For two decades, doctors and public health agencies have offered uniform advice to new mothers in poorer countries: Breast-feed your babies to protect their health.
But now, the AIDS pandemic is upsetting that simple equation. Studies are showing that mothers infected with the AIDS virus can transmit it through breast milk at significant rates. Based on such findings, the United Nations recently estimated that one-third of all infants with HIV got the virus through their mothers’ milk.
To a growing number of researchers and advocates of breast-feeding, the implications of such studies are as compelling as they were once unthinkable: Infant formula - a product whose misuse in developing countries with poor sanitation was once blamed by opponents for killing 1 million babies a year - may be a powerful weapon to reduce childhood deaths from AIDS.
Doctors in industrialized nations have long recommended that HIV-infected mothers use formula. But as women in developing countries become aware of the risks of breast-feeding, they face excruciating choices and confront societal taboos.
When Margaret Hadebe, who lives in South Africa’s Soweto township, learned last year that she had HIV, she initially ignored her doctor’s advice and breast-fed her newborn daughter, terrified that her parents would otherwise suspect that she had the AIDS virus and abandon her.
But within two weeks, the fear of infecting her baby became so great that she told her family that she could not produce enough breast milk and started using formula.
“I was afraid that my baby might get infected,” the 23-year-old woman said. “And I wouldn’t be able to live with that.”
Third World physicians such as Dr. Kuben Pillay, a pediatrician at King Edward VIII Hospital in Durban, on the east coast of South Africa, are also torn.
In many instances, he said, advising new mothers to use formula would be impractical; many lack the means to sterilize bottles or the money to afford formula. Besides, the majority of pregnant women in poor countries are not tested for HIV and thus are unaware of the risks they and their newborns face.
“Do I give information about this to all women, or do I give information only to women who appear to me to be able to afford formula feeding?” Pillay asked.
“And then do I say nothing to the woman in the squatter camp who has no access to clean water or electricity?”
To some experts, including many who led the international boycott campaign against the Swiss company Nestle and other formula makers in the 1970s, there is little to debate.
Though the data are incomplete, they say, in the vast majority of the Third World more infants will be imperiled by renewed promotion of bottle-feeding, with its accompanying risks of diarrhea and dehydration, than by the danger of HIV transmission through breast-feeding.
“In 90 percent of the developing world, the protection that is afforded by breast-feeding against the diseases of the Third World is higher than the rate of HIV transmission,” said Elizabeth Pisani, a spokeswoman for UNAIDS, a unit of the United Nations in Geneva that includes several United Nations agencies and the World Bank.
Others say, however, that it is imperative to find alternatives to breast-feeding, including ways to make safe, affordable formula widely available.
Some advocates of breast-feeding are prepared to work with formula makers, their sworn enemies for decades, on combating the growing threat.
Meanwhile, the United Nations has come under criticism from scientists who say that the group, in its zeal to promote breast-feeding, has not confronted the HIV issue.
“For years, they could say that ‘Breast is Best’ full stop,” said Dr. Angus Nicoll, a British Government epidemiologist in London, referring to the slogan of advocates for breast-feeding.
That mother’s milk might also pose dangers, he said, “is a difficult thing for them to take on board.”
xxxx RISKS OF TRANSMISSION Between 20 percent and 25 percent of infants born to HIV infected mothers become infected while in the womb or during delivery, said Dr. Joseph Saba of UNAIDS. While earlier reports indicated an additional 14 percent of infants became HIV-infected if breast-fed, more recent studies suggest the added risk could be as high as 22 percent, he said.