UNICEF calls for stronger support for exclusive breastfeeding as “most feasible option” to reduce infant HIV and boost child survivalGENEVA/NEW YORK, 8 November 2004 – The world has a major opportunity to reduce the toll of HIV/AIDS on infants by taking action now to scale up support for exclusive breastfeeding, UNICEF said today.
Several new studies have confirmed that exclusive breastfeeding is currently the most feasible way to keep the majority of babies born in HIV endemic countries alive and healthy through infancy.
The HIV virus can be passed on during breastfeeding, and about one third of the 2 million children currently living HIV were infected this way. But a mother can reduce the risk of passing HIV on to her child by more than half by exclusively breastfeeding, compared with a mother who combines breastfeeding with other foods and liquids – so called “mixed feeding”.
The new studies acknowledge that every HIV-positive woman has the right to an individual evaluation of the best feeding option for her child, including replacing breastfeeding entirely with other forms of nutrition if appropriate. But only a small proportion of HIV-positive women have access to this kind of support – and over 90 per cent are completely unaware that they even carry the virus.
“In this environment, exclusive breastfeeding is a lifesaving choice for children and the impact will be dramatic if we support it properly,” said Miriam Labbok, UNICEF expert on infant and young child feeding and care. “Exclusive breastfeeding is one of the most powerful child survival boosters available to us. And it is a feasible option for the vast majority of HIV women, regardless of their HIV status.”
Breastfeeding arms children with all the vitamins, minerals and nutrients they need to thrive, and passes on vital antibodies to ward off illnesses like pneumonia and diarrhoea. The protection afforded by exclusive breastfeeding improves survival odds six-fold for a child born into a developing setting.
Current international guidelines on HIV and infant feeding recognise that HIV transmission through breastfeeding can only be eliminated by avoiding breastfeeding altogether. But they stress that HIV-positive women should only turn to alternative feeding methods when they are shown to be “acceptable, feasible, affordable, sustainable and safe for the child”.
This list of criteria can rarely be met in the poor communities that are home to the majority of the world’s HIV-positive women. As a result, women who are not helped to exclusively breastfeed are likely to resort to mixed feeding, which skyrockets the odds of HIV infection and infant mortality.
“In an ideal world, every woman would know her HIV status, get appropriate counselling and find alternate feeding methods that are safe for her child,” said Ngashi Ngongo, a UNICEF expert on parent-to-child transmission of HIV. “But in reality, we have to weigh the number of children contracting HIV via exclusive breastfeeding against the number of those dying because they aren’t exclusively breastfed.”
“The issue is very emotive, but the data is incontrovertible: exclusive breastfeeding will save more lives where safe replacement feeding is not possible, and now we know it’s a feasible choice,” he said
Governments’ ability to support exclusive breastfeeding was confirmed by a recent UNICEF joint study HIV and Infant Feeding: A Compilation of Evidence, developed with the University Research Corporation’s Quality Assurance Project(URC/QAP), which is supported by the United States Agency for International Development (USAID). The study concludes that HIV-positive women are more likely to sustain exclusive breastfeeding for at least six months when they receive infant-feeding information, counselling and support through HIV outreach programmes.
But a lack of support for exclusive breastfeeding remains the biggest missing link in the global effort to reduce the number of children becoming infected with HIV.
“We cannot accept a status quo which allows a large number of women and children to flounder without support when the stakes are so high.” Peggy Kooniz-Booher of URC/QAP. “Thanks to these studies, we have a range of great experience to draw on. Now the challenge is to learn the lessons and take our response to scale.”
Support for exclusive breastfeeding is at the heart of all of UNICEF’s child survival programmes worldwide, backing mothers by advocating for strong national policies on infant feeding, better health services and extending support networks to reach the most vulnerable communities. UNICEF has also set up a range of ante- and post-natal outreach programmes to help women make informed and sustainable choices on feeding options for their children.
But in many areas, particularly in Sub-Saharan Africa, most of the poorest women and children are still beyond the reach of existing networks and child survival indicators have stalled or are falling.
“Every day that we delay implementing programmes to support exclusive breastfeeding, more than 3,500 children die needlessly, and HIV is allowed to spread silently among the most vulnerable.” said Labbok.
“We are talking about three critical Millennium Development Goals – reducing malnutrition, saving children from preventable deaths, and cutting the HIV/AIDS infection rate in the young,” she said. “With issues this critical, no effort is too great.”
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