Breastfeeding and prevention of mother to child transmission 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 necrotizing enterocolitis (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 child bonding 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 from the 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 because avoidance 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 in developing countries are faced with the dilemma of either transmitting the HI virus 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 HIV positive 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.
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 mother is HIV infected.