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Barriers to implementing WHO's exclusive breastfeeding policy for women living with HIV in sub-Saharan Africa: an exploration of ideas, interests and institutions.
International Journal of Health Planning and Management. 2013 Jul-Sep; 28(3):257-68.The vertical transmission of HIV occurs when an HIV-positive woman passes the virus to her baby during pregnancy, delivery or breastfeeding. The World Health Organization's (WHO) Guidelines on HIV and infant feeding 2010 recommends exclusive breastfeeding for HIV-positive mothers in resource-limited settings. Although evidence shows that following this strategy will dramatically reduce vertical transmission of HIV, full implementation of the WHO Guidelines has been severely limited in sub-Saharan Africa. This paper provides an analysis of the role of ideas, interests and institutions in establishing barriers to the effective implementation of these guidelines by reviewing efforts to implement prevention of vertical transmission programs in various sub-Saharan countries. Findings suggest that WHO Guidelines on preventing vertical transmission of HIV through exclusive breastfeeding in resource-limited settings are not being translated into action by governments and front-line workers because of a variety of structural and ideological barriers. Identifying and understanding the role played by ideas, interests and institutions is essential to overcoming barriers to guideline implementation. Copyright (c) 2012 John Wiley & Sons, Ltd.
Implications of the new WHO guidelines on HIV and infant feeding for child survival in South Africa.
Bulletin of the World Health Organization. 2011 Jan 1; 89(1):62-7.The World Health Organization released revised principles and recommendations for HIV and infant feeding in November 2009. The recommendations are based on programmatic evidence and research studies that have accumulated over the past few years within African countries. This document urges national or subnational health authorities to decide whether health services should mainly counsel and support HIV-infected mothers to breastfeed and receive antiretroviral interventions, or to avoid all breastfeeding, based on estimations of which strategy is likely to give infants in those communities the greatest chance of HIV-free survival. South Africa has recently revised its clinical guidelines for prevention of mother-to-child HIV transmission, adopting many of the recommendations in the November 2009 World Health Organization's rapid advice on use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants. However, one aspect of the new South African guidelines gives cause for concern: the continued provision of free formula milk to HIV-infected women through public health facilities. This paper presents the latest evidence regarding mortality and morbidity associated with feeding practices in the context of HIV and suggests a modification of current policy to prioritize child survival for all South African children.
Geneva, Switzerland, United Nations High Commissioner for Refugees [UNHCR], 2008 Apr. 20 p.This Guidance on Infant feeding and HIV aims to assist UNHCR, its implementing and operational partners, and governments on policies and decision- making strategies on infant feeding and HIV in refugees and displaced populations. Its purpose is to provide an overview of the current technical and programmatic consensus on infant feeding and HIV, and give guidance to facilitate elective implementation of HIV and infant feeding programmes in refugee and displaced situations, in emergency contexts, and as an integral element of coordinated approach to public health, HIV and nutrition programming. The goal of this guidance is to provide tools to prevent malnutrition, improve the nutritional status of infants and young children, to reduce the transmission of HIV infection from mother to child after delivery, and to increase HIV-free survival of infants.
HIV, infant feeding and more perils for poor people: New WHO guidelines encourage review of formula milk policies.
Bulletin of the World Health Organization. 2008 Mar; 86(3):210-214.The release of the new WHO guidelines on HIV and infant feeding, in a global context of widespread impoverishment, requires countries to re-examine their infant-feeding policies in relation to broader socioeconomic issues. This widening scope is necessitated by compelling new reports on the scale of global underdevelopment in developing countries. This paper explores these issues by addressing feeding choices made by HIV-infected mothers and programmes supplying free formula milks within a global environment of persistent poverty. Accumulating evidence on the increase in malnutrition, morbidity and mortality associated with the avoidance or early cessation of breastfeeding by HIV-infected mothers, and the unanticipated hazards of formula feeding, demand a deeper assessment of the measures necessary for optimum policies on infant and child nutrition and for the amelioration of poverty. Piecemeal interventions that increase resources directed at only a fraction of a family's impoverishment, such as basic materials for preparation of hygienic formula feeds and making flawed decisions on choice of infant feeding, are bound to fail. These are not alternatives to taking fundamental steps to alleviate poverty. The economic opportunity costs of such programmes, the equity costs of providing resources to some and not others, and the leakages due to temptation to sell capital goods require careful evaluation. Providing formula to poor populations with high HIV prevalence cannot be justified by the evidence, by humanitarian considerations, by respect for local traditions or by economic outcomes. Exclusive breastfeeding, which is threatened by the HIV epidemic, remains an unfailing anchor of child survival (author's)
Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health [INFO], 2007 Apr.  p. (INFO Reports No. 12)This issue of Focus On... is intended to help health care practitioners better understand the current state of knowledge on breastfeeding and HIV transmission. It examines the most recent studies and expert guidance on the topic and provides the key points from recent research trials, literature reviews, and program evaluation studies. For women with HIV, infant feeding decisions are shaped by their access to infant feeding counseling and antiretroviral treatment, on the social stigma surrounding people with HIV, exclusive breastfeeding, and exclusive replacement feeding, on access to clean and safe water and food supplements, and on partner and family support. A woman infected with HIV can pass HIV on to her infant during pregnancy, at the time of labor and delivery, and through breastfeeding. Without treatment, between 15% and 30% of infants born to mothers with HIV become infected with HIV during pregnancy, labor, and delivery. An additional 10% to 20% become infected during breastfeeding depending on how long the infant is breastfed. (excerpt)
Use of stable-isotope techniques to validate infant feeding practices reported by Bangladeshi women receiving breastfeeding counseling.
American Journal of Clinical Nutrition. 2007 Apr; 85(4):1075-1082.The World Health Organization recommends exclusive breastfeeding until age 6 mo. Studies relying on mothers' selfreported behaviors have shown that lactation counseling increases both the rate and duration of exclusive breastfeeding. We aimed to validate reported infant feeding practices in rural Bangladesh; intakes of breast milk and nonbreast-milk water were measured by the dose-given-to-the mother deuterium dilution technique. Subjects were drawn from the large-scale Maternal and Infant Nutrition Interventions, Matlab, study of combined interventions to improve maternal and infant health, in which women were randomly assigned to receive either exclusive breastfeeding counseling or standard health care messages. Data on infant feeding practices were collected by questionnaire at monthly visits. Intakes of breast milk and nonbreast-milk water were measured in a subsample of 98 mother-infant pairs (mean infant age: 14.3 wk) and compared with questionnaire data reporting feeding practices. Seventy-five of the 98 subjects reported exclusive breastfeeding. Mean (+or-SD) breast milk intake was 884 +or- 163 mL/d in that group and 791 +or- 180 mL/d in the group reported as nonexclusively breastfed (P = 0.0267). Intakes of nonbreast-milk water were 40 _ 80.6 and 166 +or- 214 mL/d (P < 0.0001), respectively. Objective cross-validation using deuterium dilution data showed good accuracy in reporting of feeding practices, although apparent misreporting was widely present in both groups. The dose-given-to-the-mother deuterium dilution technique can be applied to validate reported feeding behaviors. Whereas this technique shows that the reports of feeding practices were accurate at the group level, it is not adequate to distinguish between feeding practices in individual infants. (author's)
Differences between international recommendations on breastfeeding in the presence of HIV and the attitudes and counselling messages of health workers in Lilongwe, Malawi.
International Breastfeeding Journal. 2006 Mar 9; 1(1):2.To prevent postnatal transmission of HIV in settings where safe alternatives to breastfeeding are unavailable, the World Health Organization (WHO) recommends exclusive breastfeeding followed by early, rapid cessation of breastfeeding. Only limited data are available on the attitudes of health workers toward this recommendation and the impact of these attitudes on infant feeding counselling messages given to mothers. As part of the Breastfeeding, Antiretroviral, and Nutrition (BAN) clinical trial, we carried out an in-depth qualitative study of the attitudes, beliefs, and counselling messages of 19 health workers in Lilongwe, Malawi. Although none of the workers had received formal training, several reported having counseled HIV-positive mothers about infant feeding. Health workers with counselling experience believed that HIV-infected mothers should breastfeed exclusively, rather than infant formula feed, citing poverty as the primary reason. Because of high levels of malnutrition, all the workershad concerns about early cessation of breastfeeding. Important differences were observed between the WHO recommendations and the attitudes and practices of the health workers. Understanding these differences is important for designing effective interventions. (author's)
Indian Journal of Community Medicine. 2006 Jun; 31(2):65.WHO and other international agencies has recommended that mother should breast feed the children exclusively for 4-6 month from birth and continue breast feeding along with appropriate supplemental food up to second year. Breast feeding should be initiated within an hour of birth instead of waiting several hours as is often customary. Although there is little milk at that time, it helps to establish feeding and a close mother-child relationship, known as "bonding". A community based study was conducted in the area of Experimental Teaching Health Sub Centres, Mati and Banthra under the Rural Health Training Centre, Sarojini Nagar, Department of community Medicine, K, G. Medical University, Lucknow. 200 lactating mothers were interviewed using a pre tested proforma to collect information regarding sociodemographic characteristics, current feeding practices, time of initiation of breast feeding and colostrum given to the new borns. (excerpt)
Health Care for Women International. 2005 Aug; 26(7):534-554.In this article, we examine the National Breastfeeding Policy in Nigeria, the extent to which the law guarantees and protects the maternity rights of the working mother, and the interplay between the law and the National Breastfeeding Policy. Our aim is to make people aware of this interplay to lead to some positive efforts to sanitize the workplace and shield women from some of the practices against them in employment relations in Nigeria as well as encourage exclusive breastfeeding by employed mothers. We conclude that the provisions of the law in this regard are not in accord with the contemporary international standards for the protection of pregnancy and maternity. It does not guarantee and protect the freedom of the nursing mother to exclusively breastfeed the child for at least the 6 months as propagated by Baby Friendly Hospital Initiative (BFHI) and the National Breastfeeding Policy. Moreover, there is no enabling law to back up the National Policy Initiative as it affects employer and employee relations. We, therefore, suggest a legal framework for effective implementation of the National Breastfeeding Policy for women in dependent labour relations. It is hoped that such laws will not only limit some of the practices against women in employment but also will encourage and promote exclusive breastfeeding behaviour by employed mothers. (author's)
Early breastfeeding cessation as an option for reducing postnatal transmission of HIV in Africa: issues, risks, and challenges.
Washington, D.C., Academy for Educational Development [AED], 2001 Aug. 40 p.This document examines the recent WHO recommendations for modifying breastfeeding to reduce postnatal transmission of HIV in Africa. Specifically, it reviews the three-stage strategy for "modified breastfeeding" for HIV- positive mothers that involves exclusive breastfeeding followed by an early transition to exclusive replacement feeding. Organized into six chapters, this document also describes a step-by-step process for making the transition from exclusive breastfeeding to exclusive replacement feeding. However, many of the behaviors discussed in this review represent a major change in traditional infant care practices in Africa, and their feasibility and impact on child survival have yet to be determined. It is recommended, therefore, that these guidelines be subjected to additional research and testing before being implemented.