The International Code, HIV and breastfeeding

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Implementing the International Code

The International Code is more necessary than ever in areas of high HIV prevalence. It helps mothers obtain the objective information they need to make choices about infant feeding and protects all mothers and health workers from commercial pressures and the promotion of artificial feeding. Health workers are in a key position to counsel women to making a decision which will be most suitable for them; and all women should be supported in their chosen method of infant feeding.

Six-month-old Roath Chamrouen abandoned at birth and HIV-positive, cared for at Phnom Penh Nutrition Centre, Cambodia. Photo taken from the Bangkok Post, August 11, 1999.

Undermining Breastfeeding

As early as 1989, some formula companies started undermining breastfeeding with the assumption that mothers who tested HIV-positive should not breastfeed. For example, Nestlé told UK school children in 1989, that up to 50% of women in Africa should not breastfeed because they were infected with HIV. Later, the Association of Infant Food Manufacturers (IFM) was reported as giving information to individual delegates at the World Health Assembly which implied that mothers could not breastfeed if they tested positive for HIV. This was despite promises IFM had made not to exploit the HIV crisis. When visiting a hospital in Botswana, Code monitors were surprised to see the same brand by nearly every bedside of new mothers.

The International Code does not stop breastmilk substitutes from being available or being sold or used when necessary. It recognises the legitimate need for these products when necessary and seeks to ensure their proper use without compromising the decisions of the vast majority of mothers for whose babies breastfeeding presents the best possible feeding option. The International Code and subsequent World Health Assembly Resolutions do this by:

banning the advertising and giving of samples of breastmilk substitutes
banning the donation of free or subsidised supplies
regulating the distribution of formula to prevent spillover to babies who would benefit from breastfeeding
protecting artificially fed children by ensuring that product labels carry necessary warnings and instructions for safe preparation and use
ensuring that the choice of the products is made on the basis of independent medical advice, and not through commercial influence.

Limitations of testing . . .

It is not possible to find out with an HIV antibody test - the most common form of test available - whether an infant of an HIV-positive mother is really infected until after the age of 15-18 months. Before that age the baby still has its mother's antibodies, including her HIV antibodies.

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