Browsing by Author "Manderson, Lenore"

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Frontline health workers and exclusive breastfeeding guidelines in an HIV endemic South African community: a qualitative exploration of policy translation
(BioMed Central, 2018-06) Nieuwoudt, Sara; Manderson, Lenore
Background: Mothers rely heavily on health worker advice to make infant feeding decisions. Confusing or misleading advice can lead to suboptimal feeding practices. From 2001, HIV positive mothers in South Africa were counseled to choose either exclusive breastfeeding or exclusive formula feeding to minimize vertical HIV transmission. On the basis of revised World Health Organization guidelines, the government amended this policy in 2011, by promoting exclusive breastfeeding and discontinuing the provision of free formula. We explored how health workers experienced this new policy in an HIV endemic community in 2015–16, with attention to their knowledge of the policy, counselling practices, and observations of any changes. Methods: We interviewed eleven health workers, from four community health clinics, who had counseled mothers before and after the policy change. The transcribed interviews were analyzed thematically, using a hybrid coding approach. Results: The scientific rationale of the policy was not explained to most health workers, who mostly thought that the discontinuation of the formula program was cost-related. The content of their counseling reflected knowledge about promoting breastfeeding for all women, and accordingly they mentioned the nutritional and developmental benefits of breastfeeding. The importance of exclusive breastfeeding for all infants was not emphasized, instead counseling focused on HIV prevention, even for uninfected mothers. The health workers noted an increased incidence of breastfeeding, but some worried that to avoid HIV disclosure, HIV positive mothers were mixed feeding rather than exclusively breastfeeding. Conclusions: Causal links between the policy, counseling content and feeding practices were unclear. Some participants believed that breastfeeding practices were driven by finance or family pressures rather than the health information they provided. Health workers generally lacked training on the policy’s evidence base, particularly the health benefits of exclusive breastfeeding for non-exposed infants. They wanted clarity on their counseling role, based on individual risk or to promote exclusive breastfeeding as a single option. If the latter, they needed training on how to assist mothers with community-based barriers. Infant feeding messages from health workers are likely to remain confusing until their uncertainties are addressed. Their insights should inform future guideline development as key actors.
Menstrual Hygiene and Management in Zamimpilo Riverlea Informal Settlement
(University of the Witwatersrand, Johannesburg, 2021-08) Khofi, Lucy; Manderson, Lenore
Managing menstrual hygiene in low- and middle-income countries is difficult, due to lack of proper facilities. With inadequate WASH (water, sanitation, and hygiene) services and infrastructure, such as proper working toilets and lack of access to sanitary materials, some women end up using unhygienic sanitary materials, such as rags, leaves, sand, tissues and so forth to manage menstruation. In this study, I used an anthropological approach to describe and analyse women’s understandings of menstrual health and hygiene in the informal settlement of Zamimpilo, Johannesburg. Firstly, I looked at how women understood menstruation and how this was influenced by community attitudes and social norms. Secondly, I identified what material, structural and normative factors hindered or enabled women to manage their menstruation and hygiene: shame, embarrassment, level of education, access to information, gender inequality, affordability of pads and soap, access to water, and access to sanitation and hygiene facilities. Thirdly, I explored women’s experiences of their bodies, and how menstruation influenced their decisions to go out, go to school, have sex, bathe with others, manage pain, and sleep. I looked also at the practices that women used to manage menstrual waste. As I illustrate, these practices are shaped by cultural, social, and religious factors. I have explored women’s creative ways to manage menstruation, menstrual waste, and hygiene under different conditions, and explored the extent to which they have internalised or resisted negative attitudes towards their bodies and bodily products. I emphasise women’s narratives. In theorising these questions, I have adapted ideas from Purity and Danger (1984) by Mary Douglas, and following her, I have analysed menstruation as something polluting and dirty that contributes to menstrual shame. I have also drawn on Emily Martin’s book The Woman in the Body (2001) and examined how social and cultural factors shape women’s understanding of themselves. The data on which this thesis was based is drawn from research using qualitative methods. Due to constraints in movement and social interactions associated with COVID-19, primary data were collected through telephonic semi-structured interviews. Twelve women – six young women between 18 and 25 years and six women between 25 and 40 years of age – were each interviewed twice, bringing the total number of in-depth interviews to 24. Participants were recruited through a key informant, using purposeful sampling for maximum variability to ensure diversity of age, ethnicity, religion, education background, among participants. This was significant given that the population of Zamimpilo was diverse and includes people from different provinces and communities: Xhosa, Zulu, Pedi and other South Africans all live in Zamimpilo, as well as people from other African countries including Mozambique, Zimbabwe, Zambia, and Nigeria. My findings suggest that women’s MHM (Menstrual Hygiene Management) in Zamimpilo is still a huge challenge. The environment is deeply compromised, and no residents have access to adequate housing, water and sanitation. These basic challenges, along with the lack of sanitary products, hinder women from managing their menstrual hygiene. However, I found that these women used alternatives to manage their MH (Menstrual Hygiene), including various herbs for menstrual hygiene purposes and to prevent urinary tract and reproductive tract infections. Women expressed various understandings of their bodies, menstrual blood and menstruation as a process. I describe how the South African Department of Women, Youth and Persons with Disabilities has tried to address ‘period poverty’ in the country with the collaboration of non-government, non-profit organisations, the private sector, and menstrual activists. However, the need is greater than available resources. In places like Zamimpilo, women still do not receive any assistance from community organisations or from the state, and so they must improvise to manage this most private, routine, mundane event.