This World Breastfeeding Week 2016 ICW shares some insights on the just released WHO 2016 guideline updates on HIV and infant feeding. This year’s theme ‘Breastfeeding; a key to sustainable development’ underscores the critical links between breastfeeding and achieving the Sustainable Development Goals (SDGs).
For women living with HIV, making informed choices around infant feeding options for their children are often difficult due to unclear and conflicting guidelines, incorrect information given by health clinics, social workers, and other people in our circle of care as well as confusion around what is best for both the mother and the child.
ICW has documented the stigma and discrimination around breastfeeding experiences of mothers living with HIV in the ICW&GNP+ Early Infant Diagnosis report 2015
At the community and national level, consistency and clarity of information about breastfeeding is essential to achieving many of the specific SDGs including:
- 1.GOAL 3 which is focused on health and which aims to end AIDS, malaria, and tuberculosis by 2030;
- 2.GOAL 5, which aims to end all forms of discrimination against all women and girls everywhere and to ensure universal access to sexual and reproductive health and reproductive rights, including family planning.
- 3.And GOAL 1, which aims to end poverty in all its forms.
ICW applauds this much needed update to the World Health Organization (WHO) guidelines (Read here) and hopes that the new guidelines will ensure that mothers living with HIV get correct and consistent messaging around breastfeeding and infant feeding.Some of the highlights of the updated guidelines include the following strong recommendations;-
- 1.Mothers living with HIV should breastfeed for at least 12months and may continue breastfeeding for up to 24 months or longer while being fully supported for ART adherence.
- 2.National and local health authorities to actively coordinate and implement services in health facilities and activities in workplaces, communities and women to protect, promote and support breastfeeding.
- 3.Highlights reassurance that ART reduces the risk of post natal HIV transmission in the context of mixed feeding. Although exclusive breastfeeding is recommended, practicing mixed feeding is not a reason to stop breastfeeding in the presence of ARV drugs.
- 4.Mothers living with HIV and health care workers can be reassured that shorter duration of breastfeeding of less than 12 months are better than never initiating breastfeeding at all.
In 2010, the World Health Organization (WHO) recommended ARV drug interventions to prevent transmission of HIV through breastfeeding for the first time. Recently, revisions to ARV drug guidelines, emerging evidence, new experience, and a demand from women living with HIV for clarification on specific breastfeeding issues created a need to review the 2010 HIV and infant feeding guidelines. Overall, the guide states:
- Recommendations on breastfeeding are similar for all women regardless of HIV status: breastfeeding improves child survival and protects the health of the mother;
- For women living with HIV who choose to breastfeed, ART adherence is critical in order to reduce the risks of transmission ;
- Breastfeeding for any duration offers more benefits to the child that not breastfeeding at all; the most benefit is incurred during the first 12 months;
- The guidelines speak to the recommendations that health services should promote breastfeeding, however the choice and for how long to breastfeed rests with the woman taking into account her individual circumstances.
This new guideline can help women living with HIV to make informed personal decisions around choosing to breastfeed or not to breastfeed. More broadly, they can assist all stakeholders in achieving the SDGs.
As the WHO 2016 updated guidelines show, breastfeeding can move women living with HIV towards meeting SD-goals 1, 3 and 5 by improving health and nutrition for both mothers and children, increasing women’s empowerment to make choices about their reproductive and sexual health, family planning, and child rearing decisions, and by giving every child the same start in life.
ICW calls upon policy makers and development partners to ensure country updates of these guidelines are done in a process that will ensure women living with HIV at grassroots levels are involved, informed and adequately supported to make informed choices about infant feeding.
There is a need to build on these guidelines to create an enabling environment for women living with HIV to breastfeed including ensuring women have access to the right information, and supports such as viral load testing, and that there is an end to criminalization of women who choose to breastfeed their infants.
Nothing for us, without us!