Promotion of exclusive breastfeeding in the face of the HIV pandemic
Coutsoudis A. Commentary. Lancet 356: 1620, 2000

In her commentary Dr. Anna Coutsoudis, whose previous research gives preliminary evidence that HIV transmission from parent to child is no greater for exclusively breastfed infants than for artificially fed infants, yet the increased mortality and morbidity risks associated with artificial feeding are much greater for the latter, asks the important question: "In the face of the HIV-1 pandemic should policy makers and health workers be promoting exclusive breastfeeding?"

To answer this vital question, Coutsoudis, notes that in poor disadvantaged populations the benefits of exclusive breastfeeding are vital for child survival and that as shown in recent research1, "it is difficult, if not impossible, to provide safe breastmilk substitutes to children from underprivileged populations". Furthermore, where women have no other option but to breastfeed, the promotion of exclusive breastfeeding, may be the "one way of increasing the safety of breastfeeding." Additional research is now supporting exclusive breastfeeding as reducing the risk of HIV-1 transmission.

Additionally, exclusive breastfeeding has many advantages, such as reducing mortality and morbidity as well as the risk of diarrhoea and respiratory disease and takes away the stigma and discrimination for women who are HIV-1 positive and are advised to bottle feed.

Coutsoudis advises that in all populations where HIV-1 is a problem, breastfeeding counsellors need to fully inform mothers of all the risks and options and that whatever choice a mother makes needs to be fully supported. When mothers opt to breastfeed, they should be encouraged and supported to breastfeed exclusively for up to 6 months.

1. WHO Collaborative Research Team on the Role of Breastfeeding on the Prevention of Infant Mortality. Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. Lancet 355: 451-455, 2000

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