Breastfeeding and prevention of mother to childtransmission of HIV
Breastfeeding is universally accepted as the food of choice for all young infants. It provides all the nutritional requirements for infants up to six months of age – there is no need for additional food or water and also has other non-nutritional properties that are necessary for optimal growth and brain development in young babies. As such, the global recommendations for optimal nutrition of young infants and children by the WHO and UNICEF is exclusive breastfeeding for the first six months of an infant’s life and introduction of nutritionally adequate and safe complementary feeding beginning at six months of age with continued breastfeeding for up to two years of age. The benefits of breastfeeding, both short and long term are multiple and varied.
Benefits for the baby
Breastfeeding is cost effective and readily available. Breast milk makes the baby’s immune system strong because it contains unique antibodies. Infections like pneumonia and ear infections are more common and more severe in infants who are not breastfed. Breastfeeding has been shown to have a protective effect against necrotizingenterocolitis (inflammation of the bowels) in premature infants. Breastfeeding reduces the risk of allergy mediated diseases such as type one diabetes and asthma later in life. Breastfeeding is associated with greater intelligence in older childhood and adulthood. Breastfeeding has also been shown to potentially have a protective effect on obesity and childhood leukaemia. The use of formula milk in developing countries may increase the risk of mortality in young children by causing diarrhoeal diseases. Formula feeding is also associated with poor growth and development.
Benefits for the mother
Breastfeeding also has short and long term benefits for the mother. It results in a quicker contraction of the womb after delivery and thus minimizes bleeding after delivery. Breastfeeding promotes mother and childbonding and has been shown to be protective against depression or post-delivery “blues”. Breastfeeding assists may also be a form of contraception by delaying the periods from returning after the baby. (You still need to use additional contraception though!) Women who breastfeed their infants have been found in studies to have a decreased risk of having breast and ovarian cancer than their non breastfeeding counterparts.
Unfortunately, the HIV pandemic has resulted in conflicting messages about breastfeeding and this has overshadowed the benefits associated with breastfeeding. Breastfeeding has also been under threat fromthe competitive and often unethical promotion of industrial breast milk substitutes by companies producing formula milk.
Research has shown that the HI virus is transmitted through breast milk from the breastfeeding mother to her infant, and the risk of transmission is present for as long as the infant is breastfed. Public health experts estimate that HIV-infected mothers have a 10 to 15 percent chance of passing the virus to their newborns through their breast milk.In developed countries, women who are HIV infected are encouraged to avoid breastfeeding. This is becauseavoidance of breastfeeding in the developed world is not accompanied by the adverse results of formula feeding seen in developing countries. In the developing countries, avoidance of breastfeeding is associated with increased risk of death and poor growth and development due to increased risk of diarrhoeal and respiratory infections and malnutrition. As such, HIV infected women indeveloping countries are faced with the dilemma of either transmitting the HIvirus to their infants through breastfeeding or risking their children dying, malnutrition and poor growth if they avoid breastfeeding.
Policies that encouraged the avoidance of breastfeeding are based on studies from developed countries and have been shown to be inappropriate for the developing countries.
We now know from extensive research that exclusive breastfeeding lowers the risk of mother to child transmission of HIV. Antiretroviral treatment given to the mother and the baby also lowers the transmission of HIV from mother to infant. Antiretroviral treatment for the prevention of mother to child transmission (PMTCT) has evolved over the years from a single drug (Nevirapine) given to the mother in labour to fixed dose combination antiretroviral drugs. Atroiza is a combination of three drugs that are used in treating HIV: Tenofovir, Emtricitabine and Efavirenz. Atroiza is taken once daily by all pregnant women who test HIV positive during their antenatal care. The combination treatment is continued throughout the pregnancy and during breastfeeding. The newborn HIV exposed baby is also started on a daily dose of Nevirapine syrup for six weeks. The provision of combination antiretroviral drugs to both mother and baby and exclusive breastfeeding for six months with continued breastfeeding up to one year as recommended in the current South African PMTCT policy of April 2013 makes breastfeeding much safer even in HIVpositive women.
The problem is that most breastfeeding mothers do not practice exclusive breastfeeding. Breastfed babies often receive water, formula and even other foods in combination with breastmilk before six months of age.Mixed feeding (mixing breast milk with water, other foods or formula) increases the risk of the HI virus being transmitted to the baby because the young infants delicate bowels become damaged by the foods which make it easy for the virus to get into the baby through the cracks.
The challenge for health care professionals is to educate and support mothers to exclusively breastfeed for the first six months of an infant’s life. There is a need to expel myths and change mindsets towards exclusive breastfeeding by continuous education and support. This together with the provision of antiretroviral drugs as per national policy will ensure that babies get the full benefits of breastfeeding and remain free of HIV infection.
In conclusion Exclusive breastfeeding, even in HIV positive women is an important strategy for child survival. If antiretroviral drugs are given to both mother and baby and an HIV-positive woman is fully adherent with the treatment throughout the duration of breastfeeding, the actual risk of transmitting HIV through breast milk is exceedingly low.
The best food for all babies is still breast milk. This is true whether or not a motheris HIV infected.
This month the Yezingane Network officially launched the Prevention of Mother-To-Child Transmission (PMTCT) Campaign. This launch was aligned with the National Health Awareness Days of World Breastfeeding week (1-7 August), National Women's day (9 August) and Women's Month. In order for us to make this a success we invited everyone to join in the campaign to help save mothers and babies. This was done through social networks and by running interviews on media channels and is ongoing process. Recently the YN Executive member Professor Ashraf Coovadia was invited for an interview at the show called GreatExpectations which is broadcasted on E-TV every Mondays and Tuesdays from 11h30 – 12h30. The discussion topic was specifically based on Breastfeeding. In his interview Prof. Coovadia encouraged all mothers to breastfeed their babies at least for a full six months as this was one way of bonding with their babies, and provided the optimum protective factors for their baby. Mothers were also reminded that mixing breast milk and formula was dangerous for their babies because it increased the risk of HIV transmission or causing other illnesses. To watch the full interview, you can log onto: http://on.fb.me/14HiJDv
‘Saving Babies’ was one of the two articles included in the SANAC News publication which outlined the objectives of the campaign, and encouraged civil society to participate in it in various ways. The objective of the campaign is to raise awareness of the PMTCT services to pregnant and lactating mothers, to promote healthy behaviors including safe breastfeeding practices and early and regular antenatal clinic visits. As we continue with the campaign, the Yezingane Network is in a process of printing out materials educating mothers about PMTCT and highlighting to mothers the significance of breastfeeding. These will be distributed to clinics, schools and taxi ranks within the 9 provinces of the country.
We would like to encourage you to also get involved and participate in this campaign by sharing our key messages,hash-tags (#PMTCT) and @Yezingane Twitter handle on your social media platforms and to re-tweet,and share Yezingane Network’s Tweets and Facebook posts with your networks.
Let us together as the children’s sector create a ‘buzz’ on social media about PMTCT for mothers and children and helpsave our babies!
Please feel free to enquire for further information about the campaign at the Yezingane Network Secretariat via email: email@example.com
Some exciting developments have been taking place for the “My Living Positively Handbook” which helps children cope with living with HIV and the associated stigma, treatment regimens, communicating with others, and self- esteem. A community nurse, from the Matunkha Centre in Northern Malawi contacted Children’s Rights Centre, with interest in our handbook. I have copied part of her email to us below:
“I am doing home based care and palliative care. In our program we have at least 60 children who are HIV-positive. It's very difficult to find good teaching materials for these children. Next month I hope to open a ART- clinic and I think more children will come.
A friend gave me 'My living positively handbook'. I'd like to try-out this book to see if it is useful here. One of the steps I have to take is to translate it in Chitumbuka.”
At least two significant aspects of this feedback are important for us. Firstly that the book has reached not only children in South Africa, but that people believe in it so much to share it with others even so far as Malawi. Secondly, the impact that this book is having in children’s lives is significant enough for people to invest their own time, money and energy to translate it into their own language. We have been able to share the necessary documents and templates with this organization to allow for an easier update of this book, and will review the content once it has been translated to ensure the quality is still maintained.
We would like to thank you, our donors once again for your support and we hope that this feedback encourages and inspires you, as your support makes a real difference in children’s lives.
Steady progress has been made thus far with the preparations for the launch of this campaign on the 1st August 2013. The content for the information booklet for mothers is being developed by a team of pediatricians and communication specialists. The individuals involved in developing our booklet for mothers were heavily involved in the development of the newly launched National Prevention of Mother-To-Child Transmission (PMTCT) Policy for South Africa. There are few others in South Africa who understand this policy as well as these professionals and we are privileged and honored to have them working with us.
Listen out for our Yezingane Network Chairperson Prof. Ashraf Coovadia speaking about the campaign on SAFM (http://tunein.com/radio/SAFM-1051-s6404/) on Wednesday 15th May at 19h00 South African time (Africa/Johannesburg). To see what time this is in your country visit http://www.timezoneconverter.com/cgi-bin/tzc.tzc.
We sincerely appreciate your support and contributions to this project, and we will continue to keep you updated on the progress and impact that your invest is making in the lives of South African mothers and babies.
Welcome to our newly launched 'Elimination of Mother-To-Child Transmission Campaign'!
HIV transmission from an HIV positive mother to her new born child is a preventable occurrence, and one which must become the norm in South Africa if we are to have any hope of defeating HIV. Although we have been involved in this work since 2003, this is our first campaign that we have posted onto GlobalGiving. We have much work to do and look forward to partnering with donors across the world as we strive to make HIV a thing of the past.
This is a project which has been fully endorsed by the South African National AIDS Council (the highest national policy and programme decision making body in the country - see www.sanac.org.za). Yezingane Network is the children's sector representative on this council, and the mechanism through which this campaign will be implemented.
The Yezingane Network is a civil society network of organisations working to address the impact of HIV and AIDS, TB and STI’s on children, families and communities in South Africa. The Yezingane Network has represented children and children’s voices on the South African National AIDS Council since 2003 and continues to be one of the most organised and influential civil society movements in South Africa. There are a total of 194 members of Yezingane Network and an overall reach of approximately 17000 organisations in South Africa due to many of those members being networks themselves. The network consists of members from a wide variety of expertises and includes NGO’s, CBO’s, FBO’s, Networks, as well as Regional, National and International organisations. The Yezingane Network has developed a successful and cohesive model of networking and collaboration. Provincial Representatives of the Yezingane Network initiate provincial meetings and ensure that province and district specific issues are raised, collated and presented at the various AIDS Councils. Multi-sectoral collaboration, a bottom up approach, and results based programming, are foundational to the success of Yezingane Network. Genuine representation of children and children’s issues at the necessary policy and practice decision making spaces for HIV, TB and STI’s is ensured through child participation techniques and opportunities, as well as by the Network being accessible and inclusive of all child stakeholders. Yezingane Network is thus appropriately positioned to take responsibility for the implementation of this Campaign and look forward to impacting South African perceptions and practices around HIV, children, and pregnancy.
Please do not hesitate to contact us about more information about this campaign, our approach to it, and about the impact we are making.
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