Discussion
milk insufficiency
Our objective was to assess the feasibility, acceptability and potential impact of a multilevel intervention aimed at addressing financial insecurity and suboptimal infant feeding through an unconditional cash transfer and personalized, professional infant feeding support. Women found the two intervention components highly acceptable and described an overall positive impact on wellbeing. The intervention was feasible to implement with 100 % retention and did not require any adjustments or changes to the protocol. Our findings show a statistically significant reduction in food insecurity scores for the intervention group as compared to baseline and the control group. During exit interviews, women confirmed they felt more financially secure and confident to exclusively breastfeed because of their newly acquired practical knowledge and skills related to infant feeding. To our knowledge, this is the first multi-level intervention to address financial insecurity and suboptimal infant feeding.Dramatic improvements in HFIAS (food insecurity) scores were directly aligned with exit interview findings that described profound relief from food and financial stress. Prior interventions using cash transfers among perinatal WLWH have been conditional, using smaller payments and mainly centered on impacting engagement in perinatal and HIV related care. In these cases, cash transfers have positively impacted appointment attendance among perinatal women in sub-Saharan Africa [Women also reported positive changes within their relationships. This was in stark contrast to previous research in this setting that indicated that many relationships were strained or broken down during the perinatal period when women leaned heavily on their support systems to make ends meet [The wealth of knowledge and skills women gained throughout the five infant feeding support sessions is of particular significance given even one gap in knowledge or technique can derail a woman’s breastfeeding experience. Many barriers have been identified that prevent women from maintaining breastfeeding practice in this setting such as perceived milk insufficiency [Women credited both the unconditional cash transfer and the infant feeding support sessions with making them happy and hopeful, with the majority noting marked relief from stress and worry about both finances and their infant’s nutrition and health. These exit interview findings and the positive trend we observed in PHQ-9 and PSS-10 scores are consistent with findings from several previous studies in this setting which found improvements in psychological wellbeing among cash transfer recipients [