Mail & Guardian Online
THE SMART NEWS SOURCE | Feb 09 2010 20:06 | LAST UPDATED Feb 09 2010 20:06
News | National | Health

Professors provoke breastfeeding outrage

SARA BARRETT - Aug 25 2009 06:00
comments 10 comments | Post your comment


South African HIV activists are outraged by a recommendation from world-renowned University of KwaZulu-Natal researchers, professors Hoosen Coovadia and Anna Coutsoudis, that the government should stop providing free formula milk to all HIV-infected mothers at state clinics.

This follows an article in the prestigious British medical journal, the Lancet, this month, in which the two professors argued that "the time has come to confront the obvious dangers of infant malnutrition and mortality associated with formula feeding."

In an accompanying briefing document, Coovadia and Coutsoudis wrote that "precious health funds, which could be better spent on more effective interventions, are being wasted on provision of free formula, with very little positive impact on the health of infants".

According to Mark Colvin from Maromi Health Research in Durban, which conducts intensive research into HIV, there is a 15% chance of HIV-infected women who breastfeed transmitting the virus to their babies. The likelihood of infection can be reduced to as low as 2% if these mothers breastfeed exclusively for six months and are also on antiretroviral treatment (ART). However, in South Africa, many women don't have access to ART. "It is for this reason that in developed countries, HIV-positive women do not breastfeed but give their babies formula, which eliminates the risk of HIV transmission to nil once the baby has been delivered," said Colvin. "In addition, it is not the cultural norm to only exclusively breastfeed, and studies have shown that only a small minority of women are able to sustain exclusive breastfeeding in the absence of substantial support."

But in an interview with the Mail & Guardian this week, Coovadia, who also works for the reproductive health unit at the University of the Witwatersrand, argued that the risk of infant death from formula feeding in poor communities is often higher than the risk of HIV infection. "Women in particularly rural communities rarely have access to clean water and, as a result, babies die of diarrhoea and pneumonia because formula feeding provides them with little immune protection."

In addition to this, Coovadia said, the state often runs out of formula milk, "as evidently happened in Johannesburg earlier this year", leaving HIV-infected mothers with no other option than to breastfeed until formula is available again and thereby increasing the risk of HIV transmission to their babies via mixed feeding (i.e. breastfeeding combined with formula feeding). "You should never depend on technology if nature can provide it," he said.

Professor Glenda Gray from Chris Hani-Baragwanath Hospital's perinatal HIV research unit in Soweto disagrees. "What concerns me is that they would want to take away women's choices. Feeding options are a human rights choice. The same option doesn't work for everyone. Exclusive breastfeeding, meaning the baby gets nothing other than breast milk, not even water, is impractical if a woman needs to return to work."

Coovadia, however, maintained that women do have the right to choose, but it needs to be a choice based on research. "If a woman thinks her rights supersede the rights of her baby, then so be it. But what does she believe in -- science or voodoo?"

According to Colvin, in a relatively wealthy country like South Africa, we should be striving for greater equity whereby all HIV-infected mothers can safely formula feed their babies. "Instead, Coovadia and Coutsoudis seem content to maintain the old divisions in our society. If you are a wealthy or white mother who is HIV-infected, then obviously you formula feed your baby. As for the poor and black majority, these researchers suggest that they should exclusively breastfeed their infants and run the risk of giving their child a lethal disease. Coovadia and Coutsoudis would argue for greater equity in access to antiretrovirals or primary healthcare, but when it comes to safe infant feeding, suddenly equity goes out of the window."

CONTINUES BELOW


According to Coovadia, the World Health Organisation (WHO) recommends that HIV-negative women exclusively breastfeed for six months, as it increases the chance of survival of their babies by up to four times. HIV has, however, brought about a significant decrease in breastfeeding, not only among infected women in South Africa. "In some areas in KwaZulu-Natal, breastfeeding rates have decreased from 90% in the 1980s to as low as 50%," said Coovadia.

In the Lancet article, the researchers accuse formula milk companies of contravening the WHO's International Code of the Marketing of Breast Milk Substitutes, to which South Africa subscribes. According to this code, formula milk companies are not allowed to advertise in health facilities or to promote formula milk for babies younger than six months. "But all over the country they advertise follow-on formula with special vitamins for young babies," Coutsoudis said. "They thereby create the impression that the 'special' formula milk is better than breast milk and further add to the decrease in breast feeding rates in the country."
TOPICS IN THIS ARTICLE

Tags

People

Comments

The esteemed professors seemed to have fall short in applying their minds on this rather complicated subject by trying to oversimplifying it.


Prof Glenda Gray is spot on.
Jabu Ncayiyana on August 25, 2009, 7:30 am
The esteemed professors seemed to failed to realise that the opinions of "Activists" should never be questioned, challenged or debated. Activists want/demand complete monopoly of public debate.
Their (activists) issues are more important than society itself. Anyway, "activists" ALWAYS hold the moral high ground and they "know" "so much" If I had held to Professor Glenda Gray's (broad) view that my children would have been better off if my wife had eschewed breastfeeding and fed them some junk from a bottle by excercising HER human rights to go out and "work" then I would have been a moron like her. Professor, the child always comes first. Breastfeeding is fundamental to everything.
Activisms are the new religions, Bob Geldorf, Bono and Zackie are the new Gods whose views are absolute
Pearson B on August 25, 2009, 9:24 am
Jabu Ncayiyan,

If you're going to criticise and pass judgement on the work of two esteemed professors (out of interest, what are you qualifications??), at least do so by using correct grammar!
JLG on August 25, 2009, 11:39 am
@JLG, get outta here with your grammar school nonsense. A person is entitled to their opinion, regardless of whether they went to your school or not. (Back to the topic): These good people need to get together to thrash out their opinions in the best interest of the patients. They should stop shouting at each other, trying to score points. M&G: How about arranging a think tank get-together?
pete ess on August 25, 2009, 3:40 pm
Coovadia is a well known opportunist and attention seeker. Many billions has been wasted on HIV research, and people like Coovadia (who depends on HIV research funding) and LANCET, which publishes lots of HIV research papers, are both intrinsically linked to HIV-AIDS. If the disease loses its funding generating ability, then they lose funding. In fact Activists, need AIDS to be popular rather than cured.

Thank goodness Prof. Gray's comments were also shared. Simple awareness, abstinance/safe sex and cultural values will stop AIDS. It really is that simple.
Khalsa Singh on August 25, 2009, 6:20 pm
The article is talking about HIV positive women. They have a 15% risk of transferring this infection to their baby. Shouldn't the emphasis be on HOW we can ensure that these women have 1. Access to clean water and 2. A regular supply of formula milk so that we can be assured that the next generation is HIV negative?

Bout de Souffle on August 25, 2009, 6:48 pm

"In addition to this, Coovadia said, the state often runs out of formula milk, "as evidently happened in Johannesburg earlier this year",

Problem is the people who were supposed to order the formula and have money left over to pay for it are the same ones who would have had to order the anti-retroviral drugs that HIV+ people are supposed to rely on to decrease transmission in breastmilk. Stories like this seem to really only be of academic interest, seeing as how the system tends to fall down at almost every hurdle anyway.

Oh, and if its not your job and you get the drugs for your patients anyway you're liable to get fired for not following 'protocol' - three whole syllables in that one. Their mothers must be so proud.

Maybe they should study the benefits of a shower after feeding to reduce transmission rates? Makes about as much sense as the other shower argument, although, again, it would mean governement would need to supply running water to all new mothers and somehow I can't see that happenening.
James Schabort on August 26, 2009, 3:55 am
I dream of the day people contributing to debates here can do so without trading personal insults.
Back to the topic. Breast milk is best milk -period. That is what the two profs are arguing. There have always been problems with formula feed and it should always be used only when the woman is unable to breastfeed because of ill heath, is unable to produce milk, the baby doesn't want the breast, or the mother is forced to work. Breastmilk offers the best protection for the baby because it contains natural antibodies. The issue of choice is a different matter and has nothing to do with the merits of breastfeeding and disease prevention. Politicising the matter will cloud the matter and confuse the science. I don't think what Coovadia is saying is rocket science. Women should be encouraged to breastfeed whether they're HIV + or not, but positive women have a greater responsibility to protect their children from infection, and if breastfeeding achieves that objective, then why should they not be persuaded to do so?
warren oliphant on August 26, 2009, 5:25 am
@pete ess,

I never said a person wasn't entitled to their opinion, they just need to be able to back it up. Jabu Ncayiyana can't say that the professors have 'fallen short' without explaining to us why exactly she has said that. It would also be better if she used proper grammar.

As an aside, its 'get out of here', not 'outta' here.
JLG on August 26, 2009, 11:48 am
One thing that wasn't mentioned in this article is that another option for HIV positive women is to pasteurise their breast milk. It reduces the transmission to zero and is also an option for working moms since pasteurised expressed milk can be stored as well.
Frances Verfuss on August 26, 2009, 10:15 pm
You must be logged in to comment. Log in or sign up to comment
click here to log in

M&G Online Comment Guidelines In Brief

  • No hate speech;
  • No racist, sexist or homophobic remarks;
  • Keep it short;
  • Keep it on topic;
  • Show respect to all;
  • We reserve the right to remove or delete any comment without notice or reason.

Click here for the full Comment Guidelines

Advertising Links



LATEST ARTICLES IN THIS SECTION
POPULAR ARTICLES IN THIS SECTION
Kalahari.net
2,3-million titles to choose from.
iPod nano 16GB - Black, Was R2,499.00 Now R2,299.00! Save R200!
46 000 DVDs and Blu-Ray on sale now!
100s of new releases now in stock. Get the new Sade & Bon Jovi albums.
Widest toy range and unbeatable prices!




Follow the Mail & Guardian on Twitter!


Direct message us on our mailandguardian account to chat to the M&G Online team.
THIS WEEK'S PAPER

Advertisements


Advertising links