Doctors in the HIV field and mothers infected with the virus have reacted with scepticism to Health Minister Aaron Motsoaledi’s announcement of an “exclusive breastfeeding” policy according to which the government will no longer provide free milk formula to HIV-positive mothers.
Bottle-feeding in state hospitals will also no longer be permitted, unless a health worker prescribes it for a mother who suffers from certain specific medical conditions, Motsoaledi said at a media conference in Pretoria on August 23.
“We’d rather provide HIV-infected mothers and their babies with antiretroviral treatment and encourage them to exclusively breastfeed for six months,” he said.
The breast milk of infected mothers contains HIV. But “exclusive breastfeeding” for six months — giving the baby only breast milk for that period — combined with antiretroviral syrups for the infant reduces the risk of HIV transmission to as low as 1.8%, according to internationally accepted research.
However, Dr Sindisiwe van Zyl, who works with HIV patients in Orange Farm near Johannesburg, said exclusive breastfeeding was impractical for some HIV-infected women.
“Many of the mothers I see are domestic workers who often only get two months’ maternity leave. They’re not allowed to take their babies to work and send them home to their grandmothers. How on earth will they be able to only breastfeed?” she said.
Medical studies show that babies of HIV-infected mothers who are breastfed but also get formula milk or solids during the first six months are far more likely to contract the virus.
The solid food and the formula milk seem to damage their intestines’ sensitive lining, which protects them against infection.
“How do I tell poor mothers who can’t afford formula or expensive breast pumps and freezers to express and store breast milk that they can’t give their babies formula right from the start but should instead risk infecting them through mixed feeding?” Van Zyl asked.
Motsoaledi said South Africa needed laws that compelled employers to make it possible for women to breastfeed.
“Women need to be able to take their babies to work. How do the employers of domestic workers justify someone looking after their children while the workers have to neglect their own? Why can’t the nanny look after her and her employer’s children at the same time?”
Motsoaledi said he would ask the ministers of labour and social development to fast track legislation to compel employers to establish crèches and “breastfeeding rooms” in the workplace.
South Africa, at just 8%, has one of the lowest exclusive breastfeeding rates in the world. Studies show breastfeeding is closely linked to lower infant mortality rates and produces healthier babies.
In industrialised countries HIV-infected mothers give their babies only formula milk because it carries no risk of HIV infection.
In the developing world, however, mothers often do not have access to clean water or sterilised bottles, resulting in their children dying of diarrhoea. This is why breastfeeding exclusively for six months is promoted.
African countries such as Burkina Faso, Senegal and Botswana have adopted an exclusive breastfeeding policy.
Motsoaledi also plans to adopt an international code for the marketing of breast milk substitutes that will ban formula milk sponsorships and marketing.
Mia Malan works for the Discovery Health Journalism Centre at Rhodes University