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
