Chris said: Indeed, it is truly a rare
situation that contraindicates breastfeeding. IMNSHO, the data are not
entirely clear for HIV, especially in developing nations where the infant
mortality rate for formula-fed infants is 2.9/3.0 (Dettwyller).
The data are certainly far from clear with HIV+ women who choose to
breastfeed. So far we have one study (actually, maybe there was one
previous one in Zaire -- anyone have that reference off hand?) which
differentiated between EXCLUSIVE BREASTFEEDING, EXCLUSIVE REPLACEMENT
FEEDING and *MIXED FEEDING* -- where *exclusive* breastfeeding means not
just that no other non-human milks were ingested by the baby but that
NOTHING else passed the baby's lips except for medications. So, no water,
no teas, no gruels, no pre-lacteal feeds, no odd bit of potato chip (crisp,
we would say), banana, mealie-meal porridge, etc, etc. This study
(Coutsoudis et al, 1999 The Lancet) showed that the exclusively breast-fed
babies had an early transmission rate similar to that of replacement fed
babies, while the mixed fed babies had the higher rates. Coutsoudis's
further results will be published in due course.
Incidentally no study has examined the morbidity of babies born to HIV+
women. The only marker usually looked for is whether the babies test + or -
on an HIV antibody test of some kind. The recent Nduati study did say that
the authors plan to publish more info on their mortality stats and on the
morbidity of the children in their study (JAMA 1 March 2000), but don't know
when those will appear. And what quality they will be.
I have to say that I don't think the evidence available justifies saying
that a woman's HIV+ diagnosis is a contraindication for her to breastfeed,
no matter which part of the globe she lives in. Of course, she may believe
otherwise, and, so far we still have some committment to the fact that women
do have the ultimate choice (the UK govt grudgingly accepts that in its
publication, HIV and Infant Feeding, though the same page carries a veiled
threat).
It seems totally bizarre to me that I have had people being quite shocked at
the idea that someone who is HIV+ might choose to breastfeed her baby, when
we don't know the risks and she might be putting her baby in danger, when
EVERY DAY we meet women and tell them that the important thing is
establishing a relationship with their child, making a decsion they are
happy and feel comfortable with and that 'perfect, optimal' nutrition is not
the only part of being a good mother. How come it is right to do this for
ordinary replacement feeding but not when an HIV+ woman chooses to
breastfeed?
Magda Sachs
Breastfeeding Supporter, BfN, UK
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