>I understand what you are saying about bf being the norm, but then why
would some mothers in the bf group have bf for such a short time? And how
would a mother feel being told not to bf? Could we believe her compliance
would necessarily be 100%, even w/ education about risk of mixed feeds?<

Some mothers in the breastfeeding group (4%) NEVER breastfed.  Imagine, at
32 weeks of pregnancy you are recruited to a trial.  The researcher explains
that you will be randomised to breastfeeding (in the style of the country,
ie mixed feeding -- this trial began in 1992 and there was nothing about
exclusive breastfeeding as an intervention in its design) or to complete
avoidance of breastfeeding.  You accept to join the trial  Yet being given
the info for the trial is in itself an intervention "Educated scientists
think that complete formula feeding could be better for my baby -- and they
are testing this."  Powerful.

How would she feel?  Good question.  Why isn't there more than one (or two)
qualitative studies about how women feel in this situation?  In Africa, in
the west?   We have framed HIV to be so urgent and threatening that we need
our modern shamans -- men in white coats with vaccines and medications and
perscriptions on how to behave -- not to know how the people involved
understand what is happening to them.

There is no, repeat, NO, indication in either Nduati paper to say that women
received ANY information about possible dangers of mixed feeding.  The
Coovadia study was the first (?1997 from memory) to think of mixed feeding
and they defined it as mixing breastfeeding with *any other animal milk* and
found that mixed feeding carried no different risk than 'exclusive'
breastfeeding (as they had defined it).  It was only when a new research
team, headed by one of the researchers in the Coovadia study, Anna
Coutsoudis, headed up the observational study we know in her papers, that
anyone looked at exclusive breastfeeding-- as defined by the WHO --  in the
context of hiv transmission.   And no other research study has replicated
this, though some programmes on the ground may be taking note of the
information.

Magda Sachs
Breastfeeding Supporter, BfN, UK

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html