The World Alliance for Breastfeeding Action (WABA) is a global network of individuals
& organisations concerned with the protection, promotion & support of breastfeeding worldwide.
WABA action is based on the Innocenti Declaration, the Ten Links for Nurturing the Future and the
Global Strategy for Infant & Young Child Feeding. WABA is in consultative status with UNICEF & an NGO
in Special Consultative Status with the Economic and Social Council of the United Nations (ECOSOC).
  
Breastfeeding and HIV
Protecting Babies, Empowering Mothers

HIV and Infant Feeding Global Planning Meeting 2-6 Feb 2004, Lusaka , Zambia

This meeting among WABA core partners discussed and analysed the situations of infant feeding in the context of HIV, health outcomes for mothers and babies, concerns with regard to breastfeeding and the roles of breastfeeding in the context of HIV. The group brainstormed on the actions that could be taken and formulated a three-pronged strategy to approach the issue, i.e. through Advocacy, Research and Capacity Building .

Zambia 2004, Lusaka summary by Liew Mun Tip, 18 May 2004
2 page brochure

Breastfeeding movement strategises to tackle HIV and Infant Feeding

The lack of conclusive facts on the nature of HIV, breastfeeding and replacement feeding puts policy makers, counsellors and mothers in an impossible situation, as they may be not be fully aware of the implications of their decisions. Liew Mun Tip explores the dilemma and the way forward for the breastfeeding movement.By Liew Mun TipThe threat of HIV is daunting for would-be and new mothers in HIV prevalent areas. 'Have I transmitted the virus to my little baby? How can I afford to feed my baby safely?' These may be some of the questions that a mother who is HIV-positive, or unsure of her status, would ask. Unfortunately, many mothers in resource poor areas are not able to enjoy a favourable environment to provide acceptable, feasible, affordable, sustainable and safe (AFASS) replacement feeding to babies as recommended in the HIV and Infant Feeding Framework for Priority Action which was endorsed by nine UN agencies in 2003.Informed choice is no easy choice The choice to breastfeed or feed artificially in resource poor areas is not an easy one to answer, even for the experts in both the breastfeeding and HIV/AIDS fields. Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; which is also an integral part of the reproductive process with important implications for the health of mothers. According to the WHO-UNICEF Global Strategy for Infant and Young Child Feeding, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health; this is their global public health recommendation.However, the risk of mother-to-child-transmission (MTCT) of HIV through breastfeeding poses a dilemma not only for mothers, but also for policy makers and implementers of prevention of mother-to-child-transmission (PMTCT) programmes. Five to 20 percent of infants of HIV positive mothers could become infected through breastfeeding 1. The fear of any risk of transmission at all is enough to affect their decision making.The choice not to breastfeed imperils the life of infants with all the risks of artificial feeding, which are particularly serious when the safe preparation of artificial feeds is difficult, or if the level of infectious diseases is high. The World Health Organization (WHO) estimated that breastfeeding could save the lives of over 1.5 million babies who die every year from diseases such as diarrhoea, malnutrition and pneumonia 2. Furthermore, the costs related to formula feeding may impoverish families. In former Yugoslavia for example, families would need to spend approximately 70 percent of their income for the purchase of breastmilk substitutes in the first six months if they do not breastfeed. Mixed feeding, that is combining breastfeeding with formula-feeds and other foods, is a common practice in many countries. In Africa , mothers who do not conform to mixed feeding are stigmatised as they are thought to be HIV positive. However, mixed feeding is twice as likely to result in MTCT than either exclusive breastfeeding or exclusive bottle-feeding. This partly because contaminated fluids and foods may damage the bowel and facilitate the entry of HIV from breastmilk into the baby's tissues 3, and partly because mixed feeding may result in inflammation of the breast, which can increase the amount of virus in the milk 4. The matter is made worse when a spillover effect take place, that is women whose HIV status is negative or unknown decide not to breastfeed due to fear or misinformation about HIV transmission, and expose their infants to a greater risk of contracting other illnesses 5.The way forward for the breastfeeding movement Following the historic WABA-UNICEF Colloquium on HIV and Infant Feeding in Arusha , Tanzania , in 2002, the World Alliance of Breastfeeding Action (WABA) and its partners have been discussing how the breastfeeding movement should respond to the tragedies that the HIV epidemic is wreaking, including in breastfeeding patterns, particularly in Africa .In February 2004, 18 participants from WABA and its core partners - International Baby Food Action Network (IBFAN), La Leche League International (LLLI), International Lactation Consultant Association (ILCA), Wellstart International, Academy of Breastfeeding Medicine (ABM) and LINKAGES - gathered in Lusaka, Zambia for the HIV and Infant Feeding Planning Meeting to brainstorm and map out the current state of affairs, areas of concern, resources available and finally, to develop a holistic action plan for the breastfeeding movement.Learning from the grassroots The meeting began with participants visiting PMTCT programme sites in Zambia to get first hand information from local health workers and members of the community. A counsellor at a local health centre in the town of Ndola , said that most would-be mothers or mothers with newborns choose to test for their HIV status. Their husbands were also encouraged to come together for testing and counselling. Here, most HIV-positive mothers who have been counselled on their infant feeding choice opt for exclusive breastfeeding .In the village of Kantolomba , Esperia Musonda, the leader of the community volunteers, said that mothers prefer to breastfeed exclusively for six-months as they can see a visible difference between babies who are exclusively breastfed and babies who are not; and breastfed babies are evidently healthier. Community volunteers in the programme also established support groups for mothers, fathers and even grandparents to learn more about HIV and appropriate infant and young child feeding.A three-pronged strategy for the breastfeeding movement Drawing from examples from the visits, participants of the meeting identified the critical areas with 126 action ideas. These were broadly categorised as a three-pronged strategy for the breastfeeding movement, covering aspects of advocacy, research and training.Participants felt that breastfeeding groups should strengthen their collaboration with organisations dealing with HIV/AIDS. Constant exchange of up-to-date information and enhancing networking within breastfeeding groups and with HIV groups, including UN agencies especially UNICEF and UNAIDS, would help in this direction.Uncertainty about HIV and breastfeeding and replacement feeding puts policy makers, counsellors and mothers in an impossible situation, as they may be not be fully aware of the implications of their decisions, said Dr. Ted Greiner, a participant and a nutritionist with specialisation in infant and young child feeding at Uppsala University, Sweden. Indeed, little research on PMTCT has been done which takes into consideration the alternatives for infant feeding in the context of HIV, such as breastmilk based replacement feeding, heating of expressed breastmilk, expansion of human milk banks and linking feeding patterns with health outcomes for mothers and infants. Participants also suggested developing a rapid assessment tool for communities to utilise to assess the situation of HIV and infant feeding in their areas.In most cases, mothers decide on their feeding choices based on their discussions and sessions with their counsellors. However, PMTCT counsellors may not have received sufficient training on lactation counselling to provide appropriate support for mothers who choose to breastfeed. With nearly half a century of breastfeeding counselling experience globally, the breastfeeding movement has a lot to offer in this respect. Taking the Framework for Priority Action as the main guiding principles in PMTCT counselling, participants plan to identify and recommend a curriculum for PMTCT programmes that integrates infant feeding in the context of HIV, and the protection, promotion and support of breastfeeding as a public health recommendation.The conclusion of the HIV and Infant Feeding Planning Meeting signified the beginning of another journey for the breastfeeding movement. The WABA HIV and Infant Feeding Task Force, headed by Dr. Ted Greiner, was formed by the end of the meeting. The breastfeeding movement is set to coordinate its resources and efforts with the goal not merely of reducing HIV transmission, but more importantly, reducing mortality of children and increasing both their overall well-being and their HIV-free survival. WABA and its core partners invite you to join the Task Force or to be placed on an email list to receive occasional updates and to access to links and online full-text documents on HIV and Infant Feeding. Please contact the WABA Secretariat <waba@waba.org.my> and Dr. Ted Greiner, Coordinator of WABA HIV &Infant Feeding Task Force <tedgreiner@yahoo.com>.



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  1. De Cock KM, Fowler MG, Mercier E, et al. Prevention of mother-to-child HIV transmission in resource-poor countries - Translating research into policy and practice. JAMA 2000; 283: 1175-82
  2. State of the World's Children 2001, UNICEF
  3. Coutsoudis A. et al. Method of feeding and transmission of HIV-1 from mothers to children by 15 months of age: prospective cohort study from Durban , South Africa . AIDS, 15:379-387, 2001
  4. Georgeson J, Filteau S. Physiology, immunology and disease transmission in human breastmilk. Aids Patient Care and STDs. 2000;14 (10) 533-539
  5. Latham, M.C. and Kisanga, P. (2001) Current status of protection, support and promotion of breastfeeding in four African countries. Pp. 1-90. Monograph prepared for UNICEF
Other references:
This article is produced for WABALINK issue 33. Liew Mun Tip the writer and producer of WABALINK, the quarterly newsletter of the World Alliance for Breastfeeding Action (WABA). She is also the Media and Communications Coordinator of WABA and is responsible for the writing and production of news articles and publications for WABA. The World Alliance for Breastfeeding Action (WABA) is a global network of individuals and organisations concerned with the protection, support and promotion of breastfeeding. WABA action is based on the Innocenti Declaration, the Ten Links for Nurturing the Future and the Global Strategy for Infant & Young Child Feeding. Its core partners are International Baby Food Action Network (IBFAN), La Leche League International (LLLI), International Lactation Consultant Association (ILCA), Wellstart International, Academy of Breastfeeding Medicine (ABM) and LINKAGES. WABA is in consultative status with UNICEF and an NGO in Special Consultative Status with the Economic and Social Council of the United Nations (ECOSOC). P O Box 1200 , 10850 Penang , Malaysia Tel: 60-4-658 4816 Fax: 60-4-657 2655 Email: waba@waba.org.my Website: www.waba.org.my --END 18May2004--
 

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