Q. Doesn't HIV change the situation?
Answer 24 May 2004: Baby Milk Action is guided by World Health Assembly Resolutions.
In 2001 the World Health Assembly adopted Resolution 54.2, which calls for action:
In summary, where replacement feeding is feasible this is recommended for HIV-infected mothers. Where it is not, exclusive breastfeeding is recommended. There is a need for risk assessment. For example, where water is unsafe an artificially-fed child, including the child of a mother infected with HIV, is up to 25 times more likely to die as a result of diarrhoea than a breastfed child. UNICEF has stated that while over the past 20 years 1.7 million infants may have been infected with HIV through breastfeeding, 30 million have died through not being breastfed.
The Resolution states that mothers should make their decision on infant feeding: "Free from commercial influences." This means the International Code of Marketing of Breastmilk Substitutes and subsequent, relevant Resolutions of the World Health Assembly are more important in the context of HIV, not less.
At the European Parliament Public Hearing into Nestlé baby food marketing at the European Parliament in November 2000, UNICEF stated (see press release 23 November 2000):
It should also be remembered that the majority of infants, even in countries with high prevalence of HIV, are born to mothers who are not infected.
The World Health Organisation held an Expert Consultation in October 2000 from which the 2001 Resolution derived (see: http://www.who.int/reproductive-health/rtis/MTCT/mtct_consultation_october_2 000/consultation_documents/new_data_on_mtct_conclusions/New_data_prevention_ MTCT_infant_feeding.en.html).
In addition to considering the relative risks for infants in different conditions, the Expert Consultation states: "There is evidence from one study that exclusive breastfeeding in the first 3 months of life may carry a lower risk of HIV transmission than mixed feeding." (Ref: Coutsoudis, A., et al (1999). 'Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study.' The Lancet 354 (471-476). (Available on http://www.thelancet.com/ - register and search for Coutsoudis to find the paper).
The Expert Consultation also notes: "There are concerns about the possible increased risk of HIV transmission with mixed feeding during the transition period between exclusive breastfeeding and complete cessation of breastfeeding." Further research is required in this area and is underway.
The Coutsoudis study found that exclusively breastfed infants have no more risk of HIV infection than exclusively artificially-fed infants. Increased risk apprears to occur with mixed-feeding, when substances are given in addition to breastmilk, be it water, formula or other substances.
"Potential mechanisms that could explain a reduced risk of MTCT [Mother to Child Transmission] when children are exclusively breastfed include:
In simplified terms, introducing substances other than breastmilk may harm the infant's gut and immune system, putting the child at greater risk of HIV infection. Exclusive breastfeeding, without replacing feeds, may also mean the breastmilk has a better balance of anti-infective properties and lower load of HIV.
WHO's 2004 booklet "HIV transmission through breastfeeding:
A review of available evidence" can be downloaded from http://www.who.int/child-adolescent-health/publications/NUTRITION/ISBN_92_4_156271_4.htm
Despite the 2001 Resolution, which is reflected in the Global Strategy on Infant and Young Child Feeding, adopted by the World Health Assembly under Resolution 55.25 in 2002, baby food companies sometimes suggest HIV requires the promotion of artificial feeding to HIV-infected mothers and the scrapping of regulations for the marketing of breastmilk substitutes. Indeed, Nestlé set up a nutrition institute in South Africa in 2001 with the expressed intention of promoting infant formula (see Campaign for Ethical Marketing action sheet September/October 2001).
Also see the briefing papers:
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