What Works for Women and Girls

“There is no doubt that there are small groups in resource-constrained countries with basicand essential services that allow the hygienic preparation of formula milks. However, for thechild population as a whole, the unrestrained promotion of formula is generally harmful…exclusive breastfeeding, which is threatened by the HIV epidemic, remains an unfailing anchorof child survival” (Coutsoudis et al., 2008: 210). Feeding choices can be laden with stigma aswell. HIV-positive women may face heavy stigma from partners, families and communities ifthey formula feed their infants, yet if they do not formula feed, they may fear HIV transmissionto their infants.New Guidelines About Infant Feeding Still Leave Unanswered QuestionsThe WHO rolled out a new policy on infant feeding in November 2009 (WHO, 2009a: http://whqlibdoc.who.int/publications/2009/9789241598873_eng.pdf), which elaborates on anearlier WHO policy for infant formula to be used for HIV-positive women when it is “affordable,feasible, acceptable, safe and sustainable” (WHO, 2006a). The newly issued recommendationsfrom WHO now recommend that “mothers known to be HIV-infected (and whoseinfants are HIV-uninfected or of unknown HIV status) should exclusively breastfeed theirinfants for the first six months of life, introducing appropriate complimentary foods thereafter,and continue breastfeeding for the first 12 months of life. Breastfeeding should then only stoponce a nutritionally adequate and safe diet without breastfeeding can be provided” (WHO,2009a: 15). HIV-positive women should also know that breastfeeding does not harm their ownhealth (Taha et al., 2006, Allen et al., 2007a, Lockman et al., 2009, Wilfert and Fowler, 2007).The November 2009 WHO guidelines state that if infant formula is given to prevent perinataltransmission, the following conditions are needed: safe water and sanitation assured at thehousehold level and in the community; the mother or other caregiver can reliably providesufficient infant formula milk to support normal growth and development of the infant; themother or caregiver can prepare it cleanly and frequently enough so that it is safe and carries alow risk of diarrhea and malnutrition; the mother can, in the first six months, exclusively giveinfant formula milk; and the family is supportive of this practice; and the mother or caregivercan access health care that offers comprehensive child health services (WHO, 2009b: 19).The WHO also recommends that if mothers are started late in pregnancy on ART, or havenot achieved full viral suppression, that infants be given daily AZT or NVP from birth untilsix weeks of age (WHO, 2009b). However, the impact on future treatment options shouldan infant become HIV-positive while on this regimen are unclear. Studies show that infantprophylaxis can decrease breast milk transmission. However, “…it is difficult to translate theseresearch findings into policy for resource-limited countries. No consensus has been reached yetabout the duration of prophylaxis and the antiretroviral drugs to use” (Mnyani and McIntyre,2009: 73).WHAT WORKS FOR WOMEN AND GIRLS251