The 130th Annual Meeting of APHA

Abstract #38236

Patricia J. Burns, MSc, MPH, Private Consultant, 189 Rawson Road, #3, Brookline, MA 02445, 617-731-5958, pjbdgb@rcn.com

Studies proving the benefits of breastfeeding on infant mortality have been documented since the early 1600s. Yet, 2000 WHO/UNAIDS recommendations regarding breastfeeding by HIV + women are based on the small percentages of mother-to-child transmission rather than the more significant outcome of infant mortality. My paper challenges these recommendations through analyses of the research on the risks and benefits of breastfeeding and its effect on infant mortality in Sub-Saharan Africa (SSA). Background data on Sub-Saharan Africa, HIV/AIDS, and the various factors affecting HIV and Maternal-to-Child Transmission (MTCT) are given. Literature concerning infant feeding options, the infant and maternal advantages of breastfeeding, and infant and child mortality rates are reviewed. The evaluation of the risks versus benefits of breastfeeding by HIV + women in SSA, the impact of the UNAIDS recommendations on the breastfeeding initiatives in SSA, and the probability of successful artificial feeding are discussed. I have also elucidated the differences between industrialized and developing countries in the decision-making process. Based on the research and analysis, I have made recommendations. Finally, I have concluded by challenging prominent organizations to accept their responsibility to provide a systematic review of all available data and give evidence-based recommendations and guidelines to assist in policy development. Infant mortality, not MTCT must be the key outcome evaluated. Rather than attempting to give global recommendations which are inappropriate and destructive in many countries, the guidelines should support the realities of any given woman in any given community in either an industrialized or least developed country.

Learning Objectives:

• Discuss the progression of the WHO/UNAIDS recommendations for HIV+ women and breastfeeding from 1992 to 2000
• Describe the differences in the breastfeeding decision process for HIV+ women in industrialized and developing countries.
• Articulate why infant mortality, not maternal-to-child transmission should be the outcome on which to base future WHO/UNAIDS recommendations.

Keywords: Breast Feeding, Infant Mortality

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.