Becoming an African mum

I am so glad to be back at NAM after my maternity leave.

I gave birth to a beautiful baby girl last July, weighing 2.8kg. I thought I had prepared myself emotionally and physically. Yeah right!

Healthy mothers, healthy babies

This whole birthing experience made me realise how far we have come in regards to preventing vertical transmission (often called mother-to-child transmission, when HIV is passed on during pregnancy, delivery or breastfeeding). Here in the UK, the rate is now below 1%, due to routine antenatal HIV testing and effective drug regimens and care.

If a mother has an HIV test during pregnancy and the test is positive, she will have CD4 and viral load tests done. This gives the mother and her healthcare team important information to guide their decisions about HIV treatment to protect the mother’s health and also to prevent HIV transmission to the unborn child. Caesarean section is recommended for those women with a high viral load. But for those women who adhere well to their treatment and have a low viral load (full viral suppression) then vaginal delivery is an option. After the child is born he/she will be given treatment for a period of six weeks. The British HIV Association (BHIVA)/Children’s HIV Association (CHIVA) guidelines advise all mothers with HIV to refrain from breast feeding regardless of their maternal viral load and antiretroviral treatment.

The cost of prevention

BHIVA/CHIVA guidelines clearly state formula milk and sterilising equipment should be provided to all women with HIV to prevent transmission through breast feeding. I’m interested in how this is being done in practice. Are all women offered this support, no matter their salary? Does it also include those with uncertain immigration status (no recourse to public funds)? Is it targeted for the poorer or refugee women living in the UK? As a working African woman and mother I must admit that the expense of raising a child here in London is no joke! For me, this raises a question of the possibility, could middle-class working African women be struggling to buy formula milk? Could this lead them to opt to breast feed without informing their health professionals?  

In Africa, breast feeding remains a norm and is vital for child survival. I have personally witnessed women in Kenya living in extreme poverty, having no option but to continue breast feeding for as long as they can to save money. These women are burdened with the dilemma of feeding the rest of the family, faced with other economic, social and cultural pressures.

Stigma in the community

The situation is quite different here in London, yet despite all the HIV-related services available, a significant number of African women are not able to fully benefit from them. Faced with language difficulties, housing problems, domestic violence and restricted movement by domineering male partners, poverty, uncertain immigration status and fear of stigma, many do not prioritise learning more about HIV, avoiding transmission to their unborn child, and their available health options.

Stigma and discrimination is still huge within African communities, leading to late HIV diagnosis, leading to poor health. Breast feeding symbolises motherhood but also an achievement (fertility) for both partners. African women living with HIV in London are advised not to breast feed. They find it extremely difficult to justify to their husbands/partners and the wider African community. During my visit to an African community organisation, sitting in during their HIV-positive support group session, one service user, Ms A, stated “Whenever family members, relatives and friends come to visit us, my husband tells me to prepare the food and when the visitors arrive, I should greet them, show them the baby, then go to the bedroom, because he doesn’t want our visitors asking questions why I am not breast feeding, he doesn’t want people to start talking and spreading rumours, it will only bring him shame.”

Ms B said “I am from Nigeria, and in Nigeria everybody knows everybody and word travels faster than lightning. Everybody knows nowadays in Africa and UK that if an African woman does not breast feed her baby then she must be HIV-positive. For this reason I would rather let my baby cry until I get into a secure and private place, like a toilet, and feed my baby”.

Another service user mentioned “I was OK when going for my antenatal classes with my midwife but when my support was shifted to the health visitors, they immediately asked me why I wasn’t breast feeding, and I told them I was HIV-positive, since that time I feel they treat me differently, like they were afraid of touching my baby, constantly coming to visit me at home, one even advised me, ‘now that you are aware of your HIV status you should try and not have other children’. I was hurt, ashamed and felt dirty.”

For more information

I am so excited to be back to work, working with the African communities and reinforcing the vital key HIV messages of the importance of early HIV testing, regular HIV testing, practising safer sex, treatment adherence and the importance of viral load suppression. Treatment as prevention does save lives; in unborn children as well as in couples where one is HIV-positive and the other is HIV-negative. This is definitely another topic for another day.

If you are an individual or organisation working within the community and offer services to African people with HIV, please get in touch with me at jackie@nam.org.uk. If you regularly subscribe to NAM’s print or digital resources, I would be very pleased to hear your views and comments on these resources.

The BHIVA/CHIVA position statement on infant feeding is available to download here: www.bhiva.org/BHIVA-CHIVA-PositionStatement.aspx

Jackie leads NAM’s African Communities Engagement Project, which is funded by the National Lottery through the Big Lottery Fund and the Henry Smith Charity