Grandmothers as key influencers on pregnant and breastfeeding women's health and HIV prevention related decision making in Johannesburg, South Africa


BACKGROUND: The MTN-041/MAMMA study explored attitudes of pregnant and breastfeeding (P/BF) women, male partners and grandmothers (mothers/mothers-in-law of P/BF women) regarding use of the dapivirine vaginal ring (VR) and oral pre-exposure prophylaxis (PrEP) during these periods of high HIV risk. Herein, we describe the influence of grandmothers on P/BF women's health and HIV prevention related decision making in Johannesburg, South Africa.
METHODS: We collected behavioural data through surveys and conducted focus group discussions (FGDs) with three groups of participants (total N=47): HIV-uninfected, currently or recently P/BF women aged 18-40 years (median 26; N=15), male partners aged '¥18 years (median 33; N=12) and grandmothers (median age 57;N=20). FGDs were conducted in English and/or Zulu by trained facilitators using semi-structured guides and included a brief educational video about VR and oral PrEP and an opportunity to handle sample products. Discussions were audio-recorded and summarized in debrief reports before being transcribed in English, coded using Dedoose software (v7.0.23), and thematically analysed.
RESULTS: In surveys, maternal grandmothers were identified by 40% of P/BF women as key influencers on their decision making even though they considered themselves primary decision makers for medication use during pregnancy (60%) and breastfeeding (70%); a view similarly upheld by male partners (67% during pregnancy, 58% during breastfeeding). Grandmothers' influence was further explored during FGDs, with maternal grandmothers described by all three groups of participants as important sources of information due to their experience using traditional medicine and their healthy pregnancies and children. Paternal grandmothers were also included as key influencers if the male partner had compensated an unmarried pregnant woman's family for a pregnancy ['paid damages']. For HIV prevention-related decision making and oral PrEP/VR use specifically, P/BF women indicated they would make the decision themselves as with medication but would welcome support from their grandmothers.
CONCLUSIONS: Grandmothers appeared to make significant contributions to P/BF women's health-related decision making with potential to play a supportive role in HIV prevention product use. With the right framing and approach, grandmothers' advice and support could optimise uptake and adherence to biomedical HIV prevention and further contribute to the decline in HIV acquisition among P/BF women in this community.