Decisions and advice about infant feeding: findings from sociological work in KwaZulu-Natal, South Africa.

What are women's practices and experiences? And what are pregnant women being told about risks through breastfeeding in an area of high HIV seroprevalence? This work sets out to explore these two principal questions in terms of the implications for women, and for international and national policy guidelines on infant feeding. During a two-year sociological study in KwaZulu-Natal, semi-structured questionnaires, individual and group interviews, and an innovative storytelling element were used to probe women's decision-making concerning infant feeding. In-depth interviews were conducted with different groups of health workers, including AIDS counsellors and traditional birth attendants, and observations were made at both semi-rural and urban hospitals and clinics. The research was carried out at a time when new international and national guidelines concerning HIV and infant feeding were being circulated. The research is framed within critical and discursive theory, influenced by the work of Foucault, and located within a particular feminist theory, concerned with the modes of appropriation of 'the sexed body'. The conclusions centre on ethical considerations and the rights of women to make informed decisions about their own and their baby's health care. Reference is also made to the particular socialisation of health workers, especially maternity nurses. The importance of the earlier struggle against the unethical practices of multi-nationals is recognised, and how this has informed a robust breastfeeding culture. Scant attention has been paid to the results of studies undertaken in other African locations (mainly West Africa) where key players have introduced infant milk formula. The conclusions also engage with the question of the vertical paradigm: how women's lives have been caught up in these dilemmas and conflicts in a country with a rights' culture.