South Africa has some of the highest rates of HIV prevalence in the world. Over a decade ago, to prevent the mother-to-child transmission of HIV during breastfeeding, the Government of South Africa rolled out a policy providing free infant formula for all HIV-positive mothers.
But infant formula is not equivalent to breastmilk; it does not contain all the essential nutrients or antibodies to protect children from diarrhoea, pneumonia or malnutrition – some of the top causes of death among children under age 5. And child deaths remain a critical problem in South Africa, which currently lags behind the Millennium Development Goal on reducing child mortality.
A major policy shift is now underway in KwaZulu Natal, the province with the highest HIV prevalence among pregnant women. All mothers are now being encouraged to exclusively breastfeed for the first six months. And instead of formula, HIV-positive mothers and their infants will receive antiretroviral drugs that will dramatically reduce the chances of transmission.
The hidden cost of formula
UNICEF supports exclusive breastfeeding in the first six months of life. Breastfeeding provides all the nutrients infants need to grow and strengthens their immune systems as well. It also offer a range of benefits to mothers, such as facilitating bonding and reducing risk of post-partum haemorrhage.
But in the past, “all we were really interested in was preventing HIV,” said Professor Anna Coutsoudis, an expert on paediatric HIV at KwaZulu Natal University. “The best way to stop transmission from mother to child through breastfeeding was to give out free formula. But then what happened as this policy became rolled out, you started seeing that, although you get less HIV infection when you use formula, there are side effects, which is kids get more pneumonia, more diarrhoea.”
Formula not only increased infants’ vulnerability to disease, it could also be dangerous if mixed with unsafe water. “In poor settings, they actually die from formula,” Prof. Coutsoudis said.
The province began revising its recommendations for mothers living with HIV – just as the World Health Organization (WHO) was also preparing to introduce new guidelines promoting breastfeeding for all mothers.
“We just needed to move ahead rather quickly and rapidly because of the issue of saving children’s lives,” said Leonore Spies from the Department of Health, who spearheaded the new policy.
Reaching all mothers
But with South Africa’s exclusive breastfeeding rates at an extreme low of 8 per cent, they faced tremendous challenges promoting breastfeeding not just among HIV-positive mothers but among all mothers. The first step was to reach out to health workers, especially midwives and nurses.
At Prince Mshiyeni Memorial Hospital, one of the busiest hospitals in Durban, Nxumalo, a midwife, guides mothers on early initiation of breastfeeding and proper latching. Behind every bed is a poster explaining how mothers can also express and store breastmilk. She works with family members to make sure mothers are supported when they choose to exclusively breastfeed. “Before, the mothers were used to formula. But now we are teaching them breastmilk is the best,” she said.
At Nsimibini Health Clinic, south of Durban, all mothers are now given the same advice, that breastfeeding is the best option. “It was very difficult at first because people did not understand,” said Nurse Mnguni Nompumelelo. “You really had to talk to them to make them understand how important breastmilk is.”
Training is also underway for community caregivers, community members who go-house-to house advising families on the best care for their children.
Policy goes nation-wide
Almost two years since the policy shift, KwaZulu Natal’s approach is being adopted in rest of the country.
In August 2011, at a conference bringing together health officials from all the provinces, Minister of Health Pakishe Aaron Motsoaledi called on attendees to promote exclusive breastfeeding for all mothers and to end the practice of distributing free infant formula. The Tshwane Declaration, adopted in 2011, sets out a timetable for the rest of the country to comply.
|© UNICEF South Africa/2012|
|Nicolene Marx, 19, is exclusively breastfeeding her 5-month-old daughter, Thembeka, to give her the best possible start in life. A policy in South Africa's KwaZulu Natal Province promotes exclusive breastfeeding for all.|