Cover Image
close this bookPrevention of HIV Transmission from Mother to Child: Strategic options (Best Practice - Key Material) (UNAIDS, 1999, 24 p.)
View the document(introduction...)
close this folder1. Introduction
View the document(introduction...)
View the document1.1 The risk of MTCT
View the document1.2 Prevention strategies
View the document1.3 The cost of inaction
close this folder2. Major issues for decision-making
View the document(introduction...)
View the document2.1 Counselling and voluntary testing
View the document2.2 Stigma and discrimination
View the document2.3 Health care systems
View the document2.4 Replacement feeding
View the document3. Pilot projects
View the document4. The wider benefits of the package of interventions
View the document5. Questions of ethics
View the document6. Affordability and cost-effectiveness of the strategy
View the document7. A decision tree

2.4 Replacement feeding

The issue of replacement feeding is a complex one.1 Promotion of breastfeeding as the best possible nutrition for infants has been the cornerstone of child health and survival strategies for the past two decades, and has played a major part in lowering infant mortality in many parts of the world. It remains the best option for the great majority of infants, and in providing for replacement feeding as part of the strategy to reduce MTCT of HIV, policy-makers need to take into account the risks of undermining breastfeeding generally, and of relaxing vital controls on the promotion of infant formula by the industry. They also need a sound assessment of how safe it is to recommend replacement feeding in their local setting. For example, is infant formula readily available; is the supply of formula assured over the long term; do people have access to clean water and fuel for boiling it; and are they sufficiently educated and informed to make up replacement feeds correctly? If used incorrectly - mixed with dirty, unboiled water, for example, or over-diluted - breastmilk substitutes can cause infection, malnutrition and death. Where the risks associated with replacement feeding are not clear, research will be necessary to establish the facts, and strategies should be tested in pilot projects. The fact that the fertility lowering effects of breastfeeding will be inactivated makes the availability of family planning services as part of postpartum care a necessity.

1 For a comprehensive discussion of the issue, see: HIV and infant feeding: guidelines for decision-makers UNAIDS/98.3