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Understanding International Policy on HIV and Breastfeeding: A Comprehensive Resource

The World Alliance for Breastfeeding Action (WABA) has recently released the second edition of the HIV kit Understanding International Policy on HIV and Breastfeeding: A Comprehensive Resource.

According to WABA, this kit is important for those working on breastfeeding and those working on HIV issues alike. It does not replace the detailed guidance from WHO/UNICEF nor does it serve as medical advice for those affected by HIV/AIDS. It seeks to inform about the concepts and recommendations for dealing with infant feeding and HIV and enhance the understanding of the importance of HIV-free survival.

The kit provides an overview of infant feeding in the context of HIV, based on current evidence (2018). It contains information, issues to think about and discuss, actions to take, and references. The kit may serve as a useful tool for anyone who works with breastfeeding families in areas where HIV is endemic. WABA hopes the kit will be distributed widely to help families in reaching their breastfeeding goals, which could lead to a reduction in morbidity and mortality related to HIV.

Access Understanding International Policy on HIV and Breastfeeding: A Comprehensive Resource HERE.

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Take the World Breastfeeding Week Pledge

Please join us in celebrating World Breastfeeding Week (WBW) 2018, coordinated by the World Alliance for Breastfeeding Action (WABA), 1-7 August 2018!

The theme this year is Breastfeeding: Foundation of Life. Breastfeeding helps to prevent malnutrition in all its forms, ensures food security for infants and young children, and thus, helps to bring people and nations out of the hunger and poverty cycle. It is because of these life-supporting and life-altering qualities that we refer to it as a foundation of life.

Even though it is still months away, we encourage everyone to start planning how you can participate in WBW this year. Tailor your event to best meet your local needs and interests: host a lecture, show a movie, plan a support group, have a picnic, organize a panel, write your legislators, or develop a unique event for your community. Once you plan your event, be sure to sign the WBW 2018 Event Pledge Form. This pledge will track your commitment to celebrate by hosting a WBW event.

For every pledge that is received, the WBW 2018 logo will appear on a world map on their website, with celebrants names and the locations of events. See what others are doing the world over to mark the occasion by viewing the events so far. Do not forget to hashtag your event with #WBW2018!

Need inspiration or resources? Here are some other ways you can get ready for WBW!

Visit the WBW 2018 website for general information and downloadable promotional materials, including the WBW 2018 Action Folder. The action folder information on the theme, and includes useful facts and figures, infographics, case studies, and suggested ways to take action.

Share your commitment to breastfeeding advocacy and education. The links between breastfeeding and nutrition, food security, and poverty reduction may be obvious to breastfeeding advocates, but there is still work to be done to make these connections clear to others. We know what needs to be done to support and enable mothers to breastfeed optimally, but we need to be more proactive and engage more people to make this a reality.

Look for information and action steps throughout WBW at Lactation Matters, where you’ll find articles, images, action steps, and more to help with your successful WBW 2018 observance.

For the most up-to-date information about WBW 2018 and to download promotional materials, please visit the World Breastfeeding Week website by clicking here.

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Reflections from the 2014 ILCA WABA Fellow, Geraldine Cahill

The International Lactation Consultant Association® (ILCA®) and the World Alliance for Breastfeeding Action (WABA) are pleased to once again jointly sponsor the exciting opportunity for a Fellowship to travel and work with WABA on outreach and advocacy projects at their headquarters in Penang, Malaysia. ILCA has designated this annual Fellowship as the Chris Mulford WABA ILCA Fellowship. Chris had been an ILCA member and helped to guide the birth and growth of the profession with a gentle spirit and wise leadership. Chris first joined WABA in 1996 at the first WABA Global Forum in Bangkok and became a long term volunteer for WABA. She worked mainly to support working women to breastfeed globally. She also paved the way for the first WABA‐ILCA Fellowship, in 2007. At Lactation Matters, we are proud to highlight this post, by Geraldine Cahill, a recent fellow, about her experiences in Malaysia with WABA.

For more information about applying to become a Fellow, please see this document. The deadline for applications is 16 February 2015. 

By Geraldine Cahill, IBCLC, BAced., Dip.ED (Antenatal)

I am the 2014 Chris Mulford WABA/ILCA Fellow. As a part of the fellowship, I recently traveled to Penang, Malaysia, and I would like to share about my time with the WABA staff. Hopefully, my experience might encourage some of you to consider this opportunity in the future.

I applied for the fellowship in September 2013 and was told that I had been chosen in November. I felt so honoured and worried whether I would actually be able to do justice to the work that I was going to be asked to do.

I set off for Malaysia at the very end of May, where I was met at at the airport and was taken to the wonderful apartment I would be staying in for the duration. This apartment was in the centre of the city at Penang Times Square. This new development is situated on the grounds of an old tin mine and smelting works. A McDonald’s occupies the building next door, which was the old colonial home of the owner and manager of the smelting works! My apartment would be shared, for part of the time, with Jerusalem Bereket, a young college intern from Jacksonville, Florida. The apartment had a swimming pool and it was glorious to come back from work most days and head to the pool to cool off.

OLYMPUS DIGITAL CAMERAPenang is an interesting place with a mix of East and West; tall modern skyscrapers and yet, when you walk around, you are very aware of the Eastern culture with temples and places of worship all around. I visited the several temples during my time in Malaysia including the Cave Temples in Ipoh on the mainland and Kek Lok Si and the Snake Temple in Penang itself.

OLYMPUS DIGITAL CAMERAThere are three distinct cultural groups in Penang: Malay, Chinese, and Indian and they all contribute to the atmosphere, both in their dress and food. Most people in Penang speak 3-4 languages: Malay, Hokkien, and Tamil as well as English. They may not be fluent in all of them but would have a good working knowledge and be able to communicate across a number of languages. The food in Penang is pretty spectacular! I did not visit even one “fancy” restaurant but rather, I ate street food all the time. Even so, the food was of the highest standard everywhere I went.

The work was also an interesting mix. WABA is primarily an advocacy group and is, of course, the organiser of World Breastfeeding Week. The preparations for this were in full swing when I visited, with scores of resources being prepared to send to the some of the 179 countries which were holding events this year. WABA provides resource materials particularly to the very poorest countries in the world and they are a central hub for breastfeeding resources through their Breastfeeding Gateway on their website. They also have an E-map that shows where mother support groups exist all around the world. They also have an amazing photographic resource that is available from all the WBW events and which can be accessed by ILCA members by emailing peiching.chuah@waba.org.my.

In my time with WABA, I was able to work on fact sheets, help to monitor and update links on the Gateway site, did some preliminary work on a Toolkit/Checklist focusing on competencies in breastfeeding skills for healthcare workers and did some teaching for the local Mother support group by providing a 3-day workshop for their peer supporters. I generally helped out as needed in the office and also attended some Steering Committee meetings as an observer and and was able to present at the Health section of the WABA meeting.

OLYMPUS DIGITAL CAMERAThe six weeks I was in Penang was one of the most memorable experiences I have ever had. I enjoyed every part of it and loved meeting new people and becoming more aware of the invaluable work that WABA does worldwide. I hope you consider applying for this opportunity of a lifetime.

photos courtesy of Geraldine Cahill

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Reflections from a Former Chris Mulford ILCA-WABA Fellow

The International Lactation Consultant Association® (ILCA®) and the World Alliance for Breastfeeding Action (WABA) are pleased to once again jointly sponsor the exciting opportunity for a Fellowship to travel and work with WABA on outreach and advocacy projects at their headquartersin Penang, Malaysia. ILCA has designated this annual Fellowship, the 6th to be awarded, as the Chris Mulford WABA ILCA Fellowship. Chris had been an ILCA member and helped to guide the birth and growth ofthe profession with a gentle spirit and wise leadership. Chris first joined WABA in 1996 at the first WABA Global Forum in Bangkok and became a long term volunteer for WABA. She worked mainly on Women and Work and Gender issues, bringing many achievements in supporting working women to breastfeed globally. She also paved the way for the first WABA‐ILCA Fellowship, in 2007, by being an exemplar of a Fellow. At Lactation Matters, we are proud to highlight this post, by Denise Fisher, a recent fellow, about her experiences in Malaysia with WABA.

For more information about applying to become a Fellow, please see this document. The deadline for applications is October 22, 2013.

By Denise Fisher AM, MMP, BN, IBCLC

In 2010, I was honored to be selected the Fellow to work with the World Alliance for Breastfeeding Action (WABA) staff on several projects to support breastfeeding worldwide.

WABA’s home office is in Penang. Penang has been called the Jewel of the Orient, and is a beautiful island off the coast of Malaysia. Malaysia is a bustling melting pot of races and religions where Malays, Indians, Chinese, and other ethnic groups live together harmoniously. Because of this multiculturalism, this tropical paradise has also made Malaysia a gastronomical paradise, and even the Malays from Kuala Lumpur will tell you that Penang is the place for the best food.

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I was incredibly excited to be given the opportunity for this fellowship to not only continue my passion for promoting breastfeeding, but to do it in such a fascinating country.

Now, while I was working on a purely volunteer basis, I was aware that ILCA® and WABA had invested financially in my travel and accommodation, and my family and work colleagues back home were also putting in big-time for me in my absence; so while the temptation was to spend many hours on the beach, I was keen to be able to help WABA as much as possible. I was given several projects to complete. They select projects that are in line with your interests and skills, so needless to say mine were either internet-related or education-related.

The biggest project was the establishment of the Breastfeeding Gateway. We worked as a small team to establish it in time to be launched for WABA’s 20th birthday celebrations. The goal of this Gateway is to provide you with all the quality information about a topic in one easy collection.  For example, you may be asked at work to develop a policy on an HIV-positive mother breastfeeding. You only need click on the HIV heading in the Gateway to open a page with links to all the quality information sites relevant to HIV on the internet, saving you hours of searching. This is perfect for students too – so easy. I loved helping to create this resource – it was such fun to work together on it.

Another project I had was to go to one of the local hospitals and film a mother doing skin-to-skin care and have baby self-attach. As a midwife, the opportunity to visit the maternity unit was one not to be missed, and then we had the most delightful mother, with a very obliging newborn who did exactly what he was supposed to (phew!).

Presenting a full-day workshop for the medical and nursing staff at the local university was pretty nerve-wracking, but on the day it all went smoothly and everyone was happy. Doing a workshop for the mother support group that had been established by a previous WABA/ILCA Fellow was much less stressful and I got to cuddle babies!

IMG_6511It wasn’t all work though. The WABA staff welcomed me into their lives and social events, and were all very friendly. I still keep in contact with some of them. I’ve been told I have to come back when the durian are fruiting (!). A young intern from America was working there at the same time I was, so both being visitors to the island, we spent our leisure time exploring – most memorable was the bicycle tour through Georgetown (the capital of Penang). You think traffic is bad where you live – wait until you’ve ridden a bike through the streets of an Asian city! This was a history and food tour – we went to lots of the historical sites (Georgetown is a UNESCO World Heritage Site) and our guides (two lovely young men) told us about living and working in Penang now, and what it was like for their parents and grandparents. And then there was the food – they took us to each of the places that was famous for each of the dishes Penang is famous for – lucky we did lots of riding to work it off. Another tour I did with my son was a guided taxi ride around the island. It truly is a tropical paradise.

Since my time in Penang, I’ve become one of a select group who get to meet up at the ILCA conference and talk about the good old days – the former WABA/ILCA Fellows! And even better, this year ILCA decided to honor us with a special Fellow’s pin. Based on my wonderful experience which was so personally and professionally rewarding I’d encourage everyone to consider applying for this yearly fellowship. You won’t regret it.

IMG_6093Denise is a registered nurse, midwife practitioner, and lactation consultant who has worked in education for many years. In recognition of her services to health professional education, specifically in the mother and baby area, Denise was inducted as a Member of Australia last year. Recognizing that the internet was the way of the future, Denise and her team created Health e-Learning in 2000, followed by the very popular GOLD conferences, to provide breastfeeding education for lactation consultants and other health professionals. She is now the Director of Step2 Education, a company that delivers Baby Friendly education to hospitals worldwide. Denise is married to Steve and mother to 3 beautiful young adults – James, Nicholas and Laura, and lives outside a little country town in Queensland, Australia.

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Breastfeeding is a Human Right. What Does That Mean? {A Response from Baby Milk Action}

Editor’s Note:  While Lactation Matters typically publishes original material, occasionally we encounter a blog post that we feel especially deserves to be read by all IBCLCs and breastfeeding supporters.  This is just such a post.  It was originally published by Mike Brady and Baby Milk Action on the Baby Milk Action website. We appreciate their permission to repost it here.

The World Breastfeeding Conference (6 – 9 December 2012) came to an end in Delhi with participants from 86 nations approving a declaration that:

“calls upon all concerned to adopt a human right based approach to the protection, promotion, and support of breastfeeding and infant and young child feeding at international, national, and community levels.”

This is a very powerful concept, backed by international law, which campaigners can use in calling on policy makers to act. We can use it to challenge governments that have failed to provide maternity protection or to regulate the marketing of breastmilk substitutes or that invest in the baby milk industry to boost economic growth while failing to protect, promote and support breastfeeding.

But what does it mean to say breastfeeding is a human right? And what about babies who are not breastfed and mothers who do not breastfeed? Here’s the way I understand it.

Mike Brady, Baby Milk Action’s Campaigns and Networking Coordinator, at the World Breastfeeding Conference 2012 alongside campaigners from the Philippines

Human rights apply universally and it is the responsibility of governments to deliver and protect these rights.

The right to breastfeed is seen as applying to the mother/child dyad.

In other words, the mother and child as a unit have a right to breastfeed. It is not the unconditional right of the child to breastfeed, or that would oblige the mother to breastfeed regardless of her own situation. The right to breastfeed means that no outside party has the right to interfere with the relationship between the mother and child.

This is an interpretation of existing rights, such as the right to adequate food in the Universal Declaration of Human Rights, the International Covenant on Economic, Social and Cultural Rights, and the Convention on the Rights of the Child, amongst others. Professor George Kent of the University of Hawaii, who has written and spoken extensively on this topic and has provided the bibliography given below, wrote in a paper on Human Rights and Infant Nutrition prepared for the World Alliance for Breastfeeding Action Global Forum in 2002:

“The principles are based on the concept that mothers should not be legally obligated to breastfeed, but rather they should be supported in making their own informed choices as to how to feed their infants.”

Protecting the right to breastfeed does not force mothers to continue breastfeeding if they want to stop. We have the right to free speech, but that does not mean we are forced to give an opinion on every subject under the sun; if we want to speak, that right is protected.

In the UK, 90% of women who stop breastfeeding before six weeks do so before they wish to (Bolling et al, 2007 cited in UNICEF, 2012 – full Infant Feeding Survey details available at http://www.ic.nhs.uk/pubs/ifs2005). If the Government had protected the right to breastfeed, might the situation have been different?

Speaking at the Conference, Miriam Labbok suggested that instead of talking of “protecting, promoting and supporting” breastfeeding, we could speak of “empowering, inspiring and counselling” mothers and the wider public with regard to breastfeeding.

To protect and empower, we need to provide an environment that makes breastfeeding possible. Many societies present obstacles to breastfeeding, rather than remove them. Maternity leave for working women needs to be sufficient, at least for the recommended period of 6 months exclusive breastfeeding (so those who wish to do so, can do so), and working conditions must be conducive to continued breastfeeding into the second year of life and beyond. Convention 183 (2000) of the International Labour Organisation states:

“A woman shall be provided with the right to one or more daily breaks or a daily reduction of hours of work to breastfeed her child… These breaks or the reduction of daily hours of work shall be counted as working time and remunerated accordingly.”

Not all countries have ratified the Convention – click here for those that have. The UK has not yet done so.

There are many other areas where the right to breastfeed may be undermined and action should be taken. For example, in the UK mothers are sometimes abused for breastfeeding in public and the Government has acted by protecting the right for the mother/child dyad to feed in public in legislation.

Mothers also need protection from aggressive marketing of breastmilk substitutes. In part, the right to breastfeed derives from the Convention of the Rights of the Child. Article 24 speaks of the:

“right of the child to the enjoyment of the highest attainable standard of health… States Parties shall pursue full implementation of this right and, in particular, shall take appropriate measures… To ensure that all segments of society, in particular parents and children, are informed, have access to education and are supported in the use of basic knowledge of child health and nutrition, the advantages of breastfeeding…”

Ensuring parents have the required information and support on breastfeeding entails implementing the International Code of Marketing of Breastmilk Substitutes and subsequent, relevant Resolutions of the World Health Assembly. The aim of the Code is clearly stated:

The aim of this Code is to contribute to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding, and by ensuring the proper use of breastmilk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution.

Note that the Code also aims to protect mothers who use breastmilk substitutes, who also have a right to accurate, independent information. Its provisions prohibit companies from advertising and seeking direct and indirect contact with pregnant women and the mothers of infants and young children. Companies are required to label products correctly and are limited to providing scientific and factual information to health workers, who are responsible for advising parents and carers.

The Committee on the Rights of the Child now routinely looks at how governments have implemented the International Code and Resolutions when assessing their progress in complying with the Convention. It has twice called on the UK Government to implement these minimum standards in national measures, but the calls have so far gone unheeded. The Committee commented in 2008, “it is concerned that implementation of the International Code of Marketing of Breastmilk Substitutes continues to be inadequate and that aggressive promotion of breastmilk substitutes remains common”.

To promote breastfeeding and inspire mothers and their families may require investment in social marketing.

In the UK, the coalition government scrapped the Infant Feeding Coordinator posts at the Department of Health, even though these posts are called for in the Global Strategy on Infant and Young Child Feeding.

It is also short sighted if the intention is to save money. UNICEF UK issued a report this year on the unnecessary illness that could be prevented and costs saved if breastfeeding rates increased, if the mothers who stopped breastfeeding earlier than they wanted were able to continue for longer.

The theme of the World Breastfeeding Conference was “Mom-made, not man-made”. Perhaps “Mum-made, not manufactured”works better in our culture and helps us to highlight that the European Union prioritises trade and growth over health.

So we see the Irish Government’s Enterprise Ireland and Danone announcing investment of €50 million in a baby milk factory to boost the economy by exporting formula around the world. According to Enterprise Ireland “98% of the output from [the] Macroom [facility] will be exported and commercialized in more than 60 countries worldwide”. This will inevitably displace breastfeeding in other countries as well as its own. To benefit its economy, the Irish Government could instead invest in mothers, the “real milk” producers, in a country where less than half (47%) of mothers are breastfeeding on discharge from maternity services (NPRS, 2008 cited by the Health Service Executive).

In the Philippines, Nestlé is leading an industry effort to replace strong marketing regulations with a new weak law (I was honoured to share a platform with campaigners from the Philippines at the conference, pictured above) and the Department of Trade and Industry has written to Members of Congress calling on them to back the draft bill because otherwise US$400 million of investment could be cancelled by the corporations and because of the revenue infant formula sales generate for the Government. The Philippines Department of Health, UNICEF and WHO have said in a statement that the draft bill: “aims to support multinational companies while damaging the Filipino society: families, the mothers and children.”

To support breastfeeding requires provision of health care services, a supportive environment and counselling and seo services, particularly in countries where breastfeeding is not entrenched and visible.

As Prof. George Kent comments with regard to the right to adequate food :

“There is increasing recognition at the international level that good nutritional status is an outcome that depends not only on good food but also on good health services and good care. Health services consist of a broad range of measures for the prevention and control of disease, including the maintenance of a healthy environment.”

In the UK we have the National Health Service, free at the point of use, and an increasing number of hospitals are entering the UNICEF Baby Friendly Initiative, which aims to ensure support is provided to pregnant women and mothers in hospital and in the community. However, there are growing concerns about the way health workers are being targeted in the UK and other countries by baby milk companies, including through funding training and other events.

Mother support groups provide counselling services in the UK and the Department of Health does provide a grant towards the National Breastfeeding Helpline operated by a coalition of them. This is one example of the Government acting on its human rights obligations. However, a coherent approach is needed as the failure to adequately regulate the baby food industry means companies encourage pregnant women and mothers to contact company-branded telephone “carelines” for support on infant feeding and to sign up to their mother and baby clubs for information. There is an intrinsic conflict of interest in baby milk companies with products to sell making direct and indirect contact with pregnant women and mothers, and this is prohibited by the Code. The fact this is a marketing strategy was demonstrated last month when Baby Milk Action won a case against Pfizer/Wyeth before the Advertising Standards Authority (ASA) over its illegal advertising of infant formula when ostensibly providing breastfeeding support.

A human rights approach requires action on many fronts. It helps us to think coherently and logically about what is required to protect and deliver the rights in question.

In the cultural context of the UK and Europe, we need to articulate that protecting the mother/child dyad’s right to breastfeed is to provide space for all mothers to breastfeed, particularly those mothers who say they want to breastfeed for longer, but who experience problems that could not be overcome under the current circumstances. At the same time we should understand that not everyone has to exercise the rights they hold.

We need to persuade policy makers to act, because it is governments who are responsible for protecting and delivering rights.

We need to persuade governments to invest in mothers, the “real milk” producers, rather than factories built not to meet existing requirements, but to export baby milk around the world and to create new consumers and markets for economic reasons. Danone aims to supply 20% of the world’s infant formula from Ireland, supplanting the most locally produced and consumed food there is at great environmental and health cost.

We sometimes speak of breastfeeding being free and perhaps this led to it being undervalued by policy makers. But as Anwar Fazal, Chairperson Emeritus of the World Alliance for Breastfeeding Action (WABA), told the Conference in his inaugural address describing the five principles of breastfeeding: it provides medicine, it provides nutrition, it is sustainable, it protects the environment and it plays a special role in the mother/child bond.

For these benefits to be enjoyed as widely and as fully as possible, governments need to invest political effort and funding to meet their obligation to protect the right to breastfeed.

At the conference there were many inspiring stories of governments that have and are taking action and of the situation in countries where breastfeeding cultures continue to exist or have been recovered.

For those of us living in cultures where many mothers are unable to breastfeed as they would wish, this provides welcome reassurance that a new reality is within our grasp if we reach for it.

Bibliography of publications on infant feeding and human rights by Professor George Kent

“Breastfeeding: A Human Rights Issue?” Development, Vol. 44, No. 2 (June 2001), pp. 93-98.http://www2.hawaii.edu/~kent/breastfeedingrights.pdf

“Human Rights and Infant Nutrition,” WABA Global Forum II-23-27 September 2002-Arusha, Tanzania (Penang, Malaysia: World Alliance for Breastfeeding Action, 2004), pp. 178-186.http://www2.hawaii.edu/%7Ekent/HUMAN%20RIGHTS%20AND%20INFANT%20NUTRITION.pdf

“Food is a Human Right,” in Richard Pierre Claude and Burns H. Weston, Human Rights in the World Community: Issues and Action. Third Edition. Philadelphia: University of Pennsylvania Press, 2006, pp. 191-201.

“Child Feeding and Human Rights,” International Breastfeeding Journal, Vol. 1 (2006).http://www.internationalbreastfeedingjournal.com/content/1/1/27

“Breastfeeding; The Need for Law and Regulation to Protect the Health of Babies.” World Nutrition, Vol. 2, No. 9 (September 2011), pp. 465-490. http://www.wphna.org/2011_oct_wn3_kent_breastfeeding.htm

Regulating Infant Formula. Amarillo, Texas: Hale Publishing, 2011. Publisher’s announcement athttp://www.ibreastfeeding.com/catalog/p270/Regulating-Infant-Formula/product_info.html

Also see Global Obligations for the Right to Food, edited by Professor George Kent, with a chapter on Holding Corporations Accountable by myself (Mike Brady) and a chapter on International Legal Obligations for Infants’ Right to Food by Dr Arun Gupta, organiser of the World Breastfeeding Conference. Available in Baby Milk Action’s online Virtual Shop.

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New HIV and Breastfeeding Resource from the World Alliance for Breastfeeding Action (WABA)

By Pamela Morrison, IBCLC

Photo by  DFID - UK Department for International Development via Flickr Creative Commons

Photo by DFID – UK Department for International Development via Flickr Creative Commons

Have you gained the impression that maternal infection with the Human Immunodeficiency Virus (HIV) automatically rules out breastfeeding? Or that formula-feeding by HIV-positive mothers, whenever possible, is always recommended? If you have had access to different global World Health Organization (WHO) HIV and infant feeding recommendations over the years, do you find them confusing? If the answer to any one of these questions is Yes, then you are not alone.

Based on the huge amount of research conducted since the 1985 discovery that HIV could be transmitted in mothers’ milk, global guidance about breastfeeding in the context of HIV has been changing every few years. One of the spillover effects has been that IBCLCs and others who work with mothers and babies have frequently been exposed to outdated and/or myth-information.

However, IBCLCs can now feel more confident than ever before in supporting HIV-positive clients who express a desire to breastfeed. With certain safe-guards, including maternal adherence to antiretroviral (ARV) regimens which are mandatory in developed countries, the risk of transmission of HIV through breastfeeding can be reduced to virtually zero.

Originally conceived as a joint ILCA-WABA collaborative project, with a gestation period of over seven years, WABA marked World AIDS Day this December with the easy delivery of a new Comprehensive Resource entitled “Understanding International Policy on HIV and Breastfeeding” which can be downloaded HERE.

Intended for use by policy-makers, national breastfeeding committees, breastfeeding advocates, women’s health activists and others working for public health in the community, the Resource sets out why breastfeeding in the context of HIV has never been as safe as it is today. Recent research shows that HIV-positive mothers who receive effective ARVs, protecting their own health sufficiently to result in a near-normal life-span, can also expect that the risk of transmission of HIV to their babies during pregnancy, birth, and throughout the recommended period of breastfeeding, can be close to zero. As a consequence, today’s HIV-positive mothers are enabled to avoid both the stigma and the risks of formula-feeding because current HIV and infant feeding guidance is once again more closely aligned to WHO recommendations for their uninfected counterparts, in place over the last decade: exclusive breastfeeding for 6 months and continued breastfeeding with the introduction of age-appropriate complementary feeding for up to 2 years or beyond.

Building on current research, the 2010 global HIV and infant feeding guidelines and ARV recommendations for prevention of transmission of vertical HIV show that, for the first time, there is enough evidence to recommend ARVs while breastfeeding. Where ARVs are available, it is recommended that HIV-positive mothers breastfeed until their babies are 12 months of age. Furthermore, updated WHO programmatic advice issued earlier this year for ARVs for pregnant women and prevention of HIV infection in their infants has gone a long way towards clarifying many previously perceived ambiguities. Rather than different ARV regimens being decided on the basis of an individual HIV-positive mother’s disease progression, a clear recommendation is now made for provision of ARVs to all HIV positive pregnant women from the time that they are first diagnosed with HIV and continued for life.

With proper treatment, an infected mother’s viral load becomes undetectable, not only protecting her own health and survival, but also reducing to virtually zero the risk of her baby acquiring HIV through her breastmilk.

Thus, current guidance has enabled countries as diverse as South Africa and the United Kingdom to develop national recommendations which once again effectively support breastfeeding for all babies. The up-to-date guidelines simultaneously free health workers from having to tailor infant feeding advice to the HIV-status of their clients and lift from HIV-positive mothers the stigma attached to previous advice about formula-feeding. Most importantly, current guidance ensures the greatest likelihood of HIV-free survival for babies exposed to the virus.

Fully referenced throughout, the Resource’s six sections clarify many past misconceptions by helping to explain how they came about. They track the impact of HIV on women and their infants, review past and current research on transmission of the virus through breastfeeding, trace the evolution of past guidance, outline current policy and counselling recommendations and list easily accessed informational and training materials.

The Resource clarifies how, in a situation of competing infant feeding risks, breastfeeding can now be safely promoted and supported. It is hoped that this tool will enable all who work with HIV-positive mothers to confidently endorse current HIV and breastfeeding recommendations so that each individual child’s chance to survive and thrive can be maximized.

We hope that this document impacts practice and helps to support mothers with HIV all over the world. Please download your own copy of “Understanding International Policy on HIV and Breastfeeding” HERE

pmorrisonPamela Morrison’s interest in HIV and breastfeeding arose from having worked as a private practice IBCLC in a country where HIV-prevalence amongst pregnant women reached 25%, yet breastfeeding was both the cultural norm and a cornerstone of child survival. While in Zimbabwe, Pamela also worked as a BFHI Facilitator and Assessor, as well as serving on the Zimbabwe National Multi-sectoral Breastfeeding Committee and the national BFHI Task Force. She has also served on the World Alliance for Breastfeeding Action (WABA) Task Forces for Children’s Nutrition Rights, and for HIV and Infant Feeding, and the ILCA Ethics & Code Committee. After moving to England in 2005, she was employed until 2009 as a Consultant to WABA. She is currently the ILCA media representative on HIV, and continues to do volunteer work for WABA.

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