Interesting discussions about the provision of free formula in the 
WIC system in the US and Healthy Start in the UK.

I have to say that I loathe the idea of any mother anywhere being 
helped to formula-feed her baby unless it is for a case of real 
medical need - ie she doesn't lactate.  I find it really hard to 
understand how when a mother chooses not to breastfeed it should 
follow that the government "let" her baby starve.  What happened to 
the mother's responsibility to feed her child?  More importantly, 
what happened to the duty of care that a government has to enact a 
health policy designed to protect public' health, including to 
ensure, as far as possible, that a mother receives every assistance 
to breastfeed.    When we promote choice it can only be ethical if we 
do it from a balanced state of ignorance - which, based on the 
evidence that (with incredibly few exceptions) formula-feeding leads 
to poorer health outcomes, is no longer possible, if it ever was. .

But my special bug-bear is that free formula is so well accepted as 
an entitlement of low-income mothers that the precedent has been 
exported to developing countries where potentially a million 
HIV-infected mothers annually are also encouraged to "choose" not to 
breastfeed, and many HIV-prevention programmes provide them with free 
formula to support their decision.  Free formula was first provided 
to HIV+ mothers in Africa in 1998.  The consequences may never be 
known because there was no mechanism set up to record the 
results.  But, in areas where all the other things that are needed to 
make formula-feeding relatively safe are simply not available, eg  66 
kg of accessible powdered formula over 2 years, clean piped water, 
fuel to boil it, a certain level of education to appreciate the 
importance of hygiene, living conditions where hygiene is even 
possible, feeding paraphernalia, access to clinics, doctors, 
hospitals, antibiotics to treat the increased number of infections of 
formula-fed babies, it should not have been too hard to imagine.  In 
Botswana, where the free-formula-for-HIV+-mothers concept has been 
incorporated into national policy, there has been a very serious 
undermining of breastfeeding; in 1999 a national survey showed that 
95% of mothers breastfed their babies. By 2006, only 63% of mothers 
initiated breastfeeding.  Included in the 36% who didn't were 15% of 
mothers who were not infected with HIV.  This is very serious 
spillover to have occurred in a mere 8 years. Results finally coming 
from research sites in the last 18 months show vastly increased rates 
of malnutrition, increased morbidity, elevated rates of infant and 
young child mortality in a continent where the IMR is already 
186/1000 (vs 6/1000 in the industrialized countries).  Furthermore, 
it transpires that the formula itself accounted for 25-60% of entire 
programme budgets.  A recent paper reporting on formula-feeding in 
Malawi, Tanzania and Mozambique found that the cost was the same as 
providing HIV+ mothers with highly active antiretroviral therapy, so 
the researchers embarked on a second trial to encourage exclusive 
breastfeeding and HAART for the mothers instead.  They found that 
cumulative HIV-transmission rates to the breastfed babies were not a 
lot higher than those in industrialized countries (2.2% vs >2%) where 
HIV-exposed babies are always formula-fed, and were in fact lower 
than the formula-fed cohort in the study (2.7%). The way forward 
seems clear.

It may seem strange to think that domestic policy in the rich 
countries can have such a worldwide impact, but it is so.  It's not 
only that we live in a global village.  It's that the rest of the 
world is hugely influenced by what happens in the US and Europe.  Any 
rationalization of the free-formula handouts by WIC and Healthy Start 
will eventually result in the saving of lives in little African 
homes, where the cost of formula is not zero.

Please keep up the good work

Pamela Morrison IBCLC
Rustington, England (formerly Zimbabwe)

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome