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Cited by 13Breastfeeding Practices and InfluencesHIV/AIDS Research and InterventionsGlobal Maternal and Child Health

Mental health predictors of breastfeeding initiation and continuation among HIV infected and uninfected women in a South African birth cohort study

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Thomas, Eileen, Kuo, Caroline, Cohen, Sophie, Hoare, Jacqueline, Koen, Natassja, Barnett, Whitney, Zar, Heather J., Stein, Dan J.·2017·Preventive Medicine
DOI 10.1016/j.ypmed.2017.07.004PMC PMC5802398
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Abstract

Breastfeeding is a cost-effective, yet underutilized strategy to promote maternal and infant health in low and middle income countries (LMICs). Breastfeeding remains challenging for mothers living with HIV in LMICs, yet few studies have examined mental health predictors of breastfeeding initiation and continuation. We investigated breastfeeding among mothers by HIV status in South Africa, evaluating predictors of breastfeeding initiation and continuation to identify intervention-targets. Breastfeeding patterns were investigated in a subsample of 899 breastfeeding mothers from the Drakenstein Child Health Study; a prospective birth cohort of 1225 pregnant women, between March 2012 and March 2015 in a peri-urban area. Breastfeeding was assessed at 5 time-points between 6weeks and 24months' infant age. Cox proportional hazard models evaluated breastfeeding initiation and duration. Logistic regression models with breastfeeding non-initiation as the outcome parameter were performed to determine associations with maternal sociodemographic, psychosocial factors and gestational outcomes. More HIV-uninfected mothers initiated breastfeeding (n=685, 97%) than HIV-infected mothers (n=87, 45%). Median duration of exclusive breastfeeding was short (2months), but HIV-infected mothers engaged in exclusive breastfeeding for longer duration than uninfected mothers (3 vs 2months). Despite concerning high rates, mental disorders were not significant predictors of breastfeeding behaviour. Employment and HIV diagnosis during pregnancy predicted a lower likelihood of breastfeeding initiation among HIV-infected mothers, while employment was associated with earlier breastfeeding-discontinuation in HIV-uninfected mothers. Findings indicate that future interventions should target sub-populations such as HIV-infected women because of distinct needs. Workplace interventions appear particularly key for mothers in our study.

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  • Breastfeeding has a complex relationship with maternal mental health, and has been shown to have a protective effect against mental health symptoms, primarily through the release of oxytocin.

    “Breastfeeding, which has a complex relationship with maternal mental health, has also been shown to have a protective effect against mental health symptoms, primarily through the release of oxytocin [46–48].”

    From Exploring the effects of mental health on bonding and caregiving among pregnant and postpartum persons with likely depression and/or PTSD in South Africa: a qualitative analysis (2026) · cites this paper as [47]

    The Introduction and Discussion describe a complex relationship between maternal mental health and breastfeeding, including mixed findings about whether depression predicts breastfeeding behaviour. They do not say that breastfeeding protects against mental health symptoms or that oxytocin is the primary mechanism. The paper studies mental health as a possible predictor of breastfeeding, rather than that proposed protective effect. (LLM, conf=0.88)

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Cited by

Sorted by citations

Authors
Thomas, E., Kuo, C., Cohen, S., Hoare, J., Koen, N., Barnett, W., Zar, H. J., & Stein, D. J.
Affiliations
  • University of Cape Town (ZA)
  • Red Cross War Memorial Children's Hospital (ZA)
  • South African Medical Research Council (ZA)
Corresponding author
Thomas, Eileen
ORCID
Venue
Preventive Medicine
Publisher
Elsevier BV
Published
2017-09
Volume
102
Pages
100-111
ISSN
0091-7435 (ISSN-L)
DOI
10.1016/j.ypmed.2017.07.004
PMC
PMC5802398
OpenAlex
W2730004309
Cited by
13
References
3
Citations by year
2026: 1 · 2025: 2 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 2 · 2019: 4 · 2018: 1
FWCI
1.03
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Preventive Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • University of Calgary
  • National Institutes of Health
  • National Institute of Mental Health (K01MH096646)
Topics
  • Health Sciences › Medicine › Epidemiology › Breastfeeding Practices and Influences
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Keywords
breastfeeding initiation, breastfeeding duration, maternal mental health, maternal employment, workplace interventions, exclusive breastfeeding, psychosocial factors, Drakenstein Child Health Study, South Africa
MeSH terms
Adult, Mental Disorders, Breast Feeding, Employment, Female, Humans, Infant, Infant, Newborn, Mothers, Poverty, Pregnancy, Prospective Studies, South Africa, Time Factors, HIV Infections

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