Infant formula

Avoiding transmission of HIV from mother to child after birth has become one of the greatest challenges in HIV prevention. Approaches to date to reduce or prevent postnatal transmission through breastfeeding have included the avoidance of all breastfeeding through the use of exclusive replacement feeds, or exclusive breastfeeding for a limited duration with early and rapid cessation of breastfeeding as soon as it is feasible.

Although experts say that breastfeeding gives children the best start in life, protecting them from life-threatening diseases and providing essential nutrients, barely a third of all infants in developing countries are exclusively breastfed for the first six months.

TORONTO - A South African study has conclusively shown that babies with HIV positive mothers who are exclusively breastfed are significantly less likely to get the virus than if they get breastmilk and other food mixed.

DURBAN, South Africa, Jan 27 (Reuters) - Six-month-old Matthew Coetzer bounces on his mother's knee. The bubbly blond and blue-eyed child is ready for his next meal of breast milk. But Matthew's mother is not just feeding her own son. In the family refrigerator are bottles of frozen milk, donations for a bank designed to bring the benefits of mothers' milk to orphans and sick children caught up in South Africa's devastating HIV/AIDS epidemic.

International food and beverage company Nestl is to provide a full report to the South African government on how it is addressing the erratic supply of infant formula to public health facilities.

Many of the babies saved by nevirapine from getting HIV from their mothers at birth are being infected with the virus later in communities where health systems are weak and there is little support for their mothers.

For many HIV-positive mothers in resource-poor settings, breastfeeding is often the only option, despite the risk of HIV transmission. The challenge now is for healthcare workers to accept this reality and make breastfeeding safer, a recent report has said.

Dr Libertina Amathila, Minister of Health and Social Services has launched the National Policy on Infant and Young Child Feeding in Windhoek.

The Infant Feeding Association has expressed deep concerns over proposed new legislation which, in the interests of promoting breast feeding, will restrict the dissemination of information about formula or bottle feeding and will apply to product labels, advertisements and promotional material, educational material and editorial content in magazines and other media. If you're a new mom and you cannot breast feed your baby due to health reasons, you may need to start feeding your baby infant foodstuffs (formula) from a bottle. If you're a new mom and you need to go back to work, leaving your baby in a daycare facility or with a nanny or grandmother, you will either need to express milk to feed baby, or you will need to give baby formula via a bottle. What if you cannot have access to any information about formula or bottle feeding? Where do you find your information on how much and what type? From magazines? Infant foodstuff advertising? Bottle-feeding advertisements? Consumer help lines? As of next year, this type of information may be banned by a new government proposal. The proposed legislation will attempt to encourage breast-feeding by limiting access to information on bottle-feeding. The Minister of Health has drafted a white paper regarding foodstuffs (formula) for infants and young children and this could become legislation next year. With this proposed legislation, the minister has targeted labels on formula and infant feeding containers, advertisements and promotional material, educational material and editorial content in magazines and other media. What does this new legislation propose? Some of the points include: 1. Labeling on formula containers is not to show illustrations, diagrams, or graphics. 2. Formula labels are not to provide any nutritional or health information. 3. Bottle, teat and dummy labels must include a statement that cup feeding is safer for infants. 4. Manufacturers may not sell, sample or advertise products in a health establishment. 5. There may be no direct or indirect contact with the public through print media, TV, radio or the Internet. 6. No help line details may be displayed on formula labels. 7. Manufacturers may not pay for, donate or distribute educational material to health establishments. 8. Media will be curtailed in their coverage of issues relating to bottle-feeding. While the Infant Feeding Association is aware of and appreciates the benefits of breastfeeding, this legislation does pose some serious problems to South African society, and most specifically to women and children: 1. The labeling regulations suggested in the new legislation are confusing to both consumer and healthcare worker, thereby posing an even greater health risk to babies. 2. The legislation makes no mention of HIV+ mothers and the high risk of mother-to-child transmission with breastfeeding. 3. The regulations imply that without access to bottle-feeding information, mothers will have to breastfeed for the first two years of their child's life. This means that for the first few months, every two hours, a woman should be with her child in order to breastfeed. Where does this leave the country's working mothers? Is the government suggesting that women stay home instead of work? In a country where gender equality is finally becoming realized, this takes us two steps backwards. 4. The proposed Act does not take into account women who are unable to breastfeed. Neither does it consider babies who are orphaned and who do not have access to breastfeeding at all. In a country where Aids orphans are a reality, can this prejudice be allowed? 5. With the new labeling and packaging requirements, the cost of formula will increase, making it even more difficult for already cash-strapped mothers to feed their babies. 6. The price increase will also make it un-viable for top quality products to do business in South Africa, opening the gap for cheaper, inferior quality products. 7. The prohibition of advertising and the curtailment of media coverage denies mothers their right to information - information that is vital to the health and survival of their babies. 8. The prohibition of education material means that there is even less education and information in a country where we need more. 9. The curtailing of media coverage contravenes the basic right to freedom of speech in the press. 10. The legislation is stifling the growth of the infant food market, which may result in large scale job loss through restrictions on marketing. A country with already high unemployment statistics can surely not afford this? 11. The legislation suggests that in order to prevent nipple-confusion, cup feeding for babies should be promoted over bottle-feeding. According to the South African Paediatric Association's research, this suggestion is not valid. This legislation has not yet been promulgated and is currently at White Paper stage, put out for comment until the 26 December 2003. After which time, it goes forward to be drafted into a Bill and thereafter becomes legislation. It is clear that research into issues such as HIV and working women have not been considered in the drafting of this bill. We need to educate people in South Africa, giving them more options, not deprive them of choice, forcing them into a direction that, for lifestyle, health or other reasons may not be possible. What happens to a country when the government legislation contravenes the basic rights and freedoms of the people, embedded in the constitution? Is this paternalistic approach not reminiscent of the apartheid era? What we need is more, not less education. We need magazine articles, media coverage and help lines that supply accurate information and advice to the people of South Africa. We have to contest this issue in order to get the government to modify such restrictive and unrealistic legislation. The media and the public need to rally together to fight for the future mothers and babies of South Africa. (Issued by: IFA sourced through biz-community) Links //\// For more information on the regulations regarding Food Stuffs for Infants and Young Children, please contact us at: www.babyassist.co.za; ifa@baby.co.za; or call Wendy Pratt on (011) 648-7820. To read a summary of the proposed Regulations Relating to Foodstuffs for Infants and Young Children visit www.babyassist.co.za/regulations/summary.htm. Other related: Breastfeeding Ads Delayed by a Dispute Over Content http://www.nytimes.com/2003/12/04/business/media/04adcol.html Getting abreast of baby feed formulas, Sunday Tribune http://www.iol.co.za/index.php?click_id=125&art_id=qw1070175603133T655&s...

Most HIV/AIDS mother-to-child transmission prevention campaigns have focused on the potential danger of HIV infection to the infant and little attention has been given to the mother, according to a new report. This had diminished the importance of women's health, particularly when so little was known about the effects of pregnancy on the health of women living with HIV/AIDS. Policies aimed at curbing MTCT could also hold women solely accountable for their child's HIV infection, disregarding the role that men played in preventing the transmission of HIV to children. Decreasing MTCT is an important goal but campaigns should take into account the woman's health. Current debates on the use of infant formula or breast milk also ignored the role of HIV-positive women. International guidelines recommend that HIV-positive women be empowered to make fully informed decisions about infant feeding [through counselling about the risks and advantages of breastfeeding] and that they be suitably supported in carrying them out. In some countries, however, women were not given a choice. Ghana has severely limited access to breast milk substitutes for HIV-positive women by banning the sale, advertising or promotion of infant formula in public health facilities . Also research was still needed to assess the impact of breastfeeding on the health of HIV-positive mothers. Though little discussed, the high-energy demands and sleep deprivation associated with infant care, including breastfeeding, were factors that undermined the already weakened immune systems of HIV-positive women, it added. The right to pregnancy and even marriage was also at risk, as some national policies discouraged HIV-positive women from becoming pregnant. In Ethiopia, where abortion is severely limited and only 13 percent of women use contraceptives, the country’s HIV/AIDS and Human Rights Policy states that prevention of pregnancy shall be encouraged among HIV-positive individuals without specifying how this policy would be implemented. Despite evidence that men’s sexual practices played a greater role in the high prevalence of HIV/AIDS, government and traditional leaders around the world had demonised and stigmatised women’s sexuality, identifying it as the key to both prevention and containment. Efforts to control women’s sexuality relied on discriminatory social and cultural stereotypes and failed to address men’s role in driving the pandemic, the report noted. CRLP urges governments to accept their international legal obligations to protect the sexual and reproductive rights of HIV-positive women and girls, the report concluded. (Source: IRIN 11 December 2002)