UN Integrated Regional Information Networks - August 31, 2009

"The time has come to confront the obvious dangers of infant malnutrition and mortality associated with formula feeding, and to call for escalation in the promotion and support of breastfeeding for most women," wrote Prof Hoosen Coovadia of the Reproductive Health and HIV Research Unit in Durban, and colleagues, in the 1 August issue of UK-based medical journal, The Lancet.

The recent discovery of the potentially toxic chemical, melamine, in formula milk in China only reinforced the already overwhelming case in favour of breastfeeding, Coovadia maintained.

Some scientists have argued that HIV-positive women, who run the small but significant risk of transmitting the virus to their babies when breastfeeding, should have the option to formula feed.

This has become the norm in developed world, and even in South Africa state clinics provide free formula milk to HIV-positive women who decide they cannot exclusively breastfeed for six months. Mixing breast milk with formula or other foods before a baby reaches six months is thought to carry a higher HIV risk than only feeding with breast or formula milk.

Yet formula feeding often carries a number of risks in resource-limited settings, where it is sometimes prepared with contaminated water and supplies at clinics can be unreliable.

Coovadia and his co-authors blame "irresponsible marketing of formula milks and inadequate control of the quality of baby-milk powder" for the rising frequency of infant deaths from malnutrition and diarrhoea in the developing world.

They suggest that promoting breastfeeding could help achieve several of the Millennium Development Goals (MDGs), including the eradication of extreme poverty and hunger, reducing child mortality, and combating HIV/AIDS and other diseases. "I'd like to see the practice of breastfeeding preserved for all women, even through this dreadful epidemic of HIV," Coovadia told IRIN/PlusNews.

Making breastfeeding safer

The latest data from several clinical trials showed that the HIV risk from breastfeeding could be as low as 2 percent if the mother and/or child received antiretroviral (ARV) therapy, he pointed out.

"If we can make it safe for HIV-positive mothers [to breastfeed] ... Why should one avoid the best that nature has to offer and go for something where problems may arise, and often do?"

The money health departments spent on formula milk could be put to better use in other interventions that benefited HIV-infected mothers and their children, such as food parcels and social grants, Coovadia said.

Other prominent AIDS researchers disagree, arguing that not all HIV-positive women and their infants have access to ARVs, and many women do not feel able to breastfeed exclusively for six months either because of cultural norms or the need to return to work.

Prof Glenda Gray, of the Perinatal HIV Research Unit at the University of the Witwatersrand, accused Coovadia and his co-authors of taking away women's choices. "Feeding options are a human rights choice," she told a local newspaper.

"The same option doesn't work for everyone. Exclusive breastfeeding, meaning the baby gets nothing other than breast milk - not even water - is impractical if a woman needs to return to work."

Coovadia responded that activists should fight for the right of women to take maternity leave and have breastfeeding facilities at work, and that the minority of women who could not exclusively breastfeed should not supersede the benefit for the overwhelming majority who could.

"I think scientists have contributed to the confusion [about safe baby-feeding practices for HIV-positive women]," he said. "We need to reverse that."

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