Reconceptualising issues around HIV &amp; breastfeeding advice: findings from KwaZulu‐Natal, South Africa

Seidel, Gill

doi:10.1080/03056240008704486

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Review of African Political Economy

Volume 27, Issue 86

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Reconceptualising issues around HIV & breastfeeding advice: findings from KwaZulu‐Natal, South Africa

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research-article

Author(s): Gill Seidel ^a

Publication date (Print): December 2000

Journal: Review of African Political Economy

Publisher: Review of African Political Economy

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Abstract

This article is concerned with the dynamics between health care workers and pregnant women, and advice given to women about mother‐to‐child transmission (MTCT) through breastfeeding in KwaZulu‐Natal (KZN). Using ethnographic methods, it explores issues relating to HIV and infant feeding in settings where a period of breastfeeding is expected.

The anti‐baby milk action of the 1970s remains an important point of reference, which has profoundly shaped attitudes towards breastfeeding as ‘the culture of health’. For many health professionals in KZN, the breastfeeding lobby, on which the authority of many nurses depends, and its successes, are now perceived to be undermined by AIDS and the ‘AIDS camp’.

International data that point to the risks attached to any period of breastfeeding have provoked a range of reactions among health workers in KZN, from suspicion attached to information ‘from outside’, to confusion and outright disbelief. An integral part of this study is the pattern of power relations that pertain between health workers and their patients, and the values they may seek to sustain. Many nurses hold negative attitudes about young, pregnant and largely unmarried mothers, and HIV/AIDS is an additional stigma. Nurses’ professional socialisation, influencing how they construct gender, women with HIV, and ‘motherhood’, has an important bearing on how they interact with vulnerable young women, and on the information and advice they make available to them. These patterns will also shape the ways in which they engage with the new South African and UNAIDS policy guidelines, which emphasise a woman's right to make an informed decision on infant feeding, in what is a rights’ culture. These representations, investments, and practices, are also shaped by earlier identity processes, and are shot through with images of gender, class and ethnicity. How to advise and counsel HIV+ women on how best to feed their babies raises some of the most complex and hotly debated issues in health care ethics today. It is imperative that these issues, including the ideologies and discourses that may accompany changes in breastfeeding practices, and the values they underwrite, be explored from new angles, underpinned by social theory.

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Journal ID (publisher-id): crea20

Journal ID (archive): CREA

Title: Review of African Political Economy

Publisher: Review of African Political Economy

ISSN (Print): 0305-6244

ISSN (Electronic): 1740-1720

Publication date (Print): December 2000

Volume: 27

Issue: 86

Pages: 501-518

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^a Universite de Bordeaux 2 , France E-mail: ssd@ 123456u-bordeaux2.fr

Article

Publisher ID: 8704486 Coden ID: Review of African Political Economy, Vol. 27, No. 86, December 2000, pp. 501-518

DOI: 10.1080/03056240008704486

SO-VID: 8fff7546-a6ba-4791-881a-8ea59565bd19

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All content is freely available without charge to users or their institutions. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal without asking prior permission of the publisher or the author. Articles published in the journal are distributed under a http://creativecommons.org/licenses/by/4.0/.

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Figures: 0, Tables: 0, References: 93, Pages: 18

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Comments

Comment on this article

[1] Asfhar H. . 1987. . Women, State and Ideology . , (Studies from Africa and Asia). London : : Macmillan. .

[2] Barrett M. . 1980. . Women's Oppression Today: Problems in Marxist Thought . , London : : Verso. .

[3] Baylies C and Bujra J. . 1993. . ‘Challenging Gender Inequalities in Africa’. . Review of African Political Economy . , : 3––10. .

[4] Becker C. . 1995. . “‘L'apparition du Sida et la Gestion des Epidémies du Passé au Sénégal’. ”. In Les Sciences Sociales Face au Sida, Cas Africains Autour de L'exemple ivoirien . , Edited by: Dozon J‐P and Vidal L. . p. 59––80. . Paris : : ORSTOM. .

[5] Becker C, Dozon J‐P, Obbo C and Touré M. , eds. 1999. . Vivre et Penser le Sida en Afrique/ Experiencing and Understanding AIDS in Africa . , Paris : : Codesria‐Karthala‐IRD. .

[6] Becker C and Collignon R. . 1999. . “‘A History of Sexually Transmitted Diseases and AIDS in Senegal: Difficulties in Accounting for Social Logics in Health Policy’. ”. In History of Sexually Transmitted Diseases and HIV/AIDS in subSaharan Africa . , Edited by: Setel PW, Lewis M and Lyons M. . p. 65––96. . Westport : : Greenwood Press. .

[7] Bekker S. , ed. 1992. . Capturing the Events. Conflict Trends in the Natal Region, 1986–1992 . , Durban : : Indicator SA issue focus. .

[8] Bobat R, Moodley D, Coutsoudis A and Coovadia H M. . 1997. . Breastfeeding by HIV‐1 infected women and outcome in their infants: a cohort study from Durban . South Africa :

[9] Brink E. . 1990. . “‘Man‐made Women: Gender, Class and Ideology in the Volksmoeder’. ”. In Women and Gender in Southern Africa to 1945 . , Edited by: Walker C. . p. 273––292. . Cape Town : : David Phillip. .

[10] Burns D N and Mofenson L M. . 1999. . ‘Paediatric HIV‐1 infection’. . Lancet . , Vol. 354((suppl II)): 1––6. .

[11] Campbell C. . 1992. . ‘Learning to Kill: Masculinity, The Family, and Violence in Natal’. . Journal of Southern African Studies . , Vol. 18:: 3

[12] Capitan C. . 2000. . ‘Propriété privée et individu‐sujet‐des droits. La genèse historique de la notion de citoyenneté’. . L'Homme . , Vol. 153:: 63––74. .

[13] Caplan P. . 1988. . ‘Engendering knowledge: the politics of ethnography’. . Anthropology Today . , Vol. 14((5)): 8––12. .

[14] Carter P. . 1995. . Feminism, Breasts, and Breastfeeding . , London : : Macmillan. .

[15] Coovadia H M. . 1996. . “Consequences of maternal HIV‐1 infection on ante‐natal, perinatal and postnatal outcomes, with specific reference to the effects of breastfeeding on the mothers’ and infants’ health. ”.

[16] Coutsoudis A, Pillay K, Spooner E, Kuhn L and Coovadia H M. . 1999. . ‘Influence of infant feeding patterns on early mother‐to‐child transmission of HIV‐1 in Durban, South Africa’. . Lancet . , Vol. 353: 354:: 471––476. .

[17] Crewe M. . 1992. . AIDS in South Africa: The Myth and the Reality . , New York : : Creda Books. .

[18] Desclaux A. . 1994. . “‘Le silence comme politique de santé? Allaitement maternel et transmission de VIH’. ”. In Sociétés d'Afrique et Sida . p. 6 Bordeaux :

[19] Desclaux A and Taverne B. , eds. 2000. . L'allaitement dans le contexte du VIH en Afrique de l'ouest: De l'anthropologie à la santé publique . , Paris : : Karthala. .

[20] Desclaux A, Taverne B, Alfieri C. . ‘Socio‐cultural obstacles in the prevention of HIV transmission of HIV through breastfeeding in west Africa. In: . paper presented to the 13th International AIDS Conference; . July. ; , Durban . .

[21] Dozon J‐P and Vidal L. , eds. 1993. . Les sciences sociales face au sida. Cas africains autour de l'exemple ivoirien (Actes de l'Atelier Bingerville, Côte d'Ivoire 15–17 mars 1993) . , Paris et Petit Bassam : : Centre ORSTOM et GIDIS‐CI. .

[22] Evian C. . 1993. . Primary AIDS Care . Johannesburg :

[23] Evian C. . 1998. . Policy Guideline and recommendations for feeding on infants of HIV positive mothers . Pretoria :

[24] Foucault M. . 1976. . The History of Sexuality: an Introduction . , London : : Penguin Books. .

[25] 1973. . The Birth of the Clinic: an Archaeology of Medical Perception . , London : : Tavistock. .

[26] 1980. . Power/Knowledge: Selected interviews and other writings, 1972–1977 . , New York : : Pantheon. .

[27] 1989. . The Archaeology of Knowledge . , London : : Routledge. .

[28] Fraser N. . 1989. . Unruly Practices: Power, Discourse and Gender in Contemporary Social Theory . , Cambridge : : Polity Press. .

[29] Friedman M. . 1999. . ‘Effecting equity: translating commitment into practice’. . Agenda . , : 3––17. .

[30] Gaitskell D. . 1982. . “‘Waiting for Purity’. ”. In Industrial and Social Change in South Africa . , Edited by: Marks S and Rathbone S. . London : : Longmans. .

[31] Gaitskell D and Unterhalter E. . 1989. . “‘Mothers of the nation: a comparative analysis of nation, race and motherhood in Afrikaaner nationalism and the African National Congress’. ”. In Women and the State . , Edited by: Yuval‐Davies N and Anthias F. . London : : Macmillan. .

[32] Goldblatt B and Meintjes S. . 1997. . ‘Dealing with the aftermath ‐ sexual violence and the Truth and Reconciliation Commission’. . Agenda 36, Gender and Violence . , : 7––18. .

[33] Gouws A. . 1999. . ‘Beyond the equality and difference: the politics of women's citizenship’. . Agenda . , : 54––65. .

[34] Gray G, Salojee H and McIntyre J. . 1994. . ‘Breastfeeding and HIV transmission’. . AIDS Bulletin . , Vol. 3((1))

[35] Gray G, McIntyre J A and Lyons S F. . The effect of breastfeeding on vertical transmission of HIV‐1 in Soweto, South Africa. In: . XI International Conference on AIDS; . July. 1996 ; , Vancouver . .

[36] Guay L A. . 1999. . ‘Intrapartum and neonatal single‐dose nevirapine compared with zidovudine for prevention of mother‐to‐child transmission of HIV‐1 in Kampala, Uganda: HIVNET 01 randomised trial’. . Lancet . , Vol. 354:: 759––802. .

[37] Guillaumin C. . 1995. . Racism, Sexism, Power, and Ideology . , London : : Routledge. .

[38] 1981. . ‘The practice of power and belief in Nature 1: The appropriation of women; 2: naturalist discourse’. . Feminist Issues . , Vol. 1((2)): 3––28. .

[39] Heywood M. . 2000. . ‘Reporting partner notification and disclosure of HIV serostatus and/or AIDS: public health and human rights’ implications’. . Sexual Health Exchange . , Vol. 1:: 1––3. .

[40] Jewkes R. . 1998. . ‘Why do nurses abuse patients? Reflections from South African obstetric services’. . Social Science and Medicine . , Vol. 47((11)): 1781––1795. .

[41] Kabeer L. . 1994. . Reversed Realities. Gender hierarchies in Development Thought . , London : : Verso. .

[42] Karim Q A. . 1992. . ‘Teenagers seeking condoms at family planning services’. . South African Medical Journal . , Vol. 82:: 356––359. .

[43] Kuhn L and Stein Z. . 1997. . ‘Infant survival, HIV infection, and feeding alternatives in less developed countries’. . American Journal of Public Health . , Vol. 877((6)): 926––931. .

[44] Laloum M. . 1997. . A History of the Breast . , London and New York : : Harper Collins. .

[45] Le Palec A. . 1999. . “‘Le sida, une maladie des femmes’. ”. In Vivre et penser le Sida en Afrique/ Experiencing and Understanding AIDS in Africa . , Edited by: Becker C, Dozon J‐P, Obbo C and Toure M. . p. 343––362. . Paris : : Codesria‐Karthala‐IRD. .

[46] Levett A, Kottler A, Burman E. . 1997. . Culture, Power and Diffe]rence ‐ Discourse Analysis in South Africa . , London and New Jersey : : Zed Books. .

[47] Lewis D. . 1999. . ‘Gender myths and citizenship in two autobiographies by South African women’. . Agenda . , Vol. 40:: 38––44. .

[48] Lupton D. . 1993. . ‘Risk as moral danger: the social and political functions of risk discourse in public health’. . International Journal of Health Services . , Vol. 23:: 425––435. .

[49] Lupton D, McCarthy S and Chapman S. . 1995. . ‘"Panic bodies”: discourse on risk and HIV antibody testing’. . Sociology of Health and Illness . , Vol. 17((1)): 89––108. .

[50] Macciocchi M A. . 1978. . “‘Les femmes et leurs maîtres, Textes rassemblés par J Aubenas‐Bastie’. ”. Paris : : Christian Bourgois. .

[51] Maher V. . 1996. . “‘Breastfeeding and maternal depletion’. ”. In Natural Law or Social Construct? . , Edited by: Maher V. . p. 151––180. . London : : Berg. .

[52] Mare G. . 1992. . Ethnicity and Politics in South Africa . , London : : Zed Books. .

[53] Marks S. . 1998. . Divided Sisterhood. Race, Class and Gender in the South African Nursing Profession . , Johannesburg : : University of the Witwatersrand Press. .

[54] May J. . 1998. . “‘Poverty and Inequality in South Africa’. ”.

[55] Mc Clintock A. . 1991. . ‘No longer in a future heaven: Women and Nationalism in South Africa’. . Transition . , : 51

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