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Infant Feeding in HIV in Canada is an increasingly challenging and confusing aspect of clinical care for providers and patients due to differences in recommendations in Canada compared to low income countries. The frequency of breastfeeding occurring in Canada is not documented or known, and is shrouded in stigma because of fear of criminalization or child apprehension in the midst of a culture where ‘breast is best’ messaging dominates. Breastmilk transmission data comes from observational and randomized controlled trials completed in low resource settings, which may not be generalizable to Canadian clinical settings. Previous literature has not explored provider perspectives on this issue, especially in high resource settings. We developed a survey to explore the knowledge, attitudes and practices of adult and pediatric HIV care providers in Canada. This survey explores the provider knowledge levels, risk tolerance and perceived stigma pertaining to infant feeding in HIV. Using exploratory analysis including descriptive statistics and regression modelling, we developed scales on the above listed three subject areas. The overall opinions of providers were that formula feeding should remain the recommendation due to the potential risk to the infant; and that women should be supported to access formula and resources to overcome barriers to formula feeding. Providers varied in their risk tolerance and the degree of stigma they perceived associated with infant feeding for their patients. Providers did not feel that breastfeeding is a criminal matter, but in some circumstances they would consider involving child protection services. Focus group consultation with women living with HIV, provided insight into the experiences, and clinical and research priorities for women living with HIV on infant feeding. A provider meeting was organized to discuss the challenges and resources pertaining to infant feeding in Canada across the provinces. Providers described diverse patient populations with differing needs. Using a World Café model for discussion, priority needs were decided through consensus including the need for knowledge translational resources to convey information to women living with HIV on infant feeding, and the need for evidence based consensus clinical management guidelines was evident. Quantifying the frequency of breastfeeding occurring in Canada by women living with HIV will help to understand how often this issue is encountered. A preliminary qualitative approach to understanding infant feeding issues for women living with HIV using focus groups is described. However, further exploration in a community based approached is needed to explore the needs and challenges faced by families affected by HIV around infant feeding. / Thesis / Master of Science (MSc) / Infant Feeding in HIV in Canada is an increasingly challenging aspect of clinical care. Information on breastmilk transmission comes from studies completed in lower income countries, and this may not be applicable to the Canadian HIV setting. Previous literature has not explored provider perspectives on this issue, especially in high-income countries like Canada. In this knowledge, attitudes and practices survey of HIV care providers in Canada, the main findings were that formula feeding should remain the recommendation due to the potential risk of HIV infection occurring in the baby, however women should be supported to access formula and resources to overcome barriers to formula feeding. Providers do not feel that breastfeeding is a criminal matter, but in some circumstances may consider involving child protection services. We performed community consultation using focus groups to understand some of the issues women face with infant feeding, some of the clinical solutions they would support, and research questions and knowledge translation they would want undertaken. A provider meeting to discuss the challenges pertaining to infant feeding in Canada demonstrated that although populations differ, the need for knowledge translational resources to convey information to women living with HIV on infant feeding was universal. Furthermore, the need for evidence based consensus clinical management guidelines would improve the quality of care provided.

This thesis investigates breastfeeding and weaning patterns in an Iron Age (7th – 4th century BCE) sample of subadults (n=12) and adults (n=9) buried at the sites of Botromagno, Parco San Stefano and Padreterno in southern Italy. Stable isotope analysis of both human tooth dentine and bone collagen for each subadult, and tooth dentine for adults, was undertaken to create early-life feeding histories. The dentine serial sections were used to determine the onset and completion of weaning for each individual, as well as distinguish general trends in early feeding practices at these Iron Age sites. Results indicate that the average onset of weaning in subadults occurred at 8 ± 3.4 months and weaning was completed by 4 years of age at the latest for all individuals; however, the patterns of breastfeeding and weaning were variable in this sample. This study also explores variation in early childhood diet between survivors and non-survivors (i.e., < 4 years of age). Non-survivors were weaned more rapidly than survivors – possibly contributing to their earlier death – and some non-survivors demonstrated elevated δ15N values that may have been a result of physiological stress. It is, however, difficult to distinguish signals of breastfeeding versus stress in young children who were still likely consuming breast milk. Finally, differences in isotope data between dentine serial sampling and bulk-bone sampling of rib and femoral collagen from the same individuals were investigated. The results show that the combined use of dentine and bone data contribute to more nuanced interpretations of weaning. Further, rib samples represent diet closer to the time of death than femoral samples, as faster bone turnover rate in ribs allow for the incorporation of more recent dietary changes. / Thesis / Master of Arts (MA)

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no / Purpose – Audio-diary methods are under-utilised in contemporary qualitative research. The purpose of this paper is to discuss participants and researchers’ experiences of using audio-diaries alongside semi-structured interviews to explore breastfeeding experiences in a short-term longitudinal study with 22 first-time mothers. Design/methodology/approach – The authors provide a qualitative content analysis of the participants’ feedback about their experiences of the audio-diary method and supplement this with the perspectives of the research team based on fieldwork notes, memos and team discussions. The authors pay particular attention to the ways in which the data attained from diaries compared with those from the interviews. Findings – The diaries produced were highly heterogeneous in terms of data length and quality. Participants’ experiences with the method were varied. Some found the process therapeutic and useful for reflecting upon the development of breastfeeding skills whilst negative aspects related to lack of mobility, self-consciousness and concerns about confidentiality. Researchers were positive about the audio-diary method but raised certain ethical, epistemological and methodological concerns. These include debates around the use of prompts, appropriate support for participants and the potential of the method to influence the behaviour under scrutiny. Interview and diary accounts contrasted and complemented in ways which typically enriched data analysis. Practical implications – The authors conclude that audio-diaries are a flexible and useful tool for qualitative research especially within critical realist and phenomenological paradigms. Originality/value – This appears to be the first paper to evaluate both participants and researchers’ experiences of using audio-diaries in a detailed and systematic fashion.

Yes / Considerable effort has been made in recent years to gain a better understanding of the effectiveness of different interventions for supporting breastfeeding. However, research has tended to focus primarily on measuring outcomes and has paid comparatively little attention to the relational, organisational and wider contextual processes that may impact delivery of an intervention. Supporting a woman with breastfeeding is an interpersonal encounter that may play out differently in different contexts, despite the apparently consistent aims and structure of an intervention. We consider the limitations of randomised controlled trials for building understanding of the ways in which different components of an intervention may impact breastfeeding women and how the messages conveyed through interactions with breastfeeding supporters might be received. We argue that qualitative methods are ideally suited to understanding psychosocial processes within breastfeeding interventions and have been under-used. After briefly reviewing qualitative research to date into experiences of receiving and delivering breastfeeding support, we discuss the potential of theoretically-informed qualitative methodologies to provide fuller understanding of intervention processes by focusing on three examples: phenomenology, ethnography and discourse analysis. The paper concludes by noting some of the epistemological differences between qualitative methodologies and the broadly positivist approach of trials, and we suggest there is a need for further dialogue as to how researchers might bridge these differences in order to develop a fuller and more holistic understanding of how best to support breastfeeding women.

This study was conducted to investigate the factors that affect the duration of breastfeeding in low and middle income women, and to determine if low income women have a greater incidence of decreased duration of breastfeeding. Specifically, the effects of early introduction of formula and solid food and mother’s perceived inadequate milk supply, on the duration of breastfeeding, was researched. A questionnaire was developed and one on one interviews conducted on 147 women who breastfed a baby within the past five years. Data analysis included crosstabulation of selected variables, descriptive analyses, and chi square analyses. Results indicated that the majority of the women surveyed introduced formula early, were long term breastfeeders, between the ages of 30-39, and college graduates. There was no difference in duration of breastfeeding between women of low and middle incomes, however, women of middle income terminated breastfeeding early to return to work or school and tended to introduce formula earlier than low income women. Furthermore, mothers who introduced formula or solid foods early, were generally short term breastfeeders. Mothers who introduced formula and solid foods early cited insufficient milk supply as their main reason for terminating breastfeeding. Therefore, mothers perceived to have an insufficient milk supply, tend to introduce formula and solid foods early, thus, contributing to a possible decrease in duration of breastfeeding. / Master of Science

No / Lecturers Fiona Meddings and Jan Porter of the division of midwifery and women’s health at the School of Health Studies at the University of Bradford detail the difficulties faced by UK Pakistani women in making informed choices on breastfeeding.

Yes / Breastfeeding is known to be a powerful mediator of maternal and childhood health, with impacts throughout the lifecourse. Paleodietary studies of the past thirty years have accordingly taken an enduring interest in the health and diet of young children as a potential indicator of population fertility, subsistence, and mortality patterns. While progress has been made in recent decades towards acknowledging the agency of children, many paleodietary reconstructions have failed to incorporate developments in cognate disciplines revealing synergistic dynamics between maternal and offspring biology. Central to this understanding has been heavy reliance on the “weanling’s dilemma”, in which infants are thought to face a bleak choice between loss of immunity or malnutrition. Using a review of immunological and epidemiological evidence for the dynamic and supportive role that breastfeeding plays throughout the complementary feeding period, this paper offers context and nuance for understanding past feeding transitions. We suggest that future interpretative frameworks for infant paleodietary and bioarchaeological research should include a broad knowledge base that keeps pace with relevant developments outside of those disciplines.