News / Africa

    ‘Breast Best’ Policy Challenged in South Africa

    There’s optimism among some South African health workers that exclusive breastfeeding will save many lives in the country (Photos:D.taylor)   There’s optimism among some South African health workers that exclusive breastfeeding will save many lives in the country (Photos:D.taylor)
    x
    There’s optimism among some South African health workers that exclusive breastfeeding will save many lives in the country (Photos:D.taylor)
    There’s optimism among some South African health workers that exclusive breastfeeding will save many lives in the country (Photos:D.taylor)
    Darren Taylor

    This is Part Three of a five-part series on Child Health in South Africa 
    Continue to Parts:     1 / 2 / 4 / 5


    ZIDINDI, SOUTh AFRICA -- In September last year, South Africa’s health minister Aaron Motsoaledi implemented a drastic and highly contentious measure.
     
    He announced that the government would no longer provide a free six-month supply of formula milk to HIV-infected mothers. Instead, its health facilities would encourage the women to exclusively breastfeed for at least the first six months of their babies’ lives. That is, to give their infants nothing to eat or drink other than breast milk – not even water.

    Dr. Ben Gaunt is a strong proponent of exclusive breastfeeding for at least the first six months of infancy (Photo:D.Taylor)Dr. Ben Gaunt is a strong proponent of exclusive breastfeeding for at least the first six months of infancy (Photo:D.Taylor)
    x
    Dr. Ben Gaunt is a strong proponent of exclusive breastfeeding for at least the first six months of infancy (Photo:D.Taylor)
    Dr. Ben Gaunt is a strong proponent of exclusive breastfeeding for at least the first six months of infancy (Photo:D.Taylor)
    In a country with the most people infected with HIV in the world, Motsoaledi’s decision was controversial, because it’s the breast milk of HIV-positive mothers that contains the virus. Critics slammed the minister as irresponsible, saying his policy would place many babies at risk of getting HIV.
     
    But doctors at a hospital in an isolated part of South Africa’s Eastern Cape province praised the minister’s action as brave and visionary and said it would ultimately result in many lives being saved.
     
    In fact, Zithulele Hospital in Oliver Tambo District has advocated exclusive breastfeeding since 2006, in an area where one out of every four mothers is infected with HIV.
     
    “These women worry that they’re going to give their babies HIV through their breast milk. And that is a risk; one has to acknowledge that,” said Dr. Ben Gaunt, Zithulele’s head doctor. But, he maintained, this risk is far lower than the chances of their infants eventually falling ill, or dying, of malnutrition, pneumonia or diarrhea.
     
    Every year, thousands of South African children die of these preventable illnesses, which are exacerbated by poverty and inadequate public health services.
     
    Breast milk contains a mother’s antibodies that ward off these sicknesses. But feeding babies younger than six months mixes of breast milk, formula feed, solid food and water makes them much more vulnerable to potentially fatal illnesses, including HIV, Gaunt insisted. Medical studies prove that babies who are mixed fed by HIV-infected mothers are up to five times more likely to contract the virus.

    Public hospitals in South Africa now tell mothers to give only breast milk to their babies for the first six months of the youngsters’ lives (Photo: D. Taylor)Public hospitals in South Africa now tell mothers to give only breast milk to their babies for the first six months of the youngsters’ lives (Photo: D. Taylor)
    x
    Public hospitals in South Africa now tell mothers to give only breast milk to their babies for the first six months of the youngsters’ lives (Photo: D. Taylor)
    Public hospitals in South Africa now tell mothers to give only breast milk to their babies for the first six months of the youngsters’ lives (Photo: D. Taylor)
    Doctors say the additional substances damage the sensitive lining of the infants' intestines, which protects them against infection.
     
    According to the Handbook of HIV Medicine, written by international HIV experts to guide doctors who are treating the condition, an infant fed formula is six times more likely to die of an infectious disease in the first two months of life than a baby who’s breastfed.
     
    “Are some children going to get HIV because their HIV-positive mothers are breastfeeding them? Unfortunately, yes,” said Gaunt, while adding, “But the policy is going to save so many other young lives that it makes total sense to implement it.”
     
    Three casualties
     
    Gaunt’s wife, Taryn, is also a doctor at Zithulele Hospital and co-heads its pediatric HIV section. She said the clinic has seen only three babies who were born HIV-negative become HIV-positive while being breastfed in the past five years.
     
    Her husband responded, “That’s distressing; it’s distressing for everyone. (But) that is public health policy; there are going to be people who don’t have an optimal outcome because of the choices that we’ve made. But we have to accept that for the vast majority of people, if they were to follow that (exclusive breastfeeding) policy the outcome will be better.”
     
    However, none of the three youngsters who contracted HIV through breastfeeding at Zithulele were given Nevirapine. Medical researchers have found that if infected mothers breastfeed their babies exclusively for six months and give the infants a daily dose of this antiretroviral drug, the risk of them getting the virus reduces from about 20 percent to less than two percent.
     
    It’s been government policy since April 2010 to provide HIV-infected mothers who are breastfeeding with Nevirapine. Another of the hospital’s doctors, Liz Gatley, said, “As far as I know we haven’t yet had a baby that’s become positive while breastfeeding (and taking) the Nevirapine syrup.”
     
    Breastfeeding triumphs
     
    When Gatley began working at Zithulele three years ago, she said she couldn’t find a single mother who was exclusively breastfeeding. But now she said the practice is common among women attending the hospital’s HIV clinic.
     
    “I know it’s a bold thing to say but I would say 80 percent or more of those women, almost all of them are breastfeeding – exclusively breastfeeding.”

    Community health worker Ncedisa Paul (left) counsels a young mother who’s just given birth in a hospital near Zidindi, South Africa (Photos D.Taylor)Community health worker Ncedisa Paul (left) counsels a young mother who’s just given birth in a hospital near Zidindi, South Africa (Photos D.Taylor)
    x
    Community health worker Ncedisa Paul (left) counsels a young mother who’s just given birth in a hospital near Zidindi, South Africa (Photos D.Taylor)
    Community health worker Ncedisa Paul (left) counsels a young mother who’s just given birth in a hospital near Zidindi, South Africa (Photos D.Taylor)
    Dr. Taryn Gaunt maintained that this figure is closer to nine out of every 10 mothers who are now only giving breast milk to their infants for half a year, in conjunction with Nevirapine, mainly because they’re terrified of passing HIV on to their children.
     
    Gatley agreed that fear of their kids getting infectious diseases is a “huge motivating factor” encouraging the women to solely breastfeed. “I asked one woman, ‘Why are you different? Why are you only giving your child milk from your breast?’ And she said she’d seen so many babies that weren’t breastfed die of something as simple as diarrhea,” she said.
     
    Ben Gaunt and his colleagues meticulously explain the consequences of feeding children substances other than breast milk to mothers. Most other public hospitals in South Africa don’t offer this level of intensive, time consuming counseling. The result, said Gatley, is that many mothers in the country and even in Oliver Tambo District continue to mix feed, opening their babies up to possibly life-threatening diseases.
     
    Mixed feeding common
     
    A study by South Africa’s Medical Research Council shows that mothers in the country rarely breastfeed exclusively. According to the report, only one out of 10 infants in South Africa is solely breastfed by three months of age; this decreases to only two percent of six-month-old babies.


    This ensures that breastfeeding remains a dangerous practice for HIV-infected mothers, when they don’t do it exclusively. Then the possibility of their babies contracting HIV from them magnifies significantly.
     
    The experience of the health workers of Zithulele in Oliver Tambo District supports this research.
     
    “Almost all the women in this area can’t afford to formula feed. So they dilute the formula, they mix it with (porridge) which is not appropriate for a tiny baby. They sometimes give the babies flour and water. And those babies come in (to hospital) sick,” said Gatley.
     
    Many babies she sees have severe malnutrition, and she said this is directly as a result of their not being breastfed. “They get really swollen and their skin starts peeling and those patients are usually quite sick. And they’ve reached the end of their ability to compensate,” explained Gatley.

    Paul (right) says the policy of exclusive breastfeeding faces severe challenges in South Africa (Photo:D.Taylor)Paul (right) says the policy of exclusive breastfeeding faces severe challenges in South Africa (Photo:D.Taylor)
    x
    Paul (right) says the policy of exclusive breastfeeding faces severe challenges in South Africa (Photo:D.Taylor)
    Paul (right) says the policy of exclusive breastfeeding faces severe challenges in South Africa (Photo:D.Taylor)
    Ben Gaunt lamented that mixed feeding starts extremely early in South Africa, with mothers feeding solid mixes to babies as young as three weeks.
     
    “A three week old doesn’t have a gut that can handle solids. We hear about all kinds of horrible feeding practices -- everything from women using teaspoons of flour to make the water look white because they can’t afford formula,” said Gaunt.
     
    To make matters worse, babies are more often than not given water -- water that in underdeveloped parts of South Africa is usually polluted.

    “Every single water source here is contaminated, which isn’t a surprise because 80 percent of the people use the forest as a toilet. So once the rains come, it washes (feces) out into the rivers,” said Gaunt.
     
    A disaster
     
    Ncedisa Paul, a healthcare advisor working for the Philani NGO in Oliver Tambo District, praised Zithulele Hospital’s achievements in getting women who visit the facility to exclusively breastfeed.
     
    But, she added, she sees a far different reality on the ground in the region.

    “Almost all the mothers that I visit mix feed because of a lack of support and the stigma attached to HIV infection,” said Paul. She pointed out that word had in recent years spread around the area that exclusively breastfeeding is a “sure indication” that someone is HIV-positive.
     
    “Those mothers are discriminated against in all sorts of horrible ways so they end up mix feeding their babies, to try to convince people that they’re not HIV-positive, or to keep their status secret. When this happens, they usually pass the HIV on to their babies. It’s a disaster here in this place,” Paul said.
     
    Status and advertising
     
    Another problem in the district and across South Africa, she added, is that feeding babies expensive formula milk is a powerful status symbol.

    There’s optimism among some South African health workers that exclusive breastfeeding will save many lives in the country (Photos:D. Taylor)There’s optimism among some South African health workers that exclusive breastfeeding will save many lives in the country (Photos:D. Taylor)
    x
    There’s optimism among some South African health workers that exclusive breastfeeding will save many lives in the country (Photos:D. Taylor)
    There’s optimism among some South African health workers that exclusive breastfeeding will save many lives in the country (Photos:D. Taylor)
    “The mothers think they are very grand if they feed their babies formula, and mothers who breastfeed are seen as low members of society. So you find many poor mothers going into heavy debt just to keep their babies supplied with formula,” said Paul.
     
    She’s also convinced that intensive advertising campaigns by international companies manufacturing formula milk are seriously damaging South Africa’s efforts to get mothers to breastfeed.
     
    “Mothers see the adverts for milk formula and on the company posters there are these photos of smiling, fat babies. The mothers see that fat child and immediately they think formula is best and they stop breastfeeding,” said Paul.
     
    Yet despite the factors counting against the success of the exclusive breastfeeding policy in South Africa, Dr. Ben Gaunt remains optimistic.
     
    “It’ll work,” he insisted. “It’ll work when we get all public hospitals on board to advocate it properly. It’ll eventually save many, many lives and we’ll reach a point where we’ll wonder why it wasn’t instituted two decades ago.”

    Listen to: report on children and breast feeding in South Africa
    Listen to: report on children and breast feeding in South Africai
    || 0:00:00
    ...    
     
    X

    You May Like

    Candidates' Comments Fly Like New Hampshire Snowflakes

    Four days ahead of the country's first-in-the-nation Republican and Democratic party primary elections, surveys show the parties' contests tightening

    South Korea Says North Korea Moving Closer to Rocket Launch

    In phone call, US President Barack Obama and Chinese President Xi Jinping agree that Pyongyang's move would be 'provocative'

    Australian Commander: IS Changing Tactics

    Head of Australian forces in Middle East talks with VOA about training Iraqi troops, countering evolving Islamic State efforts and defeating extremism

    This forum has been closed.
    Comment Sorting
    Comments
         
    by: derek from: hill
    July 05, 2012 6:32 PM
    I am very happy to know the breastfeed policy is changed in south africa.
    www.newbreastfeeding.com

    By the Numbers

    Featured Videos

    Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
    German Artists to Memorialize Refugees With Life Jacket Exhibiti
    X
    Hamada Elsaram
    February 05, 2016 4:30 PM
    Sold in every kind of shop in some Turkish port towns, life jackets have become a symbol of the refugee crisis that brought a million people to Europe in 2015.  On the shores of Lesbos, Greece, German artists collect discarded life jackets as they prepare an art installation they plan to display in Germany.  For VOA, Hamada Elrasam has this report from Lesbos, Greece.
    Video

    Video German Artists to Memorialize Refugees With Life Jacket Exhibit

    Sold in every kind of shop in some Turkish port towns, life jackets have become a symbol of the refugee crisis that brought a million people to Europe in 2015.  On the shores of Lesbos, Greece, German artists collect discarded life jackets as they prepare an art installation they plan to display in Germany.  For VOA, Hamada Elrasam has this report from Lesbos, Greece.
    Video

    Video E-readers Help Ease Africa's Book Shortage

    Millions of people in Africa can't read, and there's a chronic shortage of books. A non-profit organization called Worldreader is trying to help change all that one e-reader at a time. VOA’s Deborah Block tells us about a girls' school in Nairobi, Kenya where Worldreader is making a difference.
    Video

    Video Genius Lets World Share Its Knowledge

    Inspired by crowdsourcing companies like Wikipedia, Genius allows anyone to edit anything on the web, using its web annotation tool
    Video

    Video Former Drug CEO Martin Shkreli Angers US Lawmakers

    A former U.S. pharmaceutical business executive has angered lawmakers by refusing to explain why he raised the price of a life-saving pill by 5,000 percent. Martin Shkreli was removed from a congressional hearing on Thursday after citing his Fifth Amendment right to stay silent. Zlatica Hoke has more.
    Video

    Video Super Bowl TV Commercials are Super Business for Advertisers

    The Super Bowl, the championship clash between the two top teams in American Football, is the most-watched sporting event of the year, and advertisers are lining up and paying big bucks to get their commercials on the air. In fact, the TV commercials during the Super Bowl have become one of the most anticipated and popular features of the event. VOA's Brian Allen has a sneak peek of what you can expect to see when the big game goes to commercial break, and the real entertainment begins.
    Video

    Video In Philippines, Mixed Feelings About Greater US Military Presence

    In the Philippines, some who will be directly affected by a recent Supreme Court decision clearing the way for more United States troop visits are having mixed reactions.  The increased rotations come at a time when the Philippines is trying to build up its military in the face of growing maritime assertiveness from China.  From Bahile, Palawan on the coast of the South China Sea, Simone Orendain has this story.
    Video

    Video Microcephaly's Connection to Zika: Guilty Until Proven Innocent

    The Zika virus rarely causes problems for the people who get it, but it seems to be having a devastating impact on babies whose mothers are infected with Zika. VOA's Carol Pearson has more.
    Video

    Video Solar Innovation Provides Cheap, Clean Energy to Kenya Residents

    In Kenya, a company called M-Kopa Solar is providing clean energy to more than 300,000 homes across East Africa by allowing customers to "pay-as-you-go" via their cell phones. As Lenny Ruvaga reports from Kangemi, customers pay a small deposit for a solar unit and then pay less than a dollar a day to get clean energy to light up their homes or businesses.
    Video

    Video Stunning Artworks Attract Record Crowds, Thanks to Social Media

    A new exhibit at the oldest art museum in America is shattering attendance records. Thousands of visitors are lining up to see nine giant works of art that have gotten a much-deserved shot of viral marketing. The 150-year-old Smithsonian American Art Museum has never had a response quite like this. VOA's Julie Taboh reports.
    Video

    Video Apprenticeships Put Americans on Path Back to Work

    Trying to get more people into the U.S. workforce, the Obama administration last year announced $175 million in grants towards apprenticeship programs. VOA White House correspondent Aru Pande went inside one training center outside of Washington that has gained national recognition for helping put people on the path to employment.
    Video

    Video New Material May Reduce Concussion Effects

    As the 2016 National Football League season reaches its summit at the Super Bowl this coming Sunday (2/7), scientists are trying to learn how to more effectively protect football players from dangerous and damaging concussions. Researchers at Cardiff and Cambridge Universities say their origami-based material may solve the problem. VOA’s George Putic reports.
    Video

    Video Saudi Arabian Women's Sports Chip Away at Stereotypes

    Saudi Arabian female athletes say that sports are on the front line of busting traditions that quash women’s voices, both locally and internationally. In their hometown of Jeddah, a group of basketball players say that by connecting sports to health issues, they are encouraging women and girls to get out of their homes and participate in public life. VOA’s Heather Murdock reports.
    Video

    Video A Year Later, Fortunes Mixed for Syrians Forging New Lives in Berlin

    In April of last year, VOA followed the progress of six young Syrian refugees -- four brothers and their two friends -- as they made their way from Libya to Italy by boat, and eventually to Germany. Reporter Henry Ridgwell caught up with the refugees again in Berlin, as they struggle to forge new lives amid the turmoil of Europe's refugee crisis.
    Video

    Video Zika Virus May be Hard to Stop

    With the Zika virus spreading rapidly, the World Health Organization Monday declared Zika a global health emergency. As Alberto Pimienta reports, for many governments and experts, the worst is yet to come.