Women Living With HIV, Low-Birthweight Babies Face Stigmatization in Ghana

Smaller babies born to mothers living with HIV are often considered “undesirable” in sub-Saharan Africa, and the mothers themselves often are blamed for this, reports a new study in PLoS One. Consequently, they frequently experience isolation and postpartum depression.

In fact, up to 75% of mothers who give birth to low-birthweight (LBW; < 2500 g) babies have been shown to experience mild to severe postpartum depression, the study authors highlighted.

“These experiences were layered on the burden of healthcare and infant feeding costs for LBW infants,” they pointed out.

HIV can significantly increase the risk of having a LBW child, and the virus disproportionately affects young and poor women in Ghana who lack access to adequate health care. Among women of reproductive age in the country, 2.8% are living with HIV. There is a lack of comprehensive data on the stigma these young mothers face, particularly that directed toward their LBW children.

The present study examined this HIV-related stigma at 2 tertiary hospitals, Korle Bu Teaching Hospital and Ridge Regional Hospital, in the Greater Accra Region of Ghana, at which 8% of infants born to women living with HIV (WLHIV) are considered to be LBW children.

Study inclusion criteria for the participating 30 postpartum women (15 with LBW children, 15 with normal birthweight [NBW; > 2500 g] children) were:

• Living with HIV
• Aged 18 or older
• Gave birth or received care at either or both of the hospitals
• Had an infant younger than 1 year

None of the study participants in the WLHIV cohort with NBW babies said, through interviews, that they faced stigma related to their baby’s size. This was in sharp contrast to the close to 50% of WLHIV who had LBW children who reported experiencing stigma.

A likely cause of this stigma, the authors noted, was unfamiliarity with the LBW babies’ small size and their so-called resulting “undesirable” physical features. This led to comparing the babies to such animals as lizards and frogs and comments that “the small babies looked ‘abnormal’ compared to other newborns.

The WLHIV with LBW babies also expressed they felt blamed by society, non-neonatal intensive care unit workers, and family for having such a small child. One mother commented that her sister said, “You are always pointing out the flaws in others’ children and insulting them, have you seen what you have given birth to?”

Others noted that family and friends refused to visit them because of their LBW children and that emotional and mental distress were frequent occurrences, as were embarrassment, depression-related symptoms, and prolonged sadness. Again, this was in contrast to the WLHIV who had NBW children, in that they reported more interaction with family and friends

In extreme cases, the outside pressure from society led to child abandonment.

“Being born small at birth is a cause of stigma against mother-infant dyad among WLHIV in urban areas of Ghana. Our findings suggest that LBW stigma in the short term may contribute to poor maternal mental health outcomes and maternal-infant isolation,” the authors concluded. “The findings support a multi-pronged approach, including prevention of LBW, sensitization, counseling, and a multi-disciplinary health care team to address this stigma and its consequences.”

They point out that ongoing structural barriers and violence in Ghana may be to blame for the persistent 60% to 80% neonatal death rate in the country despite evidence on the benefits of low-cost and effective infant survival practices. These include living in communities with a high socioeconomic disadvantage or within multifamily, low-income housing.

Study limitations included potential lack of applicability to the general population and those living in rural areas, because the study participants principally came from urban areas.

Reference

Sakyi KS, Lartey MY, Kennedy CE, et al. Stigma toward small babies and their mothers in Ghana: a study of the experiences of postpartum women living with HIV. PLos One. Published online October 16, 2020. doi:10.1371/journal.pone.0239310