Breastfeeding seminars

Policy changes around HIV drive down breastfeeding

According to an analysis of interviews with experts in the field, policy changes in infant feeding guidelines for women living with HIV have weakened confidence in breastfeeding in South Africa.

According to the analysis published in PLOS ONE last month.

In 2001, the WHO advised women in high-income countries with low infant mortality rates to refrain from breastfeeding due to the possibility of transmission of the virus through breast milk. But in 2006, exclusive breastfeeding was encouraged for the first six months.

In 2016, guidelines changed to encourage breastfeeding for at least 24 months for women taking antiretroviral drugs.

“We have struggled to improve breastfeeding in South Africa,” says Chantel Witten, study co-author and dietician based at the University of the Free State. “The evidence is clear, breastfeeding is no longer the norm and formula feeding is desired, but it is the inferior way to feed children.”

Researchers asked 15 people with expertise in infant feeding implementation eight questions about WHO’s HIV-related infant feeding guidelines and its international code of marketing of breast-milk substitutes and on how breastfeeding rates could be improved.

The government underlined its commitment to breastfeeding through the Tshwane Declaration in 2011, according to the study. The statement included “provisions to promulgate regulations to enforce the WHO code. Also that mothers living with HIV should breastfeed for 12 months and that all public health facilities should be baby friendly by 2015, and that there should be no free distribution of infant formula (except on prescription) in public health establishments from 2012”.

But infant formula companies are aggressively marketing their products, putting children’s health at risk in low- and middle-income countries, a recent study finds. WHO report.

“We have breastfeeding violations and no one is held accountable,” Witten says, adding that the infant formula industry has a huge influence because some companies fund researchers.

Prior to 2011, South Africa provided free infant formula for 10 years to HIV-positive mothers to prevent mother-to-child transmission.

This has given the infant formula industry a major boost, as many people trust health workers when deciding how to feed their babies, says study participant Sara Nieuwoudt and social and behavior change coordinator at the University of the Witwatersrand. .

“I fear the commercial formulas industry will profit from such confusion.”

The evidence has been updated and breastfeeding is now recommended for all infants, regardless of the mother’s HIV status, but confusion remains, according to the analysis.

Lindelani Mushaphi, dietitian and lecturer in community nutrition at the University of Venda, says: “I don’t think if we had the resources we had in terms of the drugs that we have now to stop transmission from mothers to babies , formula dependency could have occurred.

Mushaphi says she has never seen anyone in her province monitoring the implementation and violations of the code. “In the studies I’ve done, as early as one month, mothers start giving babies solid foods thinking breastfeeding isn’t adequate.”

South Africa has run behavior change communication campaigns such as Side-by-Side, the Road to Health booklet and Mom Loginbut experts say women’s information about infant and young child feeding was not enough.

Mushaphi says the promotion of breastfeeding is not adequate as it usually happens in August, and the rest of the year not much is done.

Nieuwoudt suggests health workers need more training on updated infant feeding guidelines and how to communicate effectively.

Witten says research remains important to understanding what is happening across Africa: “If the rest of Africa doesn’t protect itself, it will follow the same route.”

This article was produced by the UK Sub-Saharan Africa office of SciDev.Net