Infant-feeding and HIV in Southern Africa: A multi-level ethical dilemma

Researchers and practitioners often face moral dilemmas when social, political, cultural, biological and economic factors complicate the ethical design of health interventions or health promotion programs. We consider the moral dilemmas surrounding breastfeeding in Southern Africa in the face of the HIV/AIDS epidemic. Medical scientists note that the infant-feeding debate exists because breastfeeding is thought to be responsible for about 300,000 HIV infections per year, while at the same time, UNICEF estimates that not breastfeeding (formula feeding,contaminated water) is responsible for 1.5 million child deaths per year.The literature surrounding HIV and infant-feeding in developing countries clearly articulates the lack of consensus among social and medical scientists, organizations, policy makers, health care workers and political leaders on the matter. Such discourse presents an infant-feeding dilemma for an HIV-infected mother. The dilemma poses a challenge not only for mothers but for researchers attempting to design interventions in the face of confounding factors. Researchers who are sensitive to such complexities face a professional ethical dilemma as to how to cast the “breast is best” public health message in a way that doesn't create additional conflict for those women trying to determine the optimal choice for feeding their babies. We therefore argue that casting the problem as a multi-level ethical dilemma, and considering the arguments for action (and against inaction) in the face of moral dilemmas, can help us develop a more fitting ethical analysis for many of the personal, clinical, and policy decisions raised in the context of developing world bioethics.