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Introduction
The number of infants born with HIV infection is
growing every day. The AIDS pandemic represents a tragic setback in
the progress made on child welfare and survival. Given the vital importance
of breast milk and breast- feeding for child health, the increasing
prevalence of HIV infection around the world, and the evidence of a
risk of HIV transmission through breast-feeding, it is now crucial that
policies be developed on HIV infection and infant feeding.
The following statement provides policy-makers with
a number of key elements for the formulation of such
policies.
The human rights perspective
All women and men, irrespective of their HIV status, have
the right to determine the course of their reproductive life
and health, and to have access to information and services
that allow them to protect their own and their family’s
health. Where the welfare of children is concerned, decisions should be made that are in keeping with children’s
best interests.
These principles are derived from international human
rights instruments, including the Universal Declaration of
Human Rights (1948), the Convention on the Elimination
of All Forms of Discrimination Against Women (1979),
and the Convention on the Rights of the Child (1989), and
they are consistent with the Cairo Declaration (1994) and
the Beijing Platform for Action (1995).
Preventing HIV infection in women
The vast majority of HIV-infected children have been
infected through their mothers, most of whom have been
infected through unprotected heterosexual intercourse.
High priority therefore, now and in the long term, should
be given to policies and programmes aimed at reducing
women’s vulnerability to HIV infection, especially their
social and economic vulnerability – through improving
their status in society. Immediate practical measures
should include ensuring access to information about HIV/
AIDS and its prevention, promotion of safer sex including
the use of condoms, and adequate treatment of sexually
transmitted diseases which significantly increase the risk of
HIV transmission.
The health of mothers and children
Overall, breast-feeding provides substantial benefits to
both children and mothers. It significantly improves child
survival by protecting against diarrhoeal diseases, pneumonia and other potentially fatal infections, while it enhances
quality of life through its nutritional and psychosocial benefits. In contrast, artificial feeding increases risks to child
health and contributes to child mortality. Breast-feeding
contributes to maternal health in various ways including
prolonging the interval between births, and helping to
protect against ovarian and breast cancers.
However, there is evidence that HIV – the virus that
causes AIDS – can be transmitted through breast-feeding.
Various studies conducted to date indicate that between
one-quarter and one-third of infants born worldwide to
women infected with HIV become infected with the virus
themselves. While in most cases transmission occurs during late pregnancy and delivery, preliminary studies indicate that more than one-third of these infected infants are
infected through breast-feeding. These studies suggest an
average risk for HIV transmission through breast-feeding
of 1 in 7 children born to, and breast-fed by, a woman
living with HIV (i.e. infected with HIV).
Additional data are needed to identify precisely the
timing of transmission through breast-feeding (in order to
provide mothers living with HIV with better information
about the risks and benefits of early weaning), to quantify
the risk attributable to breast-feeding, and to determine
the associated risk factors. Studies are also needed to assess
other interventions for reducing mother-to-child transmission of HIV infection.
Elements for establishing
a policy on
HIV and infant feeding
- Supporting breast-feeding
As a general principle, in all populations, irrespective of
HIV infection rates, breast-feeding should continue to be
protected, promoted and supported.
- Improving access to HIV counselling and testing
Access to voluntary and confidential HIV counselling and
testing should be facilitated for women and men of reproductive age, in part by ensuring a supportive environment
that encourages individuals to be informed and counselled
about their HIV status rather than one that discourages
them out of fear of discrimination or stigmatization.
As part of the counselling process, women and men of
reproductive age should be informed of the implications of
their HIV status for the health and welfare of their children.
Counselling for women who are aware of their HIV
status should include the best available information on the
benefits of breast-feeding, on the risk of HIV transmission
through breast-feeding, and on the risks and possible advantages associated with other methods of infant feeding.
- Ensuring informed choice
Because both parents have a responsibility for the health
and welfare of their children, and because the infant feeding method chosen has health and financial implications
for the entire family, mothers and fathers should be encouraged to reach a decision together on this matter. However, it is mothers who are in the best position to decide
whether to breast-feed, particularly when they alone may
know their HIV status and wish to exercise their right to
keep that information confidential. It is therefore important that women be empowered to make fully informed
decisions about infant feeding, and that they be suitably
supported in carrying them out. This should include efforts to promote a hygienic environment, essentially clean
water and sanitation, that will minimize health risks when a
breast-milk substitute is used.
When children born to women living with HIV can be
ensured uninterrupted access to nutritionally adequate
breast-milk substitutes that are safely prepared and fed to
them, they are at less risk of illness and death if they are not
breast-fed. However, when these conditions are not fulfilled, in particular in an environment where infectious
diseases and malnutrition are the primary causes of death
during infancy, artificial feeding substantially increases
children’s risk of illness and death.
- Preventing commercial pressures for artificial feeding
Manufacturers and distributors of products which fall
within the scope of the International Code of Marketing of
Breast-milk Substitutes (1981) should be reminded of
their responsibilities under the Code and continue to take
the necessary action to ensure that their conduct at every
level conforms to the principles and aim of the Code.
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