InterPress News Service (IPS); Monday, 13 January 1997
Zarina Geloo

"My neighbor, who is a gynecologist, tells me I should bottle feed and not take any chances but my midwife says I should breast-feed because the risk of my child dying from malnutrition is higher than the risk of it contracting HIV," she says.

Mudenda, 32, is among the estimated 25 percent of Zambian mothers who tested positive for HIV while pregnant. Her baby is due in the next month and she still has not been able to obtain proper advice and information that will help her come to a decision.

It is only during the past four years that the question of vertical transmission of HIV through breast milk has surfaced. Scientists now say that between one quarter and one third of infants born to HIV mothers worldwide become infected with the virus. Statistics also reveal that one in seven breast-fed babies catch the disease.

Yet there still is a reluctance by policy makers to state that HIV infected mothers should not breast feed.

Zambian Health Minister Katele Kalumba, a staunch advocate of breast-feeding, argues that the medical risks associated with artificial feeding are greater than the risks of contamination with HIV. "You will find that more babies will die from diarrhoeal diseases and other infections through unhygienically or wrongly administered milk formula than through acquiring HIV by breast-feeding," he says.

UNICEF and the World Health Organization, WHO, endorse breast-feeding, especially in developing countries because of the cost and health implications associated with artificial feeding.

In a recent statement on vertical transmission of HIV, UNICEF reiterates the benefits of breast-feeding to both mothers and children. According to the statement, breast milk protects against infant mortality by providing protection against diarrhoeal diseases, pneumonia and other potentially fatal infections, while enhancing the quality of life through its nutritional and psychosocial benefits. Breast-feeding also contributes to maternal health in various ways including ways of prolonging the interval between births and helping protect against ovarian and breast cancers.

While UNICEF says mothers are best equipped to make the breast-feeding choice and should be supported in whatever they decide, the recently formed U.N. HIV/AIDS program goes further in its first interim statement on vertical transmission and says when children born to HIV positive mothers can ensure uninterrupted access to nutritionally adequate breast milk substitutes that are safely prepared, they are at less risk of illness and death if they are not breast-fed.

But the U.N.'s reluctance to categorically state that HIV infected mothers in developing countries should not breast feed might also smack of a turf war with multinational food processing companies.

UNICEF and WHO fought and won a hard battle with formula milk processing companies which had managed to gain a strong foothold in developing countries with their free milk feeds.

One gynecologist, who asked not to be named, described as "discriminatory" the argument by organizations such as UNICEF and WHO that women in developing countries have to breast-feed because of the high costs associated with artificial feeding.

"I become suspicious when I come across reports by the same organizations encouraging women in developed countries to bottle feed if they are HIV infected. In many developed countries milk formula is either heavily subsidized or given out free by the manufacturers. Why can't it be like that here? Why must mothers risk infecting their babies just because they are in the third world?" she asks.

Dr. Chichewa Lungu, an intern at the capital's largest hospital, the University Teaching Hospital (UTH), says the situation is not as simple as just dictating whether one should breast-feed or not.

She questions the entire aspect of testing. "Must it become compulsory for all mothers to test for HIV so that they be told whether to breast-feed or not. Do governments or society have the capacity to deal with all the HIV positive people who will make demands on their resources?" she asks.

She says routine testing will bring its own problems. "Vertical transmission depends a lot on viral load. If the woman is an 'old' HIV infected person (she has been infected for some time), her viral load is stabilized and she is less likely to pass on the infection than if she sero converts while breast-feeding or is a 'new' infectant with a huge viral load," she says.

But there is another element which women like Mudenda have to face and that is the traditional one. There is tradition attached to food preparation for a new mother to boost milk production which is done by the extended family.

According to Mudenda bottle feeding is regarded as a 'colonial hangover' and is frowned upon especially for very young babies. "Besides formula milk is too expensive for most families here. The cheapest formula feed, Lactogen, is K10,000 (about US$9) for a one kilogram can which usually lasts about three days," she says.

Another fear is that as more people discuss vertical transmission, they will be able to identify those mothers who choose not to breast-feed as likely to be HIV positive. "I am healthy and so far tests show my baby is healthy. I don't want to encourage any speculation by bottle feeding and if I have to bottle feed, I want a ready explanation other than the real reason," Mudenda says.

(Zarina Geloo is a correspondent for Africa Information Afrique, a news and feature service based in Harare, Zimbabwe.)

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