12.4.1 Breastfeeding and HIV
Breastfeeding accounts for 30–40% of mother to child transmission in populations where breastfeeding is practised until the child is two years of age. However, replacement feeding, if not carried out properly, is associated with increased risk of morbidity and mortality at a young age. This is particularly the case in low-resource settings.
Exclusive breastfeeding during the first six months of life is associated with lower transmission of HIV and improved child survival compared to non-exclusive breastfeeding children in developing countries.
There are a number of common terms used to describe infant feeding practices. You may already be familiar with these terms. Box 12.2 summarises what each one means.
Box 12.2 Common terms used in infant feeding options
- Exclusive breastfeeding: Giving only breastmilk and no other drinks or foods, not even water, with the exception of drops or syrups consisting of vitamins, mineral supplements or medicine.
- Exclusive replacement feeding: The use of breastmilk substitute totally avoiding breastmilk.
- Mixed feeding: Giving breastmilk with non-human milk and solids and other fluids.
- Complementary feeding: Addition of semi-solid or solid food in addition to breastmilk or formula at six months.
Mothers who are able to give exclusive replacement feeding can usually do this successfully if a number of factors are in place. These are known as the AFASS factors, and we have summarised these in Box 12.3.
Box 12.3 AFASS components
Acceptable: The mother has no barrier in choosing a feeding option for cultural or social reasons, or for fear of stigma and discrimination
Feasible: The mother (or family) has adequate time, knowledge, skills, and other resources to prepare feeds and to feed her infant, and the support to cope with any family, community and social pressure
Affordable: The mother and family, with available community and/or health system support, can pay for the costs of the feeding option, including all ingredients, fuel and clean water, without compromising the family’s health and nutrition spending. The current estimate for formula (without including fuel, water, mother’s time, etc.) for a child on exclusive replacement feeding is about 1200 to 1500 Eth. Birr per month
Sustainable: The mother has access to the continuous and uninterrupted supply of all ingredients and commodities needed to implement the feeding option safely for as long as the infant needs it.
Safe: Replacement foods are correctly and hygienically prepared and stored in nutritionally adequate quantities; infants are fed with clean hands using clean cups.
Why do you think that exclusive replacement feeding might be difficult for some mothers in your community?
Exclusive replacement feeding is difficult, especially in rural situations because it is expensive for families on low incomes and because preparing formula milk in consistently hygienic conditions is almost impossible.