Closing the research-practice gap for breastfeeding support using ethnographic methods in Haiti

Background: Strategies for enhancing the large-scale uptake of efficacious interventions remain a major public health challenge.  Breastfeeding is one example, with only 35% of women worldwide practicing exclusive breastfeeding in the first six months despite many documented benefits. The objective of this research is to explore the potential for structured ethnographic methods to help close the breastfeeding research-practice gap by examining the ways in which mothers interpret and prioritize messages they receive, thereby strengthening counseling and behavior change strategies.

Methods: Thirty-five mothers [HIV-infected (n=30) and HIV-uninfected (n=5)] were longitudinally interviewed during pregnancy, 0-1 month and 3-5 months postpartum in urban Haiti. Pile sorting methodologies were used to determine mothers’ perceptions and prioritizations of infant feeding messages they received from various sources. 

Results: Key themes emerging from the interviews included concern for child or maternal health and nutrition, social support and fear of stigmatization. Mothers’ infant feeding decisions during pregnancy and immediately post-partum were heavily influenced by recommendations provided by medical personnel. However, as their infants grew older, messages about mixed feeding and early weaning from community and family members became important influences. 

Conclusions: Two conclusions emerge: In light of the strong role of social influences and fear of stigmatization, there is a need not only to counsel breastfeeding mothers on desired practices, but also to empower them with strategies to negotiate and mitigate conflicting infant feeding messages they receive as their infants get older. Structured ethnographic methods can indeed identify barriers to the adoption of efficacious health and nutrition interventions.