| Types of Family Pressure |
| Mother-in-law |
| “My mother-in-law came during the delivery and influenced my choice.” |
| Woman's family |
| “I breast feed because if I don't, my mother will ask questions and I won't know what to say.” |
| Strategies to deal with family pressure |
| Living Separately |
| “I don't live with relations.” |
| Deception |
| “[I] say that my breast has problems [or] is diseased [or] has an abscess.” |
| Using Husband's authority |
| “My husband tells them he doesn't want his baby to be breastfed.” |
| Hiding |
| “They don't know that I formula feed, I hide in my bedroom.” |
| Using Hospital's Authority |
| “I tell them the hospital says I shouldn't give breastmilk.” |
| Strongly stating preference, using woman's own authority |
| “I tell them I prefer formula and they don't talk again.” |
| Reveal HIV status to family |
| “Previously my family did not know my status, but once I started formula feeding my baby, my mother would follow me to the hospital every time I went because she wanted to know why I wasn't breast feeding. Finally I told her my status.” |
| Types of Financial Difficulties |
| Shortage of fuel |
| “When I run out of kerosine, I boil water at the neighbor's house.” |
| Money for transportation |
| “Transportation money to come and pick up the milk [is a difficulty], because my salary is inconsistent.” |
| Lack of partner financial support |
| “Now I do [have financial difficulty] because my husband just died last week.” |
| Lack of personal income |
| “[I have financial difficulty] because I'm not working.” |
| Shortage of formula |
| “I have had to buy formula 3 times, when it runs out.” |
| Strategies to deal with Financial Difficulties |
| Assistance from missionaries |
| “I work with the missionaries who help.” |
| Assisistance from family |
| “My mother provides financial support, [and my] brother [and] mother-in-law.” |
| Personal savings for child |
| “I try to save for when I run out of formula.” |
| Alternative modes of transport |
| “When I don't have transport money, I trek.” |
| Types of Practical Difficulties |
| Preparing formula at night |
| “I have a back ache from waking up at night and preparing the baby's meal.” |
| Lack of resources to boil water |
| “At night there is not kerosine to light the stove.” |
| Inability to maintain sanitation of utensils |
| “[It is] difficult to keep utensils clean.” |
| General fatigue |
| “I get too tired sometimes.” |
| Maternal urge to breast feed |
| “It is natural to breast-feed, and not being able to is a very painful thing. Sometimes I shed tears for it.” |
| Strategies to deal with practical difficulties |
| Make formula in advance |
| “I premake formula for night-time feeding.” |
| Resilience |
| “I'm hard working and used to it.” |
| Assistance from family |
| “My mother-in-law helps.” |
| Types of Social Stigma |
| Stigma of not breast feeding |
| “People called me a “wicked woman” for not breast-feeding my baby. They said that it was my fault the baby died. They said that if I ever get pregnant again they will force me to breastfeed.” |
| Stigma of HIV |
| “When I formula feed my baby everyone knows why… Whenever I cook food in the morning, I have always given some to the neighbors… Now they cover the food and throw it away when I leave.” |
| Strategies to deal with social stigma |
| Deception |
| “I tell others that my breast does not have enough milk in it, and that is why I must formula feed.” |
| Examples of Partner Support and Status Disclosure |
| “When I found out my status, my husband and I laughed over the results. We took it easily. For the feeding decision, my husband advised me to go to my mother-in-law's place and let her see me breast-feeding. I went for 3 weeks, then I returned home and switched over to formula feeding.” |
| “When I found out my status, I wept and told my husband. He said that it's ok, it is an act of God. But I tried to commit suicide with drugs and a knife. My husband called my sister to help me. I wanted to tell my parents about my status, but the nurse advised against it. We made the decision to give formula to the baby together. My husband supports me very well.” |
| “The first people who I told my status to were my own parents. They encouraged me to tell my husband. I told my husband and he supports me. We decided to formula feed our baby.” |
| “When I got my HIV test done, my husband was with me. When the results came back I showed them to him right away. So he has known since the beginning and has supported me with my choice to formula feed the baby.” |
