While WHO no longer recommends individual infant feeding counselling to HIV-positive women, it may still be practised
in some settings and for specific cases. In any case, lessons can be learned by examining how well front line health
workers are able to take on counselling tasks. This qualitative study was designed to assess how counsellors deal with
challenges they face in two Kenyan provinces. It consisted of brief post-counselling exit interviews with 80 mothers,
observations of 21 counselling sessions and 11 key informant interviews. Much infant feeding counselling was of reasonable
quality, better than often reported elsewhere. However, nutrition and infant feeding were given low priority,
counsellors’ training was inadequate, individual postnatal counselling as well as growth monitoring and promotion were
rarely done and complementary feeding was inadequately covered. Acceptable, feasible, affordable, sustainable and safe
(AFASS) assessments were not of satisfactory quality. Breast milk expression was mentioned only to a minority and the
possibility of heat treatment during the transition to cessation was not mentioned. Counsellors were often biased in
discussing risks of breastfeeding and replacement feeding. Implementing the new WHO guidance will reduce the need for
AFASS assessments, greatly simplifying both the government’s and counsellor’s tasks.