News

UN amends policy on breast feeding

Scott Gottlieb, New York

After decades of promoting breast feeding for infant nutrition, the United Nations has issued recommendations intended to discourage women infected with HIV from breast feeding.

The UN directive advises that all HIV infected women should be informed of the risks of breast feeding before they decide whether to breast feed. The step is aimed at preventing transmission of HIV from mothers to babies in developing countries.

The guidelines were the result of several years of internal debate inside the United Nations and, even now, are the cause of dispute within the agency. UN officials said that they were reluctant to issue a blanket warning because the decision should be left to each mother and because no simple message could encompass the diversity of environments where women live.

In some cultures women may become stigmatised for not breast feeding, and the safety of alternatives such as formula feed varies within each country. In addition, UN officials were concerned that they would be sending out a double message--telling some women that breast feeding is best for their babies but telling others that it could kill their babies. The result could be to discourage all women from breast feeding.

In its directive, the United Nations said it decided to issue the warnings, despite these worries, because of soaring HIV infection rates in much of the world. In 13 countries in sub-Saharan Africa, at least 10% of all adults are infected with HIV, with a prevalence of 35% or more in many capital cities (4 July, p 11).

Dr Susan Holck, an expert on breast feeding at the World Health Organisation, said that many experts are also concerned that the directive could trigger a repeat of decades past, when international corporations promoted formula feed, and many babies died when it was mixed under insanitary conditions.

Last year, of the 600000 children in the world who became infected with HIV, up to a third were infected through breast feeding.