| World Alliance for Breastfeeding
Action (WABA) |
The World Alliance for Breastfeeding Action (WABA) hosted a
core partners meeting in Zambia, February 2004. The purpose
was to plan WABA's response to the threats to breastfeeding in
the context of HIV. WABA's core partners include ILCA, LLLI,
IBFAN/INFACT, Wellstart, the Academy of Breastfeeding
Medicine, and Linkages.
 The
group visited clinical sites in two different communities that
operate from very different models. Ndola has developed
HIV/Infant feeding services under the auspices of Linkages,
while Monze served as a UNICEF infant feeding pilot site. Each
provides much needed services in very different ways, with the
women who are HIV positive at the two sites making very
different decisions about infant feeding. All women and
infants receive anti-retroviral medication during delivery and
postpartum.
Ndola/Linkages utilizes an integrated model of education and
support, relying heavily on community volunteers. Most women
at this site choose exclusive breastfeeding after being
counseled as to both the risks of HIV transmission with
breastfeeding as well as the risks to their baby of not
breastfeeding. Mortality from infectious illness is not
significant at this site.
 At
the Monze site, care is more vertical in nature. Women were
more likely to choose to formula feed their babies in the past
when formula was provided free by UNICEF, as they understood
that there is no risk of transmitting HIV via formula feeding.
However, it is not clear as to whether they understood the
risk to their babies of not breastfeeding. Mortality among the
formula fed infants due to diarrhea and respiratory illness
was high. As babies are not tested for HIV until 18 months,
records were not adequate to show if formula feeding increases
overall HIV-free survival. UNICEF has changed its policy and
no longer provides free infant formula for the program.
Core concerns identified include:
Inadequate information regarding best infant feeding policies
from the standpoint of reducing PTCT (Parent to Child
Transmission), without undermining the health of the
population as a whole
Nations currently developing and implementing infant feeding
policies for women with HIV which are not based on adequate
data
Lack of consultation with breastfeeding experts in the
development phase of research projects in order to assure that
breastfeeding issues in the broadest sense are considered
Responses relate to three core areas:
Need for more involvement of breastfeeding experts in the
research process
Need for more professionals and lay workers with breastfeeding
clinical management skills - particularly in HIV endemic areas
Need for continued advocacy for breastfeeding as the social
norm
by Sallie Page-Goertz, IBCLC |
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