Breastfeeding still a life-saving formula

Recent studies indicate that exclusive breastfeeding causes a notable reduction in HIV rates of mother-to-child-transmission, and that it bears more benefits than formula feeding.

Vehement debate surrounds the question of whether women in developing countries should choose to formula-feed or breastfeed their infants. While formula feeding may eliminate HIV transmission, for women living in resource-poor communities it does incur a higher risk of death from disease than exists in breastfed infants. Prolonged breastfeeding entails a higher risk of HIV transmission, but markedly improves child health and growth.

The dilemma for Southern African mothers and policymakers in terms of this delicate balance of benefits and risks can now be viewed in the light of new data on mother-to-child transmission (MTCT) - findings that shed more light on the way forward for child survival in the wake of the HIV/AIDS epidemic.

Statistical knowledge (UNAIDS 2000) confirms that the global burden of HIV lies in sub-Saharan Africa, a region where the major cause of infant deaths is malnutrition and infectious diseases. UNICEF (1997) estimates that, in similar populations, 1,5 million non-HIV-related deaths per year can be prevented globally through breastfeeding.

The question is whether a lower risk of MTCT through replacement feeding, estimated to be about 200 000 infant infections per year by WHO/UNAIDS/UNICEF (1998), warrants the risk of undermining the life-saving cultural practice of breastfeeding in resource-poor countries.

NEW RESEARCH ON BREASTFEEDING:

Recent studies using the polymerase chain reaction (PRC) test to detect early HIV infection in infants provide more clarity on the risk of MTCT through breastfeeding. It has now been well established that breastfeeding over a period of two years (with no special interventions to make breastfeeding safer) will result in about 15 % new HIV infections (Nduati et al, 2000; Coovadia and Coutsoudis, 2001).

Of an original group of 100 children born to HIV-infected mothers who breastfeed their infants for two years, 20, i.e. 20 %, will be born infected, and over two years, another 15 will be infected through breastfeeding, showing that the risk is cumulative.

Mothers now need to be informed that breastfeeding transmission is not an isolated or single danger that occurs the minute one starts breastfeeding, but rather that the risk of HIV transmission increases over time. Shorter periods of breastfeeding carry a smaller risk of transmission.

The transmission rate over six months, (the period during which breastfeeding offers the child the highest benefit), has been reported by Coovadia and Coutsoudis (2001) to carry a 5 % risk. There is also some preliminary evidence that this 5 % risk of transmission in the first six months can be reduced even further, if exclusive breastfeeding is practised.

Exclusive breastfeeding, as defined by the World Health Organisation (WHO), refers to the child receiving only breastmilk, with no water or other fluids, milks or solids (the only exceptions being vitamin drops or sterile medicines)...

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