Paper: My life as Mae Tid Chua [mothers who contracted HIV disease]: Motherhood and women living with HIV/AIDS in central Thailand
My life as Mae Tid Chua [mothers who contracted HIV
disease]: Motherhood and women living with HIV/AIDS in central Thailand
Reference
Liamputtong, P., & Haritavorn, N. (2014). My life as Mae Tid Chua [mothers who contracted HIV disease]: Motherhood and women living with HIV/AIDS in central Thailand. Midwifery, 30(12), 1166-1172
1.
26 indepth interview with snowball and purposive
sampling
2.
Descriptive
phenomenology was thus adopted as our
methodological framework. Descriptive phenomenology allowed us to understand
the issues under study from the experiences of those who have lived through
them (Carpenter, 2013).
3.
The
in-depth data was analysed using thematic analysis (Braun
and Clarke, 2006).
4.
Motherhood is considered desirable by women
living with HIV in Thailand
5.
Becoming a mother permitted them to have a
meaningful life
6.
The women dealt with constant anxiety about the
condition of their infants
7.
Many
were advised by their doctors and nurses not to breast feed their newborn
babies as this could transmit HIV to the child.
8.
Some
health workers advised new pregnant HIV positive to abort their baby in their
womb
9.
Most
women took into account their ability to care for their children in the future
and thus did not wish to have many children.
10.
A
few implications for midwifery care:
a. Midwives need to
appreciate that many women with HIV/AIDS do and will have children. Appropriate advice on how
to achieve their reproductive goals safely would be a better recommendation
than to avoid having children.
b. Second, as we have
demonstrated, although the participants wanted to be mothers, not all wanted to have more children. Thus, an
integration of family planning and HIV services should
be established (Yeatman and Trinitapoli, 2013).
c. Regarding feeding practices, women need to receive sufficient guidance and counselling
relating to the benefits and risks of infant feeding options so that they can
make an ‘informed choice’ (Desclaux and Alfieri, 2009). They must be
given particular guidance in choosing the option which is appropriate for their
living situation, and they should be supported in the choice they have made
(Desclaux and Alfieri, 2009; Doherty, 2011).
Abstract
Background: literature suggests that many women living with
HIV/AIDS have a desire to become mothers and
indeed many of them have done so (Thiangtham and Bennett, 2009; Barnes, 2013;
Cogna et al., 2013; Lazarus et al., 2013; Ross, 2013; Yeatman and Trinitapoli,
2013). However, there is still a lack of knowledge
about the lived experiences of Thai women living with HIV/AIDS who have
become mothers. In this paper, we explored the experiences of pregnancy and
birth, motherhood, and infant feeding practices among women living with
HIV/AIDS in Thailand. Method: in-depth interviews
were conducted with 26 women living with HIV/AIDS in Thailand. Findings:
motherhood was considered desirable by women living
with HIV/AIDS who participated in our study. Despite living with a
serious illness, becoming a mother permitted them to have a meaningful life.
Motherhood prompted the women to stay alive for their children. However, the
women lived with constant anxiety about the condition of their infants.
Reproductive needs of the women in our study were often questioned by their
health care providers. Many were advised by their doctors and nurses not to
breast feed their newborn babies as this could transmit HIV to the child. Most
women took into account their ability to care for their children in the future
and thus did not wish to have many children. Conclusion: this paper contributes
to conceptual understanding about the lived experiences of motherhood among
women living with HIV/AIDS in Thailand. The findings have implications for
midwifery care.
Introduction
Literature suggests that many women living with HIV/AIDS
desire to become mothers and indeed many of them have done so.
Literature also suggests that women who are living with
HIV/AIDS and who are mothers carry a triple burden of being HIV-infected; they
are mothers of children who may or may not be positive themselves, and often
are also caregivers to their partners who live with HIV/AIDS
When a woman is labelled as having HIV, she is treated with
suspicion, her morality is questioned, and often, blame is placed on her
Methodology
We aimed to examine the lived experiences of women living
with HIV/AIDS, descriptive phenomenology was thus adopted as our methodological
framework. Descriptive phenomenology allowed us to understand the issues under
study from the experiences of those who have lived through them (Carpenter,
2013). Hence, this permitted us to examine the experiences of women with HIV
positive and how they coped with HIV/AIDS in our study. Within the
phenomenological framework, the in-depth interviewing method
is usually adopted by qualitative researchers (Carpenter, 2013; Liamputtong,
2013a). In this study, in-depth interviews were conducted with 26 Thai women.
Purposive sampling technique (Liamputtong, 2013a) was
adopted; only Thai women living with HIV/AIDs and who were mothers were
approached to participate in the study. The participants were recruited through
advertising on bulletin boards at public hospitals in Bangkok and personal
contacts made by the Thai co-researchers, who have carried out a number of HIV
and AIDS research projects with Thai women. Due to the sensitive nature of this
study, we also relied on snowball sampling techniques (Bryman,
2012); that is our previous participants suggested others who met the criteria
of our study and were interested in participating
The
in-depth data was analysed using thematic analysis (Braun
and Clarke, 2006). This method of data analysis aims to identify, analyse and
report patterns or themes within the data. Initially, we performed open coding
where codes were first developed and named. Then, axial coding was applied
which was used to develop the final themes within the data. This was done by
re-organising the codes which we have developed from the data during open
coding in new ways by making connections between categories and sub categories.
This resulted in themes, and they were used to explain the lived experiences of
the participants. The emerging themes are presented in the Findings section. In
presenting women's verbatim responses, we used fictitious names to preserve
confidentiality.
AIM
In
this paper, we explored the experiences of pregnancy and birth, motherhood, and
infant feeding practices among women living with HIV/AIDS in Thailand.
Specifically, we investigated how these women perceived themselves as mothers,
what experiences they had regarding their reproductive rights, and how they
coped with infant feeding practices in their everyday life.
FINDING
Characteristic
Respondents
Pregnancy and birth
experience
Most
women learned about their HIV status through their contacts with health
services. Most often, it was during their fak thong (antenatal care checkup)
that they were informed by health professionals that they pen AIDS (living with
HIV/AIDS): pp 1168
Not
only with the initial shock and fear of learning about their HIV status but
throughout pregnancy, the women lived in constant anxiety about the condition
of their infants.pp 1168
Abortion and
reproductive rights: women’s experience with helath care provider
Repeatedly,
women living with HIV/AIDS who participated in our study would be advised to
undergo an abortion, as the infant might also be infected by HIV. Pp 1168
Many
women did not wish to keep their pregnancy. Pp 1168
First
case: reason was: ‘Because the chance that my baby would contract HIV from me
is very high and because I don't know how long I will
be with my baby. pp 1168
Second
case: She was from a poor family and her husband
was also dying at the time. Pp 1168
Third
case: In contrast, Tasana did not seek antenatal care until she was six months
pregnant. When she learned about her HIV status, she wanted to abort the baby
as she thought the baby would be HIV-positive. However, Tasana's sister insisted that she should keep the baby and her
family would help her look after it. She decided to continue her pregnancy and
started to seek antenatal care when she moved to Bangkok. The baby underwent
HIV tests twice and he was clear both tests. He continued to take
antiretroviral drugs at the time we interviewed her. She had no difficulty in
taking care of him and she received support from family members
Living for my
children: motherhood-pp 1169
Women's
narratives clearly revealed the multiple anxieties they had toward the health and
well-being of children. Most often, the women were worried that they would die
when their children were still young
Pacharee
had two daughters who were affected by her HIV status. The girls were teased by
others in the community that their mother pen AIDS. She had to tell the girls
that they should not pay too much attention to those people and not to think
too much about it as she was healthy enough to work and take care of them. If
they were strong, no one could harm them in anyway.
Most
women held great concerns about the health status of their infants,
particularly whether the infant would have HIV like them
Due
to their concerns about their children, the women would bring them for HIV
tests to ensure that they knew clearly about the HIV status of their child.
Most
women would stress that they had to live for their children. Y
If I feed my baby
breastmilk, he will have HIV like me: infant breastfeeding practice
Most
women in our study were advised by their health care providers not to breast feed
their newborn babies as this could transmit HIV to their babies. Thus, all
mothers artificially fed their newborn babies. During their hospital stay, the
hospital would provide infant formula for all mothers. However, some women were
told by their health providers not to breast feed their infant without any
explanation. It seems that in this woman's mind, her doctor had authoritative
knowledge that she must follow
1169
Women
expressed their concerns about the health of their children who were not breast
fed. Wasana had two children. The first one was breast fed but the second one
who was conceived after she had contracted HIV was artificially fed. She
noticed that their health was different. In spite of the fact that the second
child was HIV-negative, she was sick too often. Pp 1170
More children
Many
women did not intend to have more children in the future.
Case
1: she was afraid that she would not be able to take care of them properly. She
did not know when she would die and this uncertainty made her decide not to
have more children.
Case
2: Sukhwan had a new partner who was also living with HIV. He expressed his
wish to have more children with her, but she told him that they would be
looking for trouble if she did so as it would be likely that the child would be
born with HIV like the parents. And if they had passed away, what would happen
to the child
Discussion
Conclusion and implications
for midwives
This paper contributes to conceptual understanding about the
lived experiences of motherhood among women living with HIV/ AIDS in Thailand. Motherhood was perceived as an important part of their lives,
but because of their health status and other social circumstances, future
childbearing was problematic for them. Our study was based on a qualitative
research with small number of participants. The findings cannot be generalised
to all women living with HIV/AIDS in Thailand (Bryman, 2012; Creswell, 2012;
Liamputtong, 2013a). However, our findings provided in-depth understanding
about the issues under investigation and carry a few implications for midwifery
care. First, midwives need to appreciate that many
women with HIV/AIDS do and will have children. Appropriate advice on how
to achieve their reproductive goals safely would be a better recommendation
than to avoid having children. Second, as we have demonstrated, although the
participants wanted to be mothers, not all wanted to
have more children. Thus, an integration of family
planning and HIV services should be established (Yeatman and
Trinitapoli, 2013). Third, regarding feeding practices, women need to receive sufficient guidance and counselling relating to the
benefits and risks of infant feeding options so that they can make an ‘informed
choice’ (Desclaux and Alfieri, 2009). They must be given particular
guidance in choosing the option which is appropriate for their living
situation, and they should be supported in the choice they have made (Desclaux
and Alfieri, 2009; Doherty, 2011).
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