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Debate on breastfeeding for HIV+ mothers rages on
Bertha Shoko, The Standard (Zimbabwe)
August 13, 2006

http://www.thestandard.co.zw/viewinfo.cfm?linkid=11&id=4502

THE issue of whether or not HIV positive mothers should breastfeed to reduce the risk of transmission to their infants continues to be a highly debatable subject with researchers arguing that formula milk, as an alternative to breastfeeding, is not sustainable in developing countries such as Zimbabwe.

Last week Zimbabwe was part of about 160 countries in the world that commemorated World Breastfeeding Week (WBW). WBW was initiated by the World Alliance for Breastfeeding and was first celebrated in 1992.

It is endorsed by World Health Organisation, the United Nations Children’s Fund and Food and Agriculture Organisation.

This year’s theme for the commemorations, "Code Watch: 25 Years of Protecting Breastfeeding", set to emphasise the importance of breastfeeding to mothers, communities, healthcare providers and policy makers.

Yet, for the Aids community this theme presents numerous challenges as it seeks the most appropriate responses to reduce the rate of mother to child transmission.

According to the Joint United Nations Programme on HIV and Aids (UNAIDS) there are an estimated three million children in the world living with HIV. These have been infected by their mothers, during pregnancy, during labour and delivery but there is also a significant risk of post-natal transmission through breastfeeding. The rate of transmission of HIV from infected mothers to their infants through breastfeeding is estimated to be 16%.

While breastfeeding is a route of HIV transmission from an HIV-infected mother to her infant, it is also an important pillar of child survival and growth. This is the dilemma that the Aids community faces as it searches for the appropriate responses to the HIV epidemic.

According to guidelines provided for use by the Joint United Nations on HIV and Aids in the Prevention of Mother to Child Transmission programme (PMTCT) HIV positive mothers who decide to breastfeed their infants should do so exclusively. UNAIDS also recommends that where replacement feeding or formula feed is "sustainable, affordable, feasible and safe" HIV positive mothers should forego breastfeeding.

These issues of either breastfeeding or opting for replacement feeding are issues of ongoing debate worldwide and were contentious in Zimbabwe during breastfeeding week. There were mixed feelings among health experts involved in early child development over the issue of breastfeeding in HIV positive mothers.

Many argue that in poor and developing countries such as Zimbabwe replacement feeding would not be a safe and sustainable alternative for infected mothers and instead, encourage exclusive breastfeeding.

Some of the reasons health experts cited were that replacement feed is very expensive and therefore not accessible to every mother. Although some women are accessing formula milk at PMTCT sites being funded by donors in the country, these have not been able to cater for all women.

Also cited, is the fact that not all women in the country have access to clean water to prepare the milk and facilities to properly sterilise utensils and these could lead to diarrhoeal diseases in infants. Formula-fed infants also do not derive the protective benefits of breast milk against diarrhoea and other infections, resulting in higher infant mortality rates.

Head of the Tuberculosis and HIV and Aids Unit in the Ministry of Health and Child Welfare, Dr Owen Mugurungi, told Standardhealth that government policy on breastfeeding is that all mothers should be encouraged to breastfeed for at least one and half and years.

However, Mugurungi said this policy also recognises that there could be exceptions or other situations that may make this impossible as when confronted by the HIV and Aids pandemic.

He said: "The ministry has recognised that HIV can be transmitted from mother to child through breastfeeding in a very significant way. Through our PMTCT programme we encourage all HIV positive mothers who want to breastfeed to do so exclusively for six months followed by rapid weaning.

"The other option is not to breastfeed at all and this option is availed to mothers who can afford formula milk or can access the milk substitutes at our PMTCT sites in the country. The challenges in all this are numerous."

Mugurungi said because in most cases using breast milk substitutes is not always feasible, the ministry fully backed exclusive breast feeding as it had numerous benefits for both mother and child.

Mugurungi said: "We are largely dependent on donors and our partners to finance the PMTCT programme and it cannot cover every woman. In the absence of a national programme our nurses counsel HIV positive mothers on exclusive breastfeeding."

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