Pat - thanks so much for alerting me to this disastrous article. Thanks to
others who have written so eloquently. Here is my response:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Several friends have sent me copies of the article you wrote which appeared in
The Houston Chronicle on December 10 entitled "Unicef carrying grudge to
deadly limits in Africa".
With respect, the HIV and breastfeeding dilemma in Africa is *not* just a
question of one risky feeding method vs another "safe" method, but rather a
situation of competing risks:
- on the one hand the risk of transmission of the virus via breastmilk,
stated by UNAIDS to be about 15%, which is probably over-stated, since the
studies used to reach this figure included babies who were mixed fed and/or
breastfed for only 2 - 4 weeks, during which time transmission during birth
and during breastfeeding is completely indistinguishable, but even with this
apparent risk, only 600 000 babies per year would be infected via breastfeeding
- on the other hand the risk of the babies dying from *other* causes in
impoverished, resource-poor environments because breastfeeding has been
withheld. And, accordingly to UNICEF, 1.5 million babies die each year from
these causes.
To look at it another way from my country's perspective; if 400 000 babies
are born each year in Zimbabwe, and if 30% of the mothers (133 000)
(recorded range 7% - 53% in the 1997 published figures) are infected with
HIV and if 30% of *those* babies (44 000) will become infected via
mother-to-child transmission and if one-third of *those* babies (14 600)
become infected via *breastfeeding* (not in utero or during birth, even if
we could realistically distinguish between these routes with current
technology) then should we place the lives of 130 000 babies at risk of
death or disease as a direct result of *not* being breastfed in order to
"save" 14 600 of them from HIV in breastmilk? And what shall we do about
the other two-thirds who would have been born already infected (>30 000
babies) whose lives are currently lengthened and improved because they have
the special closeness of breastfeeding and the life-giving properties of
breastmilk? Bear in mind also that we have over 60% unemployment and over
60% inflation and that 70% of the population live in abject poverty ...
Africa (albeit the last continent on the planet that practices this) has a
breastfeeding culture. To *not* breastfeed immediately identifies a mother
as aberrant. It is a brave woman who immediately advertises her HIV status
to the whole world by formula feeding; in fact many women who have been
co-erced into apparently "choosing an alternative to breastfeeding" may
formula feed at home, but will, in fact, breastfeed in public to avoid the
stigma. Of course, this places the baby at increased risk of HIV
transmission through mixed (breast and formula) feeding because the infant
gut may become damaged by the formula to more easily allow entry of the
virus in the breastmilk (a lose-lose situation).
Lastly, a randomized breast vs formula study which was recently reported
from Nairobi by Dr Ruth Nduati, who coincidentally wrote the Review upon
which the UNAIDS HIV and infant feeding guidelines are based, showed that at
2 years, the mortality rate was not significantly different between
breastfed and formula fed babies of HIV+ mothers, being 24% for the
breastfed and a whopping 20% for the formula fed babies.
So if there is no benefit, why disturb the life-saving cultural practice of
a whole contininent? Commercial gain, perhaps?? Writings and research
suggesting that the mothers of Africa should *not* breastfeed, for any
reason, deserve the very closest scrutiny for conflict of interest.
Should you wish to have any further information I will be happy to copy to
you several lengthy review papers I have written which have been published
in the last year. Should you wish to see the conditions pertaining in
Africa, where you suggest that HIV-infected mothers should not breastfeed, I
invite you to come and see for yourself.
Pamela Morrison
International Board Certified Lactation Consultant
10 Camberwell Close
Borrowdale
Harare
Zimbabwe
email: [log in to unmask]
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