South Africa to Shift Policy on Breastfeeding

14/04/2012 – Starting with the province of KwaZulu Natal, which has the highest rate of HIV prevalence among pregnant women, South Africa will promote exclusive breastfeeding for the first six months of a child’s life

For years, South Africa has had one of the highest rates of HIV prevalence in the world. But guidelines regarding infant feeding are said to have partly  hindered reductions in child deaths—until this month.

Today, Chantell Witten spoke to the United Nations (UN) Radio about child mortality the apparent battle between breastfeeding and formula use. Ms. Witten, a nutrition specialist with the UN Children’s Fund, said that the reason why children die of diarrhoea, for example, is that their immune systems are immature and that formula, which is mixed with water, can introduce contaminants.

A decade ago, the South African government provided free infant formula, which is mixed with water and fed to babies in lieu of breastmilk. The reason for this was the the prevention of mother-to-child transmission (PMTCT) of HIV through the milk.

At the best of times, formula is a poor substitute for mother’s milk because it does not contain all essential nutrients, nor does it contain the helpful antibodies that strengthen babies' immune systems. Formula use tends to lead to more cases of water-borne illnesses, pneumonia and diarrhea, which can be life threatening for youngsters.

South Africa’s child mortality rates have changed little since 1990, ten years before the Millennium Development Goals were created and the international community pledged to reduce child mortality in each country by two-thirds of the 1990 levels. About sixty per cent of neonatal deaths in South Africa are caused by malnutrition, said Ms. Witten.

In the province of KwaZulu Natal, all mothers are being advised to breastfeed for the first six months of their children’s lives, as per the recommendations of the World Health Organization (WHO). For PMTCT, both mother and child will receive antiretroviral drugs.

The policy is expected to become a national one soon, ending the free distribution of formula except in special cases where medical reasons render it necessary. Transforming this from a goal written on paper into a policy practiced by the country’s mothers on a day-to-day basis will be difficult, as only 8 per cent of South African mothers breastfeed—the lowes ratet in the world. Public and primary health care professionals will be central to promoting the new policy.

But the policy shift is not without its critics, who address pragmatic concerns about the probability of implementation.

Community paediatrics professor at the University of Witwatersrand, Haroon Saloojee, warned the Inter Press Service that “the likely scenario is that clinics don't have nevirapine [antiretroviral drug], and mothers will not be able to give the babies their medication and will continue to breastfeed. The situation in the health service currently makes that a high-risk probability.”

The World Health Organization, however, notes that such concerns ignore global data that women are indeed adhering to their drug regimens, helping to bring MTCT below five percent.