Breastfeeding advisable

in spite of risk of HIV

The Centre for International Health is coordinating an EU project that will document the benefits of breastfeeding, even in regions where many mothers are HIV-positive.

Fifteen million children could be saved in the next ten years if they were given only breast milk. However, many mothers are currently advised not to breastfeed because of the risk of HIV infection.

Powdered milk puts health at risk

“The seventies really showed us what could happen to many African children who were not breastfed. Even today the use of breast milk substitutes is highly risky for children, because conditions in large areas of Africa are such that they cannot be prepared properly. When health personnel stop recommending breastfeeding for fear of transmitting HIV from mothers to children we risk that many more children will die of severe malnutrition,” says Thorkild Tylleskär, director of the project “Promoting infant health and nutrition in Sub-Saharan Africa,” which has partners in seven countries and will build on already well-established relationships between researchers at institutions in the South and the North. Experts on the biology of HIV and specialists in child health are working in this area in order to ensure as well as they can that children will have a future.

Without treatment we can expect that around 30 percent of all HIV-positive pregnant women will be capable of transmitting the disease to their children in the course of pregnancy, birth or breastfeeding. However, in most places HIV-positive mothers will now be given medical treatment in the form of a single dose of Nevaripin at the onset of labour, and the baby will be given a little mouthful as soon as it is born. This has been shown to prevent infection in many cases, but there are few well-documented studies of what should be done next.

Counselling is essential

“If HIV-positive mothers breastfeed for about eighteen months, there is an estimated 15 percent risk of infection. In 1998, therefore, WHO, UNICEF and UNAIDS recommended that such mothers should use breast milk substitutes when these are reasonably priced, sustainable and safe in use, and the following year these UN organisations launched a pilot project that distributed free breast milk substitutes at a number of clinics in nine African countries, among other places. Unfortunately, the UN did not follow up the children who received the milk substitute, but in many places, they gained the impression that it did more harm than good. In Uganda , for example, there was a sharp rise in the number of malnourished children during that period, says Tylleskär.

In South Africa , HIV-positive mothers are still offered free breast milk substitute for six months. In addition to the problem of supplies that are often unreliable, in areas without electricity or a piped water supply it is difficult to prepare the milk properly.

This underlines the importance of counselling in order to persuade mothers that they should simply continue to breastfeed. In this EU project we will be studying the importance of using voluntary non-professional advisors, or “peer counsellors” as they are called, who are in a similar situation and live near the new mothers,” says Tylleskär.

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