Exclusive breastfeeding policy, practice and influences in South Africa, 1980 to 2018: A mixed-methods systematic review

Autoři: Sara Jewett Nieuwoudt aff001;  Christian B. Ngandu aff002;  Lenore Manderson aff001;  Shane A. Norris aff002
Působiště autorů: School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Braamfontein, Johannesburg, South Africa aff001;  SAMRC Developmental Pathways Health and Research Unit, University of the Witwatersrand, Braamfontein, Johannesburg, South Africa aff002;  Institute at Brown for Environment and Society, Brown University, Providence, RI, United States of America aff003;  School of Social Sciences, Menzies Building, Clayton Campus, Monash University, Melbourne, Australia aff004;  School of Human Development and Health, and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, United Kingdom aff005
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0224029



In 2011, South Africa committed to promoting exclusive breastfeeding (EBF) for six months for all mothers, regardless of HIV status, in line with World Health Organization recommendations. This was a marked shift from earlier policies, and with it, average EBF rates increased from less than 10% in 2011 to 32% by 2016.


The aim of this mixed-methods systematic review was to describe EBF practices in South Africa and their multi-level influences over four policy periods.


We applied PRISMA guidelines according to a published protocol (Prospero: CRD42014010512). We searched seven databases [Africa-Wide, PubMed, Popline, PsychINFO, CINAHL, Global Health, and The Cochrane Library] and conducted hand searches for eligible articles (all study designs, conducted in South Africa and published between 1980–2018). The quality of articles was assessed using published tools, as appropriate. Separate policy analysis was conducted to delineate four distinct policy periods. We compared EBF rates by these periods. Then, applying a three-level ecological framework, we analysed EBF influences concurrently by method. Finally, the findings were synthesized to compare breastfeeding influences by policy period, maintaining an ecological framework.


From an initial sample of 20,226 articles, 72 unique articles were reviewed, three of which contributed to both quantitative and qualitative analysis. Despite the large sample, several provinces were poorly represented (if at all) and many studies were assessed as low to moderate quality. Despite these limitations, our historical lens enabled us to explore why South African progress on increasing EBF practices has been slow. The review reflects a context that increasingly supports EBF, but falls short in accounting for family, community, and workplace influences. The findings also highlight the unintended damage caused by rapidly adopting and introducing global guidelines to an unsupported health workforce.


From a South African perspective, we identified geographic and methodological biases, as well as gaps in our understanding and potential explanations of inequities in EBF. Our recommendations relate to policy, programming, and research to inform changes that would be required to further improve EBF practice rates in South Africa. While our review is South Africa-specific, our findings have broader implications for investing in multi-level interventions and limiting how often infant feeding guidelines are changed.

Klíčová slova:

HIV epidemiology – Infants – Mothers – Parenting behavior – Qualitative studies – South Africa


1. Du Plessis L, Peer N, Honikman S, English R. Breastfeeding in South Africa: Are we making progress? In: Padarath A, King JF, Mackie E, Casciola J, editors. S Afr Health Rev. Durban: Health Systems Trust; 2016. pp. 109–23.

2. Victora CG, Bahl R, Barros AJ, Franca GV, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017): 475–90. doi: 10.1016/S0140-6736(15)01024-7 26869575

3. World Health Organization. Indicators for assessing infant and young child feeding practices: Conclusions of a consensus meeting held 6–8 November 2007 in Washington DC. Geneva: WHO; 2008.

4. Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, et al. Why invest, and what it will take to improve breastfeeding practices? Lancet. 2016;387(10017): 491–504. doi: 10.1016/S0140-6736(15)01044-2 26869576

5. National Department of Health, Statistics South Africa, South African Medical Research Council, ICF. South Africa demographic and health survey 2016: Key indicators. Pretoria, South Africa and Rockville, Maryland, USA: NDoH, Stats SA, SAMRC, and ICF, 2017.

6. South African National Department of Health, Medical Research Council of South Africa, Demographic and Health Surveys, Macro International Inc. South African demographic and health survey, 1998 report. Pretoria, South Africa and Rockville, Maryland, USA: NDoH, SAMRC, and Macro, 1998.

7. National Department of Health. The 2015 National antenatal sentinel HIV & syphilis survey, South Africa. Pretoria: National Department of Health, 2017.

8. National Department of Health. Policy and guidlines for the implemention of the PMTCT programme. Pretoria: National Department of Health, 2008.

9. National Department of Health. Protocol for providing a comprehensive package of care for the prevention of mother to child transmission of HIV (PMTCT) in South Africa. Pretoria: South African National Department of Health; 2001.

10. Department of Health. The Tshwane Declaration of support for breastfeeding in South Africa. South Afr J Clin Nutr. 2011;24(4):214.

11. Goga AE, Doherty T, Jackson DJ, Sanders D, Colvin M, Chopra M, et al. Infant feeding practices at routine PMTCT sites, South Africa: Results of a prospective observational study amongst HIV exposed and unexposed infants—birth to 9 months. Int Breastfeed J. 2012 Apr;7(1): 4.

12. Hunter M. Reaction to conquest: Effects of contact with Europeans on the Pondo of South Africa, second edition. London: Oxford University Press; 1961.

13. Kruger R, Gericke GJ. A qualitative exploration of rural feeding and weaning practices, knowledge and attitudes on nutrition. Public Health Nutr. 2003 Apr;6(2): 217–23. doi: 10.1079/PHN2002419 12675965

14. Schoub BD, Greeff A, Lecatsas G, Prozesky O, Hay I, Prinsloo J, et al. A microbiological investigation of acute summer gastroenteritis in black South African infants. Epidemiol Infect. 1977;78(3): 377–85.

15. Lazarus R, Struthers H, Violari A. Promoting safe infant feeding practices–the importance of structural, social and contextual factors in Southern Africa. J Int AIDS Soc. 2013 Jan;16(1): 0–7448.

16. Department of Health UNICEF. Infant and young child feeding policy. Pretoria: Department of Health Nutrition Directorate; 2007. p. 45.

17. Moher D, Liberati A, Tetzlaff J, Altman DG, Prisma Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009;6(7): e1000097. doi: 10.1371/journal.pmed.1000097 19621072

18. Baek C, Mathambo V, Mkhize S, Friedman I, Apicella L. Key findings from an evaluation of the mothers2mothers program in Kwazulu-Natal, South Africa. Washington, D.C.: Population Council, Horizons, 2007.

19. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013 Sep 18;13:117. doi: 10.1186/1471-2288-13-117 24047204

20. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. Br Med J (Clin Res Ed). 2008;336(7650): 924–6.

21. Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64: 401–6. doi: 10.1016/j.jclinepi.2010.07.015 21208779

22. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADe guidelines: 1. Introduction-grade evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64: 383–94. doi: 10.1016/j.jclinepi.2010.04.026 21195583

23. Wells G, Shea B, O’connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa (ON): Ottawa Hospital Research Institute, 2009.

24. Lewin S, Glenton C, Munthe-Kaas H, Carlsen B, Colvin CJ, Gülmezoglu M, et al. Using qualitative evidence in decision making for health and social interventions: An approach to assess confidence in findings from qualitative evidence syntheses (GRADE-CERLQUAL). PLoS Med. 2015;12(10):e1001895. doi: 10.1371/journal.pmed.1001895 26506244

25. Lewin S, Booth A, Glenton C, Munthe-Kaas H, Rashidian A, Wainwright M, et al. Applying GRADE-CERQUAL to qualitative evidence synthesis findings: Introduction to the series. Implement Sci. 2018 January 25;13(1): 2.

26. Downe S. Metasynthesis: A guide to knitting smoke. Evid Based Midwif. 2008;6: 4–8.

27. Ross SM, Loening WEK, Van Middelkoop A. Breast-feeding-evaluation of a health education programme. S Afr Med J. 1983;64(10): 361–3. 6612532

28. Myburgh J, Price S. To breastfeed or not to breastfeed? That is the question. Curationis. 1985;8(1): 32. 3848355

29. Mkhasibe C, Wagstaff L. Breast feeding practices of nurses at Baragwanath, Coronation and Johannesburg hospitals. Curationis. 1988 Dec;11(4): 19–21. 3219768

30. Ransome OJ, Chalmers B, Herman AAB, Reinach SG. Infant feeding in an urban community. S Afr Med J. 1988;74(8): 393–5. 3187817

31. Ransome OJ, Chalmers B, Herman AAB, Reinach SG. Factors influencing breast-feeding in an urban community. S Afr Med J. 1989;76(8): 431–3. 2799596

32. Zöllner E, Carlier ND. Breast-feeding and weaning practices in Venda, 1990. S Afr Med J. 1993;83(8): 580–3. 8211520

33. Roberts GJ, Cleaton-Jones PE, Richardson BD, Sinwell RE, Lucas VS. Breast and bottle feeding in rural and urban South African children. J Hum Nutr Diet. 1995 Jan 1;8(4): 255–63.

34. Mamabolo RL, Alberts M, Mbenyane GX, Steyn NP, Nthangeni NG, Delemarre-Van De Waal HA, et al. Feeding practices and growth of infants from birth to 12 months in the central region of the Limpopo province of South Africa. Nutr. 2004;20(3): 327–33.

35. Whitfield M. Breastfeeding in South Africa: Why the lack of support?: Research hot off the press. Health Systems Trust Update. 1996 Jan 1;17(19): 5–6.

36. Kruger R, Gericke G. Feeding practices of children [aged 0–2 years] in a rural area in North West province in South Africa. South Afr J Clin Nutr. 2000;13(3):127.

37. Ukpe IS, Blitz J, Hugo J, Theledi M. The infant feeding practices of mothers enrolled on the prevention of mother to child transmission of HIV programme at a primary health care clinic in Mpumalanga province, South Africa. S Afr Fam Pract. 2009;51(4): 337–9.

38. Marais D, Koornhof HE, du Plessis LM, Naude CE, Smit K, Hertzog E, et al. Breastfeeding policies and practices in health care facilities in the Western Cape province, South Africa. South Afr J Clin Nutr. 2010;23(1): 40–5.

39. Kassier SM, Veldman FJ. Cry, the beloved bottle: Infant-feeding knowledge and the practices of mothers and caregivers in an urban township outside Bloemfontein, Free State province. South Afr J Clin Nutr. 2013;26(1): 17–22

40. Morgan JJ, Jeggels JD. Factors influencing the infant feeding choices of HIV-positive mothers at a level two hospital in Cape Town. Afr J Midwifery Womens Health. 2015;9(2): 66–70.

41. Kyei K, Netshikweta M, Spio K. Breastfeeding in the Vhembe district of Limpopo province, South Africa: Duration and factors. Studies on Ethno-Medicine. 2014;8(3): 317–24.

42. Matji JN, Wittenberg DF, Makin JD, Jeffery B, MacIntyre UE, Forsyth BW. Psychosocial and economic determinants of infant feeding intent by pregnant HIV-infected women in Tshwane/Pretoria. SAJCH. 2008 Jan 1;2(3): 114–18.

43. Zunza M, Theron GB, Harvey C. Compliance with infant formula feeding by HIV-positive women one week after delivery in khayelitsha, South Africa. South Afr J Epidemiol & Infect. 2011;26(4): 274–9.

44. Ross SM, Middelkoop AV, Khoza NC. Breast-feeding practices in a black community. S Afr Med J. 1983;63(1): 23–5. 6849147

45. Ross SM, Loening WEK, Mbele BE. Breast-feeding support. S Afr Med J. 1987;72(5): 357–8. 3616847

46. Doherty T, Chopra M, Jackson D, Goga A, Colvin M, Persson L-A. Effectiveness of the WHO/UNICEF guidelines on infant feeding for HIV-positive women: Results from a prospective cohort study in South Africa. AIDS. 2007;21(13):1791–7. doi: 10.1097/QAD.0b013e32827b1462 17690578

47. Bork K, Cames C, Cournil A, Musyoka F, Ayassou K, Naidu K, et al. Infant feeding modes and determinants among HIV-1-infected African women in the Kesho Bora study. J Acquir Immune Defic Syndr. 2013 Jan 1;62(1): 109–18. doi: 10.1097/QAI.0b013e318277005e 23075919

48. Kuhn L, Mathews C, Fransman D, Dikweni L, Hussey G. Child feeding practices of HIV-positive mothers in Cape Town, South Africa. AIDS. 1999 Jan 14;13(1):144–6. 10207563

49. Mostert D, Steyn NP, Temple NJ, Olwagen R. Dietary intake of pregnant women and their infants in a poor black South African community. Curationis. 2005 Nov;28(4):12–9. doi: 10.4102/curationis.v28i4.1002 16450555

50. Engebretsen IMS, Nankabirwa V, Doherty T, Diallo AH, Nankunda J, Fadnes LT, et al. Early infant feeding practices in three african countries: The PROMISE-EBF trial promoting exclusive breastfeeding by peer counsellors. Int Breastfeed J. 2014;9(1):19.

51. Hoffman M. A programme to promote breast feeding in a socio-economically disadvantaged area of Cape Town. SALDRU, School of Economics, University of Cape Town, 1984.

52. Goosen C. Factors influencing feeding practices of primary caregivers of infants [0–5.9 months] in Avian Park and Zwelethemba, Western Cape, South Africa. Doctoral dissertation, Stellenbosch University, 2013.

53. Goosen C, McLachlan MH, Schübl C. Infant feeding practices during the first 6 months of life in a low-income area of the Western Cape province. SAJCH. 2014 May 21;8(2): 50–4.

54. Hoffman MN, Durcan NM, Disler PB. Breast-feeding in a socio-economically disadvantaged area of Cape Town. Part I. Analysis of breast-feeding patterns among clinic attenders. S Afr Med J. 1984 Jul 14;66(2): 64–5. 6740427

55. Hoffman MN, Durcan NM, Disler PB. Breast-feeding in a socio-economically disadvantaged area of Cape Town. Part II. The introduction of an educational and support programme. S Afr Med J. 1984 Jul 14;66(2):66–7. 6740428

56. Bland RM, Little KE, Coovadia HM, Coutsoudis A, Rollins NC. Intervention to promote exclusive breast-feeding for the first 6 months of life in a high HIV prevalence area. AIDS. 2008 Apr 23;22(7): 883–91. doi: 10.1097/QAD.0b013e3282f768de 18427207

57. Bland RM, Rollins NC, Coovadia HM, Coutsoudis A, Newell ML. Infant feeding counselling for HIV-infected and uninfected women: Appropriateness of choice and practice. Bull World Health Organ. 2007 Apr;85(4): 289–96. doi: 10.2471/BLT.06.032441 17546310

58. Bland RM, Rollins NC, Coutsoudis A, Coovadia HM. Breastfeeding practices in an area of high HIV prevalence in rural South Africa. Acta Paediatr. 2002;91(6): 704–11. doi: 10.1080/080352502760069151 12162606

59. Bork K, Cames C, Cournil A, Musyoka F, Ayassou K, Naidu K, et al. Infant feeding modes and determinants among HIV-1-infected African women in the Kesho Bora study. J Acquir Immune Defic Syndr. 2013 Jan 1;62(1): 109–18. doi: 10.1097/QAI.0b013e318277005e 23075919

60. Ghuman MR, Saloojee H, Morris G. Infant feeding practices in a high HIV prevalence rural district of Kwazulu-Natal, South Africa. South Afr J Clin Nutr. 2009;22(2): 74–9.

61. Kassier S, Maunder E, Senekal M. Infant feeding practices in Kwazulu-Natal: An exploratory study of current infant feeding practices of mothers with 0–6 month old infants attending PMTCT and non-PMTCT clinics in central Durban. Durban Institute of Technology, 2003.

62. Ijumba P, Doherty T, Jackson D, Tomlinson M, Sanders D, Swanevelder S, et al. Effect of an integrated community-based package for maternal and newborn care on feeding patterns during the first 12 weeks of life: A cluster-randomized trial in a South African township. Public Health Nutr. 2015; 18(14): 2660–8 doi: 10.1017/S1368980015000099 25660465

63. Swarts S, Kruger HS, Dolman RC. Factors affecting mothers' choice of breastfeeding vs. Formula feeding in the lower Umfolozi District War Memorial hospital, Kwazulu-Natal. Health SA: interdisciplinary research journal. 2010 Jan 1;15(1):119–26.

64. Tomlinson M, Doherty T, Ijumba P, Jackson D, Lawn J, Persson L, et al. Goodstart: A cluster randomised effectiveness trial of an integrated, community-based package for maternal and newborn care, with prevention of mother-to-child transmission of HIV in a South African township. Trop Med Int Health. 2014; 19(3): 256–66 doi: 10.1111/tmi.12257 24433230

65. Tylleskär T, Jackson D, Meda N, Engebretsen IM, Chopra M, Diallo AH, et al. Exclusive breastfeeding promotion by peer counsellors in sub-saharan africa (PROMISE-EBF): A cluster-randomised trial. Lancet. 2011; 378(9789): 420–7 doi: 10.1016/S0140-6736(11)60738-1 21752462

66. Horwood C, Butler L, Barker P, Phakathi S, Haskins L, Grant M, et al. A continuous quality improvement intervention to improve the effectiveness of community health workers providing care to mothers and children: A cluster randomised controlled trial in South Africa. Hum Resour Health. 2017 Jun 13;15(1): 39. doi: 10.1186/s12960-017-0210-7 28610590

67. Pillay S, Sibanda W, Ghuman MR, Coutsoudis A. Infant feeding practices of teenage mothers attending a well-baby clinic in a public hospital in Umlazi, Kwazulu-Natal, South Africa. South Afr J Clin Nutr. 2018;31(1): 14–9.

68. Reimers P, Israel-Ballard K, Craig M, Spies L, Thior I, Tanser F, et al. A cluster randomised trial to determine the efficacy of the 'feeding buddies' programme in improving exclusive breastfeeding rates among HIV-infected women in rural Kwazulu-Natal, South Africa. AIDS Behav. 2018 Jan 1;22(1): 212–23. doi: 10.1007/s10461-017-1865-8 28741134

69. Tuthill EL, Pellowski JA, Young SL, Butler LM. Perinatal depression among HIV-infected women in Kwazulu-Natal South Africa: Prenatal depression predicts lower rates of exclusive breastfeeding. AIDS Behav. 2017 Jun;21(6): 1691–8. doi: 10.1007/s10461-016-1557-9 27752868

70. Tuthill EL, Butler LM, Pellowski JA, McGrath JM, Cusson RM, Gable RK, et al. Exclusive breast-feeding promotion among HIV-infected women in South Africa: An Information-Motivation-Behavioural skills model-based pilot intervention. Public Health Nutr. 2017 Jun;20(8): 1481–90. doi: 10.1017/S1368980016003657 28173897

71. van der Elst CW, Pick W, Isaacs S, Malan AF. Current trends in infant feeding. S Afr Med J. 1989 Oct 21;76(8): 434–7. 2799597

72. Petrie KEM, Schmidt SD, Schwarz CE, Koornhof HE, Marais D. Knowledge, attitudes and practices of women regarding the prevention of mother-to-child transmission (PMTCT) programme at the Vanguard Community Health Centre, Western Cape—a pilot study. South Afr J Clin Nutr. 2007:20(2): 71–8.

73. Sibeko L, Dhansay MA, Charlton KE, Johns T, Gray-Donald K. Beliefs, attitudes, and practices of breastfeeding mothers from a periurban community in South Africa. J Hum Lact. 2005 Feb;21(1): 31–8. doi: 10.1177/0890334404272388 15681633

74. Rotheram-Borus MJ, Richter LM, Heerden Av, Rooyen Hv, Tomlinson M, Harwood JM, et al. A cluster randomized controlled trial evaluating the efficacy of peer mentors to support South African women living with HIV and their infants. PLoS ONE. 2014;9(1): e84867–e. doi: 10.1371/journal.pone.0084867 24465444

75. Budree S, Goddard E, Brittain K, Cader S, Myer L. Infant feeding practices in a South African birth cohort-a longitudinal study. Matern Child Nutr. 2017 Jul;13(3): e12371.

76. Myer L, Phillips TK, Zerbe A, Brittain K, Lesosky M, Hsiao N, et al. Integration of postpartum healthcare services for HIV-infected women and their infants in South Africa: A randomised controlled trial. PLoS Med. 2018;15(3):e1002547–e. doi: 10.1371/journal.pmed.1002547 29601570

77. Steyn N, Zunza M, Decloedt EH. A cross-sectional descriptive study of breastfeeding behaviour and galactogogue use among private-sector patients in Cape Town, South Africa. SAJOG. 2017;23(1):20–3.

78. Thomas E, Kuo C, Cohen S, Hoare J, Koen N, Barnett W, et al. Mental health predictors of breastfeeding initiation and continuation among HIV infected and uninfected women in a South African birth cohort study. Prev Med. 2017;102:100–11. doi: 10.1016/j.ypmed.2017.07.004 28694059

79. Chalmers B. Urban/rural differences in infant feeding practices among Pedi women. S Afr Med J. 1986 Jul 5;70(1): 63–4. 3726691

80. Chalmers B, Ransome OJ, Herman A. Psychosocial factors related to infant feeding patterns. J Reprod Infant Psychol. 987 Jul-Sep;5(3): 153–64.

81. Ellison GT, Wagstaff L, Cameron N, de Wet T. Geographical differences in infant feeding patterns in disadvantaged communities. S Afr Med J. 1997;87(8): 1025–6. 9323423

82. MacIntyre UE, de Villiers FP, Baloyi PG. Early infant feeding practices of mothers attending a postnatal clinic in Ga-rankuwa. SAJCN. 2005 Sep;18(2): 70–5.

83. Nikodem VC, Hofmeyr GJ, Kramer TR, Gulmezoglu AM, Anderson A. Audiovisual education and breastfeeding practices: A preliminary report. Curationis. 1993;16(4): 60–3.

84. du Plessis D. Breastfeeding: Mothers and health practitioners in the context of private medical care in Gauteng. Health SA Gesondheid. 2009;14(1): 39–48.

85. Mnyani CN, Tait CL, Armstrong J, Blaauw D, Chersich MF, Buchmann EJ, et al. Infant feeding knowledge, perceptions and practices among women with and without HIV in Johannesburg, South Africa: A survey in healthcare facilities. Int Breastfeeding J. 2016;12(1):17.

86. Sepeng L, Ballot DE. Audit of feeding practices in the neonatal wards at the Charlotte Maxeke Johannesburg academic hospital. SAJCH. 2016;9(4): 133–6.

87. Siziba LP, Jerling J, Hanekom SM, Wentzel-Viljoen E. Low rates of exclusive breastfeeding are still evident in four South African provinces. South Afr J Clin Nutr. 2016;28(4): 170–9.

88. Delport SD, Bergh AM, Hay IT. Breast-feeding practices in a private maternity hospital. S Afr Med J. 1988 Oct 15;74(8): 396–9. 3187818

89. Some EN, Engebretsen IM, Nagot N, Meda N, Lombard C, Vallo R, et al. Breastfeeding patterns and its determinants among mothers living with human immuno-deficiency virus -1 in four African countries participating in the ANRS 12174 trial. Int Breastfeed J. 2017 May 2;12(22):1–12.

90. Yako EM, Nzama NP. Maintenance of the selected infant feeding methods amongst postnatal mothers at risk of HIV in the Eastern Cape province, South Africa. Health SA Gesondheid. 2013 Apr 29;18(1): 7

91. Ladzani R, Peltzer K, Mlambo MG, Phaweni K. Infant‐feeding practices and associated factors of HIV‐positive mothers at Gert Sibande, South Africa. Acta Paediatr. 2011;100(4): 538–42. doi: 10.1111/j.1651-2227.2010.02080.x 21062356

92. Kruger R, Gericke G. Breast feeding practices of mothers with children [aged 0–36 months] in a rural area of South Africa a qualitative approach. Journal of Family Ecology and Consumer Sciences. 2001 March15; 29(1): 60–70.

93. Seidel G. Reconceptualising issues around HIV & breastfeeding advice: Findings from Kwazulu‐Natal, South Africa. Rev Afr Pol Econ. 2000;27(86): 501–18.

94. Seidel G. Decisions and advice about infant feeding: Findings from sociological work in Kwazulu-Natal, South Africa. Afr J AIDS Res. 2004 Jun 17; 3(2):167–77. doi: 10.2989/16085900409490331 25875065

95. Seidel G, Sewpaul V, Dano B. Experiences of breastfeeding and vulnerability among a group of HIV-positive women in Durban, South Africa. Health Policy Plan. 2000;15(1): 24–33. doi: 10.1093/heapol/15.1.24 10731232

96. Buskens I, Jaffe A. Demotivating infant feeding counselling encounters in Southern Africa: Do counsellors need more or different training? AIDS Care. 2008;20(3): 337–45. doi: 10.1080/09540120701660346 18351482

97. Buskens I, Jaffe A, Mkhatshwa H. Infant feeding practices: Realities and mind sets of mothers in Southern Africa. AIDS Care. 2007;19(9):1101–9. doi: 10.1080/09540120701336400 18058394

98. Chopra M, Piwoz E, Sengwana J, Schaay N, Dunnett L, Saders D. Effect of a mother-to-child HIV prevention programme on infant feeding and caring practices in South Africa. S Afr Med J. 2002 Apr;92(4): 298–302. 12056362

99. Doherty T, Chopra M, Nkonki L, Jackson D, Greiner T. Effect of the HIV epidemic on infant feeding in South Africa: "When they see me coming with the tins they laugh at me". Bull World Health Organ. 2006 Feb;84(2): 90–6. doi: 10.2471/blt.04.019448 16501725

100. Doherty T, Chopra M, Nkonki L, Jackson D, Persson L-A. A longitudinal qualitative study of infant-feeding decision making and practices among HIV-positive women in South Africa. J Nutr. 2006;136(9): 2421–6. doi: 10.1093/jn/136.9.2421 16920864

101. Nor B, Ahlberg BM, Doherty T, Zembe Y, Jackson D, Ekströ, et al. Mother's perceptions and experiences of infant feeding within a community-based peer counselling intervention in South Africa. Matern Child Nutr. 2012;8(4): 448–58. doi: 10.1111/j.1740-8709.2011.00332.x 21736700

102. Nor B, Zembe Y, Daniels K, Doherty T, Jackson D, Ahlberg BM, et al. "Peer but not peer": Considering the context of infant feeding peer counseling in a high HIV prevalence area. J Hum Lact. 2009;25(4): 427–34. doi: 10.1177/0890334409341050 19622755

103. Du Plessis D. Breastfeeding: Mothers and health practitioners in the context of private medical care in Gauteng. Health SA. 2009;14(1): 1–10.

104. Mackowski AM. An assessment of the factors that influence the infant feeding practices of HIV-positive mothers in the mothers' programmes: A qualitative study. Doctoral dissertation, University of Cape Town, 2005.

105. Sibeko L, Coutsoudis A, Nzuza S, Gray-Donald K. Mothers' infant feeding experiences: Constraints and supports for optimal feeding in an HIV-impacted urban community in South Africa. Public Health Nutr. 2009 Nov;12(11): 1983–90. doi: 10.1017/S1368980009005199 19323863

106. Stinson K, Myer L. HIV-infected women's experiences of pregnancy and motherhood in Cape Town, South Africa. Vulnerable Child Youth Stud. 2012;7(1): 36–46.

107. Thairu LN, Pelto GH, Rollins NC, Bland RM, Ntshangase N. Sociocultural influences on infant feeding decisions among HIV-infected women in rural Kwa-zulu Natal, South Africa. Mat Child Nutr. 2005;1(1): 2–10.

108. Varga C, Brookes H. Preventing mother-to-child HIV transmission among South African adolescents. J Adolesc Res. 2008;23(2): 172–205.

109. Andreson J, Dana N, Hepfer B, Kingori E, Oketch J, Wojnar D, et al. Infant feeding buddies: A strategy to support safe infant feeding for HIV-positive mothers. J Hum Lact. 2013 Feb;29(1): 90–3. doi: 10.1177/0890334412469056 23277462

110. Chaponda A, Goon DT, Hoque ME. Infant feeding practices among HIV-positive mothers at Tembisa Hospital, South Africa. Afr J Prim Health Care Fam Med. 2017 Jul 27;9(1):e1–e6.

111. Goosen C, McLachlan MH, Schübl C. Factors impeding exclusive breastfeeding in a low-income area of the Western Cape province of South Africa. Afr J Nurs Midwifery. 2014;16(1):13–31.

112. Ijumba P, Doherty T, Jackson D, Tomlinson M, Sanders D, Persson L-Å. Social circumstances that drive early introduction of formula milk: An exploratory qualitative study in a peri-urban South African community. Mat Child Nutr. 2014;10(1): 102–11.

113. Laher F, Cescon A, Lazarus E, Kaida A, Makongoza M, Hogg RS, et al. Conversations with mothers: Exploring reasons for prevention of mother-to-child transmission [PMTCT] failures in the era of programmatic scale-up in Soweto, South Africa. AIDS Behav. 2012 Jan 1;16(1): 91–8. doi: 10.1007/s10461-010-9875-9 21197599

114. Madiba S, Langa J. Cultural practices interfere with adherence to exclusive infant feeding: A qualitative study among HIV positive post natal women in Hammanskraal, South Africa: Child nutrition and feeding practices. Afr J Phys Health Educ Recreat Dance. 2014;20(S1): 264–78.

115. Madiba S, Letsoalo R. HIV disclosure to partners and family among women enrolled in prevention of mother to child transmission of HIV program: Implications for infant feeding in poor resourced communities in South Africa. Glob J Health Sci. 2013 Jul;5(4): 1. doi: 10.5539/gjhs.v5n4p1 23777716

116. Ramara NS, Maputle MS, Lekhuleni ME. Infant feeding and HIV positive mothers in the Capricorn district of Limpopo province. Curationis. 2010 Mar;33(1): 5–16. doi: 10.4102/curationis.v33i1.1000 21469459

117. Zulliger R, Abrams EJ, Myer L. Diversity of influences on infant feeding strategies in women living with HIV in Cape Town, South Africa: A mixed methods study. Trop Med Int Health. 2013;18(12):1547–54. doi: 10.1111/tmi.12212 24151822

118. Hunter-Adams J, Myer L, Rother HA. Perceptions related to breastfeeding and the early introduction of complementary foods amongst migrants in Cape Town, South Africa. Int Breastfeed J. 2016;11(1): 29.

119. Jama NA, Wilford A, Masango Z, Haskins L, Coutsoudis A, Spies L, et al. Enablers and barriers to success among mothers planning to exclusively breastfeed for six months: A qualitative prospective cohort study in Kwazulu-Natal, South Africa. Int Breastfeed J. 2017;12: 43. doi: 10.1186/s13006-017-0135-8 29026431

120. Modiba LM. Dilemma for choosing exclusive replacement feeding for HIV positive mothers of infants at a public hospital in Gauteng province, South Africa. Afr J Phys Health Educ Recreat Dance. 2015 08/31/;21(3): 1–11.

121. Mushaphi LF, Mahopo TC, Nesamvuni CN, Baloyi B, Mashau E, Richardson J, et al. Recommendations for infant feeding policy and programs in Dzimauli Region, South Africa: Results from the MAL-ED birth cohort. Food Nutr Bull. 2017;38(3): 428–40. doi: 10.1177/0379572117696662 28958169

122. Ntuli B, Modibedi K. Decision-making and practice on infant feeding: A case study of women in a prevention of mother to child transmission programme in Gauteng province, South Africa: Public health intervention for maternal and child health. Afr J Phys Health Educ Recreat Dance. 2015;21(Suppl. 2.1): 12–24.

123. World Health Organization, UNICEF. Baby-friendly hospital initiative: Revised, updated and expanded for integrated care. 2009.

124. Bhattacharjee NV, Schaeffer LE, Marczak LB, Ross JM, Swartz SJ, Albright J, et al. Mapping exclusive breastfeeding in Africa between 2000 and 2017. Nat Med. 2019 Aug;25(8):1205–12. doi: 10.1038/s41591-019-0525-0 31332393

125. Burns E, Schmied V, Sheehan A, Fenwick J. A meta-ethnographic synthesis of women's experience of breastfeeding. Mat Child Nutr. 2010;6(3): 201–19.

126. Marshall JL, Godfrey M, Renfrew MJ. Being a ‘good mother’: Managing breastfeeding and merging identities. Soc Sci Med. 2007 Nov;65(10): 2147–59. doi: 10.1016/j.socscimed.2007.06.015 17681409

127. Leeming D, Williamson I, Lyttle S, Johnson S. Socially sensitive lactation: Exploring the social context of breastfeeding. Psych Health. 2013;28(4): 450–68.

128. Abrahams SW. Milk and social media:Online communities and the international code of marketing of breast-milk substitutes. J Hum Lact. 2012;28(3): 400–6. doi: 10.1177/0890334412447080 22674963

129. Kwazulu-Natal provincial guidelines on mother-baby friendly initiative implementation in Department of Health healthcare facilities, Pietersmaritzburg: KZN Department of Health, 2012.

130. Balogun OO, O'Sullivan EJ, McFadden A, Ota E, Gavine A, Garner CD, et al. Interventions for promoting the initiation of breastfeeding. Cochrane Database Syst Rev. 2016 Nov:11.

131. McFadden A, Gavine A, Renfrew MJ, Wade A, Buchanan P, Taylor JL, et al. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev. 2017; 2.

132. World Health Organization, United Nations Children’s Fund. Guideline: Updates on HIV and infant feeding: The duration of breastfeeding, and support from health services to improve feeding practices among mothers living with HIV. Geneva: World Health Organization; 2016.

133. Du Plessis L, Pereira C. Commitment and capacity for the support of breastfeeding in South Africa. South Afr J Clin Nutr. 2013;26(S): S120–S8.

134. Nguyen PH, Headey D, Frongillo EA, Tran LM, Rawat R, Ruel MT, et al. Changes in underlying determinants explain rapid increases in child linear growth in Alive & Thrive study areas between 2010 and 2014 in Bangladesh and Vietnam. J Nutr. 2017 Mar;147(3): 462–9. doi: 10.3945/jn.116.243949 28122930

135. Martin-Wiesner P. A policy review: South Africa’s progress in systematising its international and national responsibilities to protect, promote and support breastfeeding Johannesburg: DST-NRF Centre of Excellence in Human Development, 2018.

136. Pillay N. Pathways to school completion for young mothers: Are we winning the fight? SAJCH. 2018;2018(Special Edition):s15–s8.

137. Guidelines to industry and health care personnel: The regulations relating to foodstuffs for infants and young children, Resolution 911, Pretoria; 2012

138. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358: j4008. doi: 10.1136/bmj.j4008 28935701

139. South African National AIDS Council. Let our actions count: South Africa’s National Strategic Plan for HIV, TB and STIs 2017–2022. South African National AIDS Council Pretoria; 2017.

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