empowering activities that were critical for survival within their natural surroundings. Once trusted and understood, uptake of the feeding strategy was facilitated by these existing empowering behaviours. In turn, these mothers provided valuable knowledge for reaching other women in similar situations. Being open to reciprocity in knowledge sharing, facilitates a pathway to less restrictive power dynamics resulting in mothers’ perception of their knowledge being valued, a true empowerment for both actors and facilitators.