The March issue of MS magazine, Volume VIII number 5 has an article prominently advertised on its cover as "Breast vs. Bottle, a New Twist On the Global Struggle."  Inside is an eight page article titled "Striking a Balance as AIDS Enters the Formula Fray" by Sharon Lerner, an investigative reporter.  It starts out saying that public health experts have agreed with breastfeeding advocates that "from a nutritional standpoint, 'breast is best.'  Only mothers with rare problems are unable to breast-feed (by some estimates, 1 percent or less or women) and only babies whose mothers are dead or absent need anything other than breast milk.  And a dangerous combination of poverty and unsanitary conditions makes baby formula a deadly alternative to breast milk.  The lives of an estimated 1.5 million infants would be saved worldwide every year if all children were exclusively breast-fed in the first six months of life."
  The article goes on to say that "developing countries are home to 90 percent of the world's AIDS cases, and the latest studies of HIV transmission show that an HIV-positive mother who breast-feeds has a 10 to 20 percent chance of pasing the virus through her milk.  That means that at least 300 infants per day are being infected through breast-feeding, accounting for one third of all HIV-infected babies.  The AIDS epidemic has thus provided  formula with its first big role in protecting infant health.
  The article states that in some countries the thread of AIDS is not large enough to cause concern, in others "the sanitaiton situation is so bad that the dangers of using formula outweigh even the significant probability of passing HIV through breast-feeding."
  But in some countries where "AIDS is already the second biggest cause of infant death...women and children face...a 'balancing act,' in which the risk of AIDS must be balanced against the risk of death and disease associated with formula.  That's the gist of the article.  That in balancing breastfeeding agianst HIV transmission there is controversy and room for compromise.
  There's a very good synopsis of the Nestle boycott, the reasons it began, the promise to comply with the World Health Organizations code which ended the boycott, and the reasons for its resumption.  It's 2 pages of good explanation.
  Now the problem is that some health care workers are trying to find a way for formula companies to supply their product to HIV-positive women who can use it without disrupting breastfeeding for the whole population.  It seems companies are more than willing to supply formula, but in hospitals where formula has been donated, it has gone to all moms, not just the HIV-positive ones.  So we're back to square one.
 Dr. Glenda Gray in Soweto, South Africa says that 18 percent of her mothers are HIV-positive, "and of those who do breast-feed, one in four would use formula if they had the money.  Gray believes every woman who wants formula should be able to get it free from the government.  But since there is no such program in South Africa, Gray buys formula from the government herself at 'state price' and sells it to HIV infected mothers at cost.  Doing so...puts her in violation of the WHO marketing code."
  "Some health experts, like Miriam Labbok, are unswerving in their support of breastmilk almost regardless of the situation... <she is> an adjunct associate professor at Johns Hopkins University who specializes in infant feeding...says across all developing countries, one of the leading causes of child mortality is diarrhea, which can result from inapporpriate substitutes for breast-feeding."
  "When the nonprofit advocacy group, the Community Nutrition Institute (CNI) recently invited industry representatives, breast-feeding advocates, and AIDS experts to a series of meetings, breast-feeding advocates responded negatively."  Betty Crase, a member of LLL declined to go because she "claims CNI...has representatives who are tied to the formula industry." (which CNI denies)   LLL "maintains the evidence about transmission <of HIV> remains unclear.
  "Edith White, a lactation consultant and board member of Action for Corporate Accountability, a U.S. group that in recent years has revived the boycott against Nestle and instituted another against American Home Products <states> There is such an enormous body of information.  There's no doubt this virus is in breast milk and is transmitted to babies."
  LLL advocates solutions that involve breastmilk, but the same unsanitary conditiobns that make bottle feeding formula deadly apply to bottle fed breastmilk.
  ..."After years of raging against big babyfood companies, White is now aiming most of her frustration at members of the old breast-feeding guard who would prefer not to deal with the sticky question of HIV.
  The article calls for more research on HIV transmission, on the current dangers associated with bottle feeding, and on methods of lowering mother to infant transmission "such as the taking AZT or vitamin A during pregnancy" (ever hear of that one?)
  A controversial but very interesting article, I think, and fits in with the new thread just right.
    Joyce Jones RNC



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