Open Access Highly Accessed Research article

Exclusive breastfeeding prenatal intentions among HIV-positive mothers in Blantyre, Malawi: a correlation study

Ursula K Kafulafula1*, Mary K Hutchinson2, Susan Gennaro3, Sally Guttmacher2 and Andrew Kumitawa4

  • * Corresponding author: Ursula K Kafulafula

  • † Equal contributors

Author Affiliations

1 Kamuzu College of Nursing, P.O. Box 415, Blantyre, Malawi

2 New York University School of Nursing, 726 Broadway, 10th Floor, New York, NY 10003, USA

3 Boston College, Connell School of Nursing, Boston, MA, USA

4 College of Medicine, P/Bag 360, Chichiri, Blantyre, Malawi

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BMC Pregnancy and Childbirth 2013, 13:203  doi:10.1186/1471-2393-13-203

Published: 7 November 2013



Exclusive breastfeeding is an important component of child survival and prevention of mother-to-child transmission of HIV in resource-poor settings like Malawi. In Malawi, children under the age of six months are exclusively breastfed for an average duration of 3.7 months. This falls short of the recommendations by the World Health Organization as well as the Malawi Ministry of Health that mothers exclusively breastfeed for the first six months of the child’s life. Understanding factors that influence exclusive breastfeeding duration among HIV-positive mothers is important in promoting exclusive breastfeeding among these mothers. An exploratory study was therefore conducted to determine factors that influence HIV-positive mothers’ prenatal intended duration of exclusive breastfeeding and their likelihood to exclusively breastfeed for six months.


This paper is based on data from a longitudinal, descriptive and correlation study that was conducted at Queen Elizabeth Central Hospital in Blantyre, Malawi between May 12, 2009 and March 22, 2010. Theory of Planned Behavior guided the study. A face-to-face survey was utilized to collect data from a convenience sample of 110 HIV-positive mothers who were at least 36 weeks pregnant at baseline. A modified and pre-tested breastfeeding attrition prediction tool was used to measure exclusive breastfeeding beliefs, intentions and external influences at baseline. Data were analyzed using descriptive and association statistics. Additionally, multiple regressions were run to determine significant predictors of HIV-positive mothers’ prenatal intended duration of exclusive breastfeeding and their likelihood to exclusively breastfeed for six months.


Results revealed high exclusive breastfeeding prenatal intentions among HIV-positive mothers. Prenatal intended duration of exclusive breastfeeding was positively associated with normative, control beliefs and negatively associated with positive beliefs, maternal education and disclosure of HIV status.


Current results suggest that assessment of mothers’ level of education and their positive beliefs towards exclusive breastfeeding may help to identify mothers who are at risk of discontinuing exclusive breastfeeding. Interventions to promote exclusive breastfeeding could include provision of appropriate skills, support and information to help HIV-positive mothers gain control over exclusive breastfeeding.

Prenatal intentions; Intended duration of exclusive breastfeeding; HIV-positive mothers; Behavioral beliefs; Normative beliefs; Control beliefs