Martha - thank you so much for updating us on your HIV+ mom.  What you have
described is heart-rending, "Then she got a visit from the pediatric
infectious disease specialist to whom she'd been referred antenatally.  The
specialist reiterated standard recommendations to the parents, and made a
referral to the child protective service, who told the mom that if she
breastfed even one more time, her baby would be removed from her physical
custody.  So she quit, and has been feeding formula.  At this point, the
child protective service has legal custody of the baby, but the parents are
allowed to keep physical custody if they follow the recommended medical
treatment plan."

Firstly, page 4 of the UNICEF/UNAIDS/WHO "HIV and Infant Feeding Guidelines
for decision makers" sets out the mother's rights:

"Protect, respect and fulfil women's rights.  It is the mother's right to
decide how she will feed her child.  She should be given the fullest
possible information on which to base her decision, as wide a range of
choices as possible, and appropriate support for the course of action she
chooses.  However, a mother's choice may well have implications for her
family as a whole and she may encourage other members (for example the
child's father) to share responsibility for the decision-making, at her own
discretion."

Secondly, page 7 of this document sets out the value of breastfeeding and
breastmilk - in detail.

Thirdly, page 12 sets out an option under "modified breastfeeding" which
this mom already chose, but has now been prevented from carrying out:

"Expressing and heat treating breastmilk.  A mother can express her milk and
either pasteurise it (heat to 62.5 C for 30 minutes) or boil it briefly and
cool it.  This kills the HIV virus.  Mothers need good motivation to feed
this way long term at home...."

Surely this is clear enough?  But perhaps the social services are not aware
of the terms of these recent Guidelines?

The facts of the matter are 1) that no-one can tell if this baby was born
already infected or not because there is no *sure* way of testing 2)
research seems to suggest that 20% of the babies born to HIV+ mothers are
infected in utero or during delivery, and these babies suffer fewer
infections and live longer if they are *breastfed*, and 3) the recent Leroy
multi-centre pooled analysis (Lancet, August 1998) shows that only 5% of MTC
transmission can be directly attributed to *breastfeeding*.

If I was this mother I would apply to the Courts to protect my right to make
an informed choice about how to feed my baby.

Pamela Morrison IBCLC, Zimbabwe
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