InterPress News Service (IPS) - Tuesday, March 10, 1998
Thalif Deen

"UNICEF believes that breastfeeding - one of the fundamentals of good nutrition - is still the best possible way of feeding young children," says David Alnwick, head of the Health Section at UNICEF. "We are fully cognizant of the data and recognise the scientific evidence that there's a risk that the human immunodeficiency virus (HIV), tragically, can be passed through breastmilk."

Of the 30 million people infected with HIV, the virus that causes Acquired Immuno-Deficiency Syndrome (AIDS), more than 1.1 million are children under the age of 15, according to the World Health Organisation (WHO).

UNAIDS, the joint U.N. body dealing with the deadly disease, says that various studies conducted to date indicate that between one-quarter and one-third of infants born worldwide to women with HIV become infected with the virus themselves.

"While in most cases transmission occurs during late pregnancy and delivery, preliminary studies indicate that more than one third of those infected infants are infected through breastfeeding," UNAIDS said.

UNICEF, however, supports a joint U.N. policy which states that women who are HIV-positive should be given an option: they should be told of the risks associated with the transmission of the virus through breastmilk against the potential risks of breastmilk substitutes, mostly infant formula.

UNICEF and WHO advocate breastfeeding over bottle-feeding, and both have been at odds with multinational companies such as Nestle's, who produce milk foods which are deemed substitutes for breastmilk.

In 1981, the World Health Assembly, WHO's governing body, adopted the International Code of Marketing of Breastmilk Substitutes which establishes minimum standards to regulate marketing practices.

The Code specifically stipulates that health facilities should never be involved in the promotion of breastmilk substitutes and that free samples should not be provided to pregnant women or new mothers. But UNICEF points out that progress has been relatively slow in translating the Code's minimum provisions into national laws. As of September 1997, only 17 countries had approved laws that put them into full compliance with the Code.

"We have helped support efforts in developing countries and other countries to implement the Code," Alnwick said. "We believe it has been highly effective although we are cognizant of the fact that there are relatively few countries where all companies abide by the Code," he said.

Alnwick also pointed out that "if the Code had not been implemented, the situation of breastfeeding will be far less satisfactory than it is today." In its annual report released late last year, UNICEF argued that since human development proceeds rapidly for the first 18 months of life, the nutritional status of pregnant and breastfeeding mothers and young children is of paramount importance for a child's later development.

Breastfeeding perfectly combines the three fundamentals of sound nutrition - food, health and care. In countries where infant mortality rates are high or moderately high, a bottle-fed baby in a poor community is 14 times more likely to die from diarrhoeal diseases and four times more likely to die from pneumonia than a baby that is exclusively breastfed, according to the report.

"However, for mothers infected with HIV, breastfeeding's enormous value must be weighed against the 14 percent risk that they may transmit the virus to their infants through breastmilk - and the vastly greater risk, especially in poor communities with inadequate water and sanitation, that feeding their children artificially will lead to infant deaths and diarrhoeal dehydration and respitatory infections," UNICEF said.

To help support breastfeeding, UNICEF and WHO have an ongoing intensive effort to transform practices in maternity hospitals. The Baby-Friendly Hospital Initiative, as the effort is called, has in the last six years helped transform some 12,700 hospitals in 114 countries into centres of support for good infant feeding.

According to UNICEF, a number of studies have shown that initiating breastfeeding immediately after birth, as most women do in baby-friendly hospitals, stimulates the contraction of the uterus and reduces blood loss. Also, a recent study in the United States demonstrated that women who breastfed their children had a lower risk of breast cancer in the pre-meopausal period, and that the longer they breasfed, the lower the risk. (END/IPS/td/mk/98)

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