ILCA: Position Paper on HIV and Infant Feeding

The value of human milk

• Exclusive breastfeeding for six months followed by continued breastfeeding with complementary foods and fluids for up to age two years and beyond (the World Health Organization standard) is the normal, optimal way of feeding infants and the foundation of health and development, except in rare circumstances.
• Artificial feeding (use of substitutes for human milk)increases infants’ risks of acute illness, chronic disease,and slower cognitive development, and increases mothers’ risks of cancer.
• It is estimated that yearly, at least one million infants die due to lack of optimal breastfeeding. A three-country World Health Organization analysis of infant mortality data showed a six-fold greater risk of death from infectious disease for infants who were not breastfed in the first two months of life (3). A 17-country study carried out by MACRO, International found that a four-fold risk continued through about eight months.
• Globally, over 90% of deaths among children one month to five years are due to causes other than HIV/AIDS. Malnutrition is an underlying cause of about 60% of these deaths. Lack of exclusive breastfeeding, complementary feeding that begins too early or too late, inadequate quality or quantity of complementary foods, and challenges in safely preparing, serving and storing such foods all contribute to malnutrition
• Among newborn infants testing HIV-positive within 48 hours after birth, approximately 50% die within six months, primarily due to infectious diseases such as pneumonia (75%) and diarrhea (40%) (4), diseases which are known to occur more frequently and with more severe consequences when infants are not exclusively breastfed.
• Any replacement of breastfeeding must be acceptable, feasible, affordable, ustainable, and safe (AFASS), or it will increase risks to infant survival, regardless of exposure to HIV (5). Infant feeding counseling must comprehensively address changing circumstances surrounding replacement feeding, acknowledging the difficulties of reestablishing a mother’s breastmilk supply.

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