News / Africa

‘Breast Best’ Policy Challenged in South Africa

There’s optimism among some South African health workers that exclusive breastfeeding will save many lives in the country (Photos:D.taylor)   There’s optimism among some South African health workers that exclusive breastfeeding will save many lives in the country (Photos:D.taylor)
x
There’s optimism among some South African health workers that exclusive breastfeeding will save many lives in the country (Photos:D.taylor)
There’s optimism among some South African health workers that exclusive breastfeeding will save many lives in the country (Photos:D.taylor)
TEXT SIZE - +
Darren Taylor

This is Part Three of a five-part series on Child Health in South Africa 
Continue to Parts:     1 / 2 / 4 / 5


ZIDINDI, SOUTh AFRICA -- In September last year, South Africa’s health minister Aaron Motsoaledi implemented a drastic and highly contentious measure.
 
He announced that the government would no longer provide a free six-month supply of formula milk to HIV-infected mothers. Instead, its health facilities would encourage the women to exclusively breastfeed for at least the first six months of their babies’ lives. That is, to give their infants nothing to eat or drink other than breast milk – not even water.

Dr. Ben Gaunt is a strong proponent of exclusive breastfeeding for at least the first six months of infancy (Photo:D.Taylor)Dr. Ben Gaunt is a strong proponent of exclusive breastfeeding for at least the first six months of infancy (Photo:D.Taylor)
x
Dr. Ben Gaunt is a strong proponent of exclusive breastfeeding for at least the first six months of infancy (Photo:D.Taylor)
Dr. Ben Gaunt is a strong proponent of exclusive breastfeeding for at least the first six months of infancy (Photo:D.Taylor)
In a country with the most people infected with HIV in the world, Motsoaledi’s decision was controversial, because it’s the breast milk of HIV-positive mothers that contains the virus. Critics slammed the minister as irresponsible, saying his policy would place many babies at risk of getting HIV.
 
But doctors at a hospital in an isolated part of South Africa’s Eastern Cape province praised the minister’s action as brave and visionary and said it would ultimately result in many lives being saved.
 
In fact, Zithulele Hospital in Oliver Tambo District has advocated exclusive breastfeeding since 2006, in an area where one out of every four mothers is infected with HIV.
 
“These women worry that they’re going to give their babies HIV through their breast milk. And that is a risk; one has to acknowledge that,” said Dr. Ben Gaunt, Zithulele’s head doctor. But, he maintained, this risk is far lower than the chances of their infants eventually falling ill, or dying, of malnutrition, pneumonia or diarrhea.
 
Every year, thousands of South African children die of these preventable illnesses, which are exacerbated by poverty and inadequate public health services.
 
Breast milk contains a mother’s antibodies that ward off these sicknesses. But feeding babies younger than six months mixes of breast milk, formula feed, solid food and water makes them much more vulnerable to potentially fatal illnesses, including HIV, Gaunt insisted. Medical studies prove that babies who are mixed fed by HIV-infected mothers are up to five times more likely to contract the virus.

Public hospitals in South Africa now tell mothers to give only breast milk to their babies for the first six months of the youngsters’ lives (Photo: D. Taylor)Public hospitals in South Africa now tell mothers to give only breast milk to their babies for the first six months of the youngsters’ lives (Photo: D. Taylor)
x
Public hospitals in South Africa now tell mothers to give only breast milk to their babies for the first six months of the youngsters’ lives (Photo: D. Taylor)
Public hospitals in South Africa now tell mothers to give only breast milk to their babies for the first six months of the youngsters’ lives (Photo: D. Taylor)
Doctors say the additional substances damage the sensitive lining of the infants' intestines, which protects them against infection.
 
According to the Handbook of HIV Medicine, written by international HIV experts to guide doctors who are treating the condition, an infant fed formula is six times more likely to die of an infectious disease in the first two months of life than a baby who’s breastfed.
 
“Are some children going to get HIV because their HIV-positive mothers are breastfeeding them? Unfortunately, yes,” said Gaunt, while adding, “But the policy is going to save so many other young lives that it makes total sense to implement it.”
 
Three casualties
 
Gaunt’s wife, Taryn, is also a doctor at Zithulele Hospital and co-heads its pediatric HIV section. She said the clinic has seen only three babies who were born HIV-negative become HIV-positive while being breastfed in the past five years.
 
Her husband responded, “That’s distressing; it’s distressing for everyone. (But) that is public health policy; there are going to be people who don’t have an optimal outcome because of the choices that we’ve made. But we have to accept that for the vast majority of people, if they were to follow that (exclusive breastfeeding) policy the outcome will be better.”
 
However, none of the three youngsters who contracted HIV through breastfeeding at Zithulele were given Nevirapine. Medical researchers have found that if infected mothers breastfeed their babies exclusively for six months and give the infants a daily dose of this antiretroviral drug, the risk of them getting the virus reduces from about 20 percent to less than two percent.
 
It’s been government policy since April 2010 to provide HIV-infected mothers who are breastfeeding with Nevirapine. Another of the hospital’s doctors, Liz Gatley, said, “As far as I know we haven’t yet had a baby that’s become positive while breastfeeding (and taking) the Nevirapine syrup.”
 
Breastfeeding triumphs
 
When Gatley began working at Zithulele three years ago, she said she couldn’t find a single mother who was exclusively breastfeeding. But now she said the practice is common among women attending the hospital’s HIV clinic.
 
“I know it’s a bold thing to say but I would say 80 percent or more of those women, almost all of them are breastfeeding – exclusively breastfeeding.”

Community health worker Ncedisa Paul (left) counsels a young mother who’s just given birth in a hospital near Zidindi, South Africa (Photos D.Taylor)Community health worker Ncedisa Paul (left) counsels a young mother who’s just given birth in a hospital near Zidindi, South Africa (Photos D.Taylor)
x
Community health worker Ncedisa Paul (left) counsels a young mother who’s just given birth in a hospital near Zidindi, South Africa (Photos D.Taylor)
Community health worker Ncedisa Paul (left) counsels a young mother who’s just given birth in a hospital near Zidindi, South Africa (Photos D.Taylor)
Dr. Taryn Gaunt maintained that this figure is closer to nine out of every 10 mothers who are now only giving breast milk to their infants for half a year, in conjunction with Nevirapine, mainly because they’re terrified of passing HIV on to their children.
 
Gatley agreed that fear of their kids getting infectious diseases is a “huge motivating factor” encouraging the women to solely breastfeed. “I asked one woman, ‘Why are you different? Why are you only giving your child milk from your breast?’ And she said she’d seen so many babies that weren’t breastfed die of something as simple as diarrhea,” she said.
 
Ben Gaunt and his colleagues meticulously explain the consequences of feeding children substances other than breast milk to mothers. Most other public hospitals in South Africa don’t offer this level of intensive, time consuming counseling. The result, said Gatley, is that many mothers in the country and even in Oliver Tambo District continue to mix feed, opening their babies up to possibly life-threatening diseases.
 
Mixed feeding common
 
A study by South Africa’s Medical Research Council shows that mothers in the country rarely breastfeed exclusively. According to the report, only one out of 10 infants in South Africa is solely breastfed by three months of age; this decreases to only two percent of six-month-old babies.


This ensures that breastfeeding remains a dangerous practice for HIV-infected mothers, when they don’t do it exclusively. Then the possibility of their babies contracting HIV from them magnifies significantly.
 
The experience of the health workers of Zithulele in Oliver Tambo District supports this research.
 
“Almost all the women in this area can’t afford to formula feed. So they dilute the formula, they mix it with (porridge) which is not appropriate for a tiny baby. They sometimes give the babies flour and water. And those babies come in (to hospital) sick,” said Gatley.
 
Many babies she sees have severe malnutrition, and she said this is directly as a result of their not being breastfed. “They get really swollen and their skin starts peeling and those patients are usually quite sick. And they’ve reached the end of their ability to compensate,” explained Gatley.

Paul (right) says the policy of exclusive breastfeeding faces severe challenges in South Africa (Photo:D.Taylor)Paul (right) says the policy of exclusive breastfeeding faces severe challenges in South Africa (Photo:D.Taylor)
x
Paul (right) says the policy of exclusive breastfeeding faces severe challenges in South Africa (Photo:D.Taylor)
Paul (right) says the policy of exclusive breastfeeding faces severe challenges in South Africa (Photo:D.Taylor)
Ben Gaunt lamented that mixed feeding starts extremely early in South Africa, with mothers feeding solid mixes to babies as young as three weeks.
 
“A three week old doesn’t have a gut that can handle solids. We hear about all kinds of horrible feeding practices -- everything from women using teaspoons of flour to make the water look white because they can’t afford formula,” said Gaunt.
 
To make matters worse, babies are more often than not given water -- water that in underdeveloped parts of South Africa is usually polluted.

“Every single water source here is contaminated, which isn’t a surprise because 80 percent of the people use the forest as a toilet. So once the rains come, it washes (feces) out into the rivers,” said Gaunt.
 
A disaster
 
Ncedisa Paul, a healthcare advisor working for the Philani NGO in Oliver Tambo District, praised Zithulele Hospital’s achievements in getting women who visit the facility to exclusively breastfeed.
 
But, she added, she sees a far different reality on the ground in the region.

“Almost all the mothers that I visit mix feed because of a lack of support and the stigma attached to HIV infection,” said Paul. She pointed out that word had in recent years spread around the area that exclusively breastfeeding is a “sure indication” that someone is HIV-positive.
 
“Those mothers are discriminated against in all sorts of horrible ways so they end up mix feeding their babies, to try to convince people that they’re not HIV-positive, or to keep their status secret. When this happens, they usually pass the HIV on to their babies. It’s a disaster here in this place,” Paul said.
 
Status and advertising
 
Another problem in the district and across South Africa, she added, is that feeding babies expensive formula milk is a powerful status symbol.

There’s optimism among some South African health workers that exclusive breastfeeding will save many lives in the country (Photos:D. Taylor)There’s optimism among some South African health workers that exclusive breastfeeding will save many lives in the country (Photos:D. Taylor)
x
There’s optimism among some South African health workers that exclusive breastfeeding will save many lives in the country (Photos:D. Taylor)
There’s optimism among some South African health workers that exclusive breastfeeding will save many lives in the country (Photos:D. Taylor)
“The mothers think they are very grand if they feed their babies formula, and mothers who breastfeed are seen as low members of society. So you find many poor mothers going into heavy debt just to keep their babies supplied with formula,” said Paul.
 
She’s also convinced that intensive advertising campaigns by international companies manufacturing formula milk are seriously damaging South Africa’s efforts to get mothers to breastfeed.
 
“Mothers see the adverts for milk formula and on the company posters there are these photos of smiling, fat babies. The mothers see that fat child and immediately they think formula is best and they stop breastfeeding,” said Paul.
 
Yet despite the factors counting against the success of the exclusive breastfeeding policy in South Africa, Dr. Ben Gaunt remains optimistic.
 
“It’ll work,” he insisted. “It’ll work when we get all public hospitals on board to advocate it properly. It’ll eventually save many, many lives and we’ll reach a point where we’ll wonder why it wasn’t instituted two decades ago.”

Listen to: report on children and breast feeding in South Africa
Listen to: report on children and breast feeding in South Africai

You May Like

Multimedia Anti-Keystone XL Protests Continue

Demonstrators are worried about pipeline's effect on climate change, their traditional way of life, health and safety More

Thailand's Political Power Struggle Continues

Court gave Prime Minister Yingluck Shinawatra until May 2 to prepare her defense over abuse of power charges but uncertainty remains over election timing More

Malaysia Plane Search Tests Limits of Ocean Mapping Technology

Expert tells VOA existing equipment’s maximum operating depth is around 6 kilometers as operation continues on ocean bed for any trace of MH370 More

This forum has been closed.
Comment Sorting
Comments
     
by: derek from: hill
July 05, 2012 6:32 PM
I am very happy to know the breastfeed policy is changed in south africa.
www.newbreastfeeding.com

Featured Videos

Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
Pet Kangaroo Helps Spread Environmental Messagei
X
Penelope Poulou
April 22, 2014 5:53 PM
Children’s author Julia Heckathorn travels the world to learn about different ecosystems and endangered animals. She pours her knowledge into children’s books, hoping the next generation will right the environmental wrongs of our times. As in many children's books, the main character in Heckathorn's stories is an animal. Unlike those other characters, though, this one is real - a kangaroo, that lives in the author’s backyard. VOA’s Penelope Poulou has more.
Video

Video Pet Kangaroo Helps Spread Environmental Message

Children’s author Julia Heckathorn travels the world to learn about different ecosystems and endangered animals. She pours her knowledge into children’s books, hoping the next generation will right the environmental wrongs of our times. As in many children's books, the main character in Heckathorn's stories is an animal. Unlike those other characters, though, this one is real - a kangaroo, that lives in the author’s backyard. VOA’s Penelope Poulou has more.
Video

Video Pro-Russian Separatists Plan 'Federalization Referendum' in Eastern Ukraine

Pro-Russian separatists in eastern Ukraine say they plan to move forward next month with a referendum vote for greater autonomy, despite the Geneva agreement reached with Russia, the U.S. and Ukraine to end the political conflict. VOA's Brian Padden reports from the city of Donetsk in Eastern Ukraine.
Video

Video Pope Francis Hopes Dual Canonizations Will Reconcile Church

On April 27, two popes - John the XXIII and John Paul II - will be made saints in a ceremony at St. Peter’s Square. VOA religion correspondent Jerome Socolovsky says the dual canonization is part of the current pope’s program to reconcile liberals and conservatives in the Roman Catholic Church.
Video

Video In Capturing Nature's Majesty, Film Makes Case for Its Survival

French filmmaker Luc Jacquet won worldwide acclaim for his 2005 Academy Award-winning documentary "March of the Penguins". Now Jacquet is back with a new film that takes movie-goers deep into the heart of a tropical rainforest - not only to celebrate its grandeur, but to make the case for its survival. VOA's Rosanne Skirble reports.
Video

Video Boston Marathon Bittersweet for Many Runners

Monday's running of the Boston Marathon was bittersweet for many of the 36,000 participants as they finished the run that was interrupted by a double bombing last year. Many gathered along the route paid respect to the four people killed as a result of two bombings near the finish line. VOA's Carolyn Presutti returned to Boston this year to follow two runners, forever changed because of the crimes.
Video

Video International Students Learn Film Production in World's Movie Capital

Hollywood - which is part of Los Angeles - is the movie capital of the world, and many aspiring filmmakers go there in hopes of breaking into the movie business. Mike O'Sullivan reports that regional universities are also a magnet for students who hope to become producers or directors.
Video

Video Pacific Rim Trade Deal Proves Elusive

With the U.S.-led war in Iraq ended and American military involvement in Afghanistan winding down, President Barack Obama has sought to pivot the country's foreign policy focus towards Asia. One aspect of that pivot is the negotiation of a free-trade agreement among 12 Pacific Rim nations. But as Obama leaves this week on a trip to four Asian countries he has found it very difficult to complete the trade pact. VOA's Ken Bredemeier has more from Washington.
Video

Video Autistic Adults Face Housing, Job Challenges

Many parents of children with disabilities fear for the future of their adult child. It can be difficult to find services to help adults with disabilities - physical, mental or emotional - find work or live on their own. The mother of an autistic boy set up a foundation to advocate for the estimated 1.2 million American adults with autism, a developmental disorder that causes communication difficulties and often social difficulties. VOA's Faiza Elmasry reports.
AppleAndroid