In 2002, world leaders gathered at the World Summit on Sustainable Development in South Africa to determine how humans could live comfortably without destroying our planet.
The declarations taken at the conference are the now well-known eight millennium development goals (MDGs), of which three are linked to health. A fourth goal focuses on child mortality.
The child mortality rate is the number of children who die before the age of five out of every100 000 live births. The aim is to reduce child mortality by two thirds by the year 2015. A decade after the adoption of this goal, only 12 countries have failed to bring down their child mortality rates and South Africa is oneof them. It is imperative that we address this situation.
What kills children around the world? It depends on where you live. Is your country rich or poor?
Child mortality is closely linked to socioeconomic conditions. That is why the United Nations uses it as a measure of development in countries around the world. In the developing world the top four killers of babies are HIV, gastroenteritis, malnutrition and pneumonia.
Over and over again, research has shown that breast-feeding is the most effective child survival strategy. Why then was it abandoned by so many mothers, particularly in South Africa?
Our country has one of the lowest rates of breast-feeding in the world. Ironically, breast-feeding was done away with because of “development and civilisation”. It was suddenly deemed uncivilised to breastfeed and seen as a sign of poverty if you could not afford formula milk. Working mothers were regarded as automatically exempt from this “primitive” method of raising their offspring.
The aggressive marketing of breast milk substitutes, with misleading adverts, reinforced this false belief. The consequence was a massive onslaught on babies. Millions of infants were subjected to formula milk too early in their lives — before their stomachs were mature enough to handle such substitutes.
As a result, gastroenteritis became so widespread in underprivileged communities that people regarded it as an inevitable step that every baby had to go through as part of growing up. As if gastroenteritis, pneumonia and malnutrition were not enough, another onslaught followed. Thirty years ago, HIV and Aids visited our planet and changed life as we knew it.
Medical research revealed that the breast milk of HIV-infected mothers contained HIV and they could infect their babies. This reinforced the already negative perceptions of breast-feeding.
In South Africa, HIV positive mothers were discouraged from breast-feeding to protect their babies from contracting the virus and the state provided free formula milk to HIV-infected mothers.
What has changed since? Why would I, as health minister, suddenly encourage all mothers, including those who are HIV positive, to breast-feed?
In discouraging HIV-positive mothers from breast-feeding, we were doing what we thought was right in the light of what we knew then. But, in the context of new research, things have to change.
Although HIV kills the most children, particularly in sub-Saharan Africa, gastroenteritis, pneumonia and malnutrition remain devastating killers. They kill children, regardless of their mothers’ HIV status, and particularly those who are not breast-fed. The death rate of babies who are not breast-fed is six to 10 times higher than among breastfed infants.
But what about HIV-negative babies born to HIV-positive mothers? Infants who survived the virus because their mothers saved them by not exposing them to their breast milk? Yes, indeed, they survived HIV and Aids but the problem is that often they didn’t live for long either. They succumbed to these other killers.
To save children, scientists recommend that everyone, regardless of their mothers’ HIV status, be breastfed. Babies of HIV-infected mothers are, along with their mothers, given an antiretroviral drug for the entire breast-feeding period, even if the baby was born HIV-negative.
Why is breast milk so vital? The human body has an inherent immune system that protects the body from diseases. HIV is a big threat to life because it kills off this immunity — that is why people with HIV get sick and die.
Human beings are not born with mature immune systems. Infants are, therefore, not fully protected against diseases. They get their immune protection from breast milk. When they grow up, they acquire their own immune systems. But, until then, they depend on their mothers’ milk for protection — not cow’s milk in tins. Hence children not on breast milk are always sickly and die very easily.
Despite modern scientific advances, no scientist has been able to incorporate immune protection into formula milk. Marketers of infant feeding formulas won’t disclose this to mothers. It will discourage them from using their products.
In encouraging breast-feeding, the government will abolish false marketing of formula milk. We know the truth. We will use the World Health Organisation’s code of marketing of breast-milk substitutes. We will try to establish breast milk banks for orphaned children and for those whose mothers can’t breastfeed owing to acceptable reasons.
Countries such as Brazil already have milk banks where human milk can be obtained for babies who can’t get it from their own mothers. Research recommends that breast-feeding be exclusive for at least six months. After the sixth month, breast-feeding can be supplemented by solids.
Breast-feeding should, however, continue until the baby is at least one year old. Extending this to two years will be even better for your child. The government will no longer be offering free formula milk at public health facilities. It would be grossly irresponsible in the light of what we now know.
Authorised health workers will be the only ones permitted to advise whether a mother should be exempted from the breast-feeding rule. This policy shift was arrived at last month in Johannesburg at the breast-feeding consultation, a broad forum attended by an array of stakeholders.
Aaron Motsoaledi is South Africa’s health minister