On the eve of World AIDS Day, the World Health Organization has released updated recommendations on preventing mother-to-child transmission of HIV. And the news for breastfeeding is really big.
You may recall that HIV can be transmitted from mother to child during pregnancy, childbirth, and breastfeeding. In the developing world this has been a major source of new infections.
For this reason, it's been the recommendation that women who are HIV positive not breastfeed, as long as formula feeding is "acceptable, feasible, affordable, sustainable and safe."
Many women in developing countries don't have access to clean water, much less the resources to purchase formula, and not breastfeeding puts their infants at a high risk of death and disease. In one recent study of 14 developing countries, not breastfeeding resulted in over 325 deaths per 1,000 births compared to 35 deaths per 1,000 births among breastfed babies.
That's why breastfeeding, even though it may mean that a child becomes infected with HIV, is considered safer than not breastfeeding in much of the developing world. Both feeding options carry significant risks, but a child is far likelier to die early in life if he is not breastfed.
So, until today, the recommendation has been that women in developing countries feed their babies breastmilk substitutes only if it is "acceptable, feasible, affordable, sustainable and safe." Otherwise, exclusive breastfeeding is recommended during the first six months of life, to be discontinued as soon as is feasible thereafter.
This has been a really difficult recommendation to follow, for several reasons. Exclusive breastfeeding (considered the safest method) is relatively rare. Weaning from exclusive breastfeeding to no breastfeeding at six months, as you can imagine, is extremely difficult. And women face significant stigma when not breastfeeding. Unlike in the U.S., many developing countries never lost the "breastfeeding culture," and not breastfeeding is considered a give away that a woman is HIV positive.
But recent research has shown that when HIV positive mothers take antiretroviral drugs while breastfeeding, it reduces the risk of transmission dramatically. Access to ARVs has increased significantly in recent years. Accordingly, the WHO has changed its recommendation:
WHO now recommends that breastfeeding continue until the infant is 12 months of age, provided the HIV-positive mother or baby is taking ARVs during that period. This will reduce the risk of HIV transmission and improve the infant's chance of survival.
"In the new recommendations, we are sending a clear message that breastfeeding is a good option for every baby, even those with HIV-positive mothers, when they have access to ARVs," said Daisy Mafubelu, WHO's Assistant Director General for Family and Community Health.
National health authorities are encouraged by WHO to identify the most appropriate infant feeding practice (either breastfeeding with ARVs or the use of infant formula) for their communities. The selected practice should then be promoted as the single standard of care.
I think that this is really good news for mothers, babies, and the tradition of breastfeeding.