Breastfeeding is a culturally accepted way of feeding a baby despite the risk of HIV transmission. In the context of HIV, it is especially important to protect, promote and support exclusive breastfeeding for the first six months of life. The aim of this study was to explore social-cultural determinants of exclusive breastfeeding to inform interventions. We utilised ethnographic approaches and triangulation through focus group discussions; in-depth interviews; participant observations and field notes to collect data and saturation was achieved. Thirty HIV-positive mothers were followed at six days, six weeks, 12 weeks and 18 weeks after delivery. Inadequate knowledge of exclusive breastfeeding was pronounced. Predominantly, mixed feeding was practiced as a cultural norm and to compensate for the delay in initiation of breastfeeding for HIV-exposed infants. Use of herbs were reported for reasons varying from medication to treat abdominal pains, protection of the baby from childhood illnesses and protecting the baby from evil spirits.
We conclude that breastfeeding is the customary way of feeding newborn babies, however, the recommended exclusive breastfeeding for all mothers in Zambia is alien in populations driven by their culture. Therefore, developing culturally appropriate counselling tools that address known practices has potential to improve breastfeeding in the context of prevention of mother-to-child transmission of HIV.