Home / Episode 19

Siyayinqoba Beat It! 2005 Episode 19 –

Exclusive Breastfeeding vs Exclusive Formula Feeding

Siyayinqoba Beat It! – the programme for people living with HIV and AIDS, and our partners, families and friends, discussed the choices facing mothers living with HIV in feeding their babies by breastfeeding or formula feeding. With the practical experience of mothers living with HIV, Simphiwe Mabaso from Mpumalanga and Nompumelelo Buthelezi from KwaZulu-Natal we learnt more about the two options.

Jason Wessenaar: Hello and welcome to the Siyayinqoba Beat It! Support Group. My name is Jason. In the Siyayinqoba Support Group we are all living positively with HIV. Each week we get together to discuss issues that affect our lives with HIV from gender-based violence to healthy eating for the positive person. Siyayinqoba is your guide to better living with HIV. If you are living with HIV or have a partner, a family member or a friend who is HIV positive, Siyayinqoba is for you. This week we are talking about the controversy that has been raging over breastfeeding vs bottle-feeding for mothers living with HIV. During the World AIDS Conference held in Durban in 2000, Dr Anna Coetzee surprised the medical world with her research findings that exclusive breastfeeding had a very low rate of HIV transmission. Due to the advantages of mother’s milk, it now seems possible to recommend HIV positive mothers to exclusively breastfeed. Exclusive means using breast milk only for three to six months with no juice, no water or anything else at all. There is still some risk of HIV transmission through breast milk. Exclusive formula feeding on the other hand, done correctly, is 100% safe. This week we ask the question, what is the best option for mothers living with HIV? To help us discuss this issue, we are joined by Dr Ullah Mothibi from the HIV Unit at the Department of Health in the Western Cape. Welcome Dr Ullah. But first the Siyayinqoba team visited Simphiwe Mabaso in Vlaklaagte, Mpumalanga. She shares with us her personal experience with exclusive breastfeeding vs formula feeding.

The dangers of mixing breast and formula feed

Vlaklaagte, Mpumalanga

Simphiwe Mabaso: Ngiqale ukuzazi i-status sam from 1999 ukuthi ngi-HIV positive ngabuya ngaba-pregnant ngo-2003, ngatesta futhi e-Jo’burg ngathola ukuthi ngi-positive. Ngathola i-Nevirapine, bangakhansela. Ngathola i-Nevirapine mangina-7 months. bangitshela ukuthi uma ngabe ngincelisa umntwana, ngimncelise until six months ngingamphuzisi amanzi, ngingamuphi nokudla, ngimncelisa kuphela. Noma ngabe ngimdlisa ibhodlela ngimnike ibhodlela. Ngamncelisa, wancela three weeks waliyekela, mase ngimnika ibhodlela. Wagula eloka elala es’bhedlela washona. Gugulethu mntanam ngithi ngiyabona ukuthi ningivulele intlantla, ngicela usisi wenu nimphathe kahle ninobhuti wenu. {IsiZulu} [I found out about my status in 1999, that I’m HIV positive. I fell pregnant in 2003 and I tested at Johannesburg General Hospital, and I found out that I’m HIV positive. I was counselled and I got Nevirapine when I was seven months pregnant. They told me that if I choose to breastfeed my baby, I must exclusively do so for six months. I was told to exclusively breastfeed, without giving the baby any water or food. If I choose to bottle-feed, I had to do it exclusively. I breastfed for three weeks and I changed to bottle-feeding. He was very sick and was in and out of hospital, eventually he died. Gugulethu, my baby, thanks for wishing me well. Please make sure that you and your brother look over your sister.]

Prof. Anna Coutsoudis (Paediatrics and Child Health, University of KwaZulu Natal): Mix-feeding is a real problem for HIV transmission because when a mother is giving formula feeding to a child, we know that there’s damage to the gut and that allows the HIV through. So that’s why we’re very clear that women must decide. If they’re going to be breastfeeding then they must be exclusively breastfeeding, if they decide to formula feed then they must exclusively formula feed and that’s the bottom line. So if a women wants to formula feed, that’s fine and it’s safe but she must be convinced in her mind and empowered enough to not give breast milk as well because that’s the worst situation for a baby, to get both.

Lynne Moeng (Director of Nutrition, Department of Health): {Sesotho} The challenge mothers face in continuing with the chosen method of feeding their babies is the lack of support structures in their homes. Because in many homes people are used to babies being fed one way; if mothers don’t disclose their HIV status, it becomes difficult for them to stick to one method of feeding.

Simphiwe Mabaso: My new baby is three weeks old. I haven’t had any problems with her, she drinks and eats well. I haven’t had any problems in getting the formula milk here at the clinic. I hear some people say that sometimes the formula milk is not available and you have to buy it yourself.

Lynne Moeng: {Sesotho} It’s important that when HIV positive mothers choose one method of feeding, they should ask themselves questions like: “Will the milk be available at all times?” If the milk is not available at the clinic, will she able to afford to buy it? Will she be able to prepare the milk safely and at all times? Will mothers be available at all times and can they leave the milk for the baby if they have to go somewhere, so that the baby is not given other milk.

Simphiwe Mabaso: Umlayezo wami kubomama abanabantwana, ngithi ngicela bahambe baye emakliniki bayotesta, bazazi ukuthi banjani ngoba igciwane likhona. Sengibonile ngam ukuthi igciwane likhona ngoba ngangithatha ukuthi yinto enamanga. Bengicela ukuthi abantu baziphathe kahle, basebenzise ama-condom. Abomama abazithwele bazwele iingane zabo bayotesta. {IsiZulu} [My message to all the mothers with babies is that they must go and get tested so that they know where they stand because HIV exists. I’m a witness to HIV existing because I used to think it was a myth. I advise people to look after themselves and use condoms. Pregnant mothers must have mercy for their unborn babies and test for HIV.]

Support Group

Jason Wessenaar: {Sesotho} Dr Ullah, what is the current government protocol towards breast and formula feeding?

Dr Ullah Mothibi: The current protocol in the provincial government is that HIV positive women who are pregnant, expecting to have babies, should be given a choice as to which way they want to choose to feed their babies meaning they should be counselled, they should be prepared long before they deliver so that they can think this through and then at the end, they should be able to make a choice between exclusively breastfeeding their babies or exclusively formula feeding their babies.

Lihle Dlamini: Usually we’ve heard that either way a mother chooses, has to be done for six months but now the problem we face is that in clinics, most women are told to exclusively breast or formula feed for four months. And we also know that if a mother is going to formula feed, she can also give the baby porridge or Panado syrup when they are sick. Most clinics tell mothers to give nothing but formula milk for four months and it’s confusing people because they don’t know what to do.

Dr Ullah Mothibi: The first point is the duration, if the mother has chosen to breastfeed her baby, how long should this be? If you look at the guidelines we are giving, we are saying exclusive breastfeeding for at least six months, which means in that six months the baby mustn’t be given water, juice or Nestum. It is just breast milk for up to six months. There are people who choose to breastfeed, however before the six months is over, then they find that it’s difficult to continue. The advice is don’t just stop by yourself, go to the clinic, speak to your counsellors, speak to the sisters and explain the situation and they will be able to help you in that. If you choose to formula feed, there is no need for you to give other feeds as well. The exclusivity applies to breastfeeding. But children who are being formula fed through the cup, they can have their water, they can have their juice.

Lihle Dlamini: Ukusho ukuthi uma ngabe nginikeza umntwana wam ubisi lwebhodlela, ngingakwazi ukuthi ngimnikeze ukudla, amanzi nazo zonke lezizinto ze-Panado? {IsiZulu} [Does that mean that if I choose to formula feed my baby, I can also give him other food, water and things like Panado syrup?]

Dr Ullah Mothibi: Yes, Lihle and that is the advantage with the formula feeding.

Busisiwe Maqungo: Ezinye zezizathu ezidala abantu uba bakhethe u-breastfeeda ngenxa yento ye-culture yethu kufumaniseke awunangakwazi ukunga-breastfeedi. Abanawuthi es’bhedlele su-breastfeeda ibe i-culture yakho isithi breastfeeda, ndikuve kakuhle? {IsiXhosa} [One of the things that encourages most mothers to breast feed is culture. People don’t usually accept the advice from clinics, they choose to breastfeed as a result of cultural pressures. You know what I mean?]

Dr Ullah Mothibi: I think if I have to answer, it will go back to your counselling; your one-to-one with the counsellor, because as we counsel people we go into their background to say: “How will they accept your decision at home?” If we find that the person is going to run into difficulties about their decision, sometimes we do advise: “Why don’t you tell them this, maybe they will accept.” So that goes back to the counselling as to what you will be told or what different way out of the situation, they will discuss with you.

Jason Wessenaar: We’ll talk more about exclusive breastfeeding vs formula feeding for mothers living with HIV after this break. Don’t go away.

Jason Wessenaar: Welcome back to the Siyayinqoba Support Group – the programme for everyone infected and affected by HIV. So far we have learnt about the dangers of mix feeding and the importance of exclusive breast and formula feeding. Siyayinqoba went to Umlazi near Durban where we met Nompumelelo Buthelezi, an HIV positive mother who used Nevirapine as part of the PMTCT programme. Nompumelelo was blessed with twins whom she chose to exclusively formula feed and at 18 months both children were tested negative. Let’s meet Mpumie.

The benefits of exclusive formula feeding

Umlazi, KwaZulu Natal

Nompumelelo Buthelezi: Igama lam ngingu-Nompumelelo wakwa-Buthelezi. Ngahamba ngayotesta nges’khathi ngiseno-3 months then ngathola ukuthi ngi-positive. Ngafuna ikhansela langichazela ukuthi ikhona i-Nevirapine. Umesele usikwa uphuze before utete uliphuze lihlale kuwe ingane yakho ibe-safe. Ngenza kanjalo, bangitshela ukuthi kumele ngitshuze ukuthi ngizoncelisa ibele kuphela ukuze kuphele i-6 months noba ngizoncelisa ibhodlela, awumixi ukuze ingani yakho ingabine-problem. {isiZulu} [My name is Nompumelelo Buthelezi. I tested when I was three months pregnant and I found out that I am HIV positive. A counsellor told me about the availability of Nevirapine. She told me I have to take it two hours before I give birth, so my children would be safe. I did everything they told me, then I had to choose whether I was going to breastfeed or bottle-feed for six months because you are not allowed to mix feed so that your child can be safe.]

Prof. Anna Coutsoudis (Paediatrics and Child Health): For HIV infected mothers who have to make a decision on how to feed their babies, what we usually suggest to mothers is that they need to look at their particular living condition. So in conditions where diarrhoea and pneumonia are big problems for children and children often get sick with diarrhoea and pneumonia, where they don’t have facilities to make formula, then in situations like that, it’s actually much safer for women to exclusively breast feed.

Dr Mark Colvin (Centre for AIDS Development, Research and Evaluation): I think the world over, we know that the way to reduce transmission of HIV from the mother to the child is to provide antiretrovirals before and during the birth period and then after birth to exclusively formula feed. We know that between seven and up to 20% of children born to HIV positive mothers can acquire the HIV infection from being breastfed which is a very high proportion. In South Africa, the Department of Health estimates 104 000 babies acquire HIV each year from their mothers. So we are talking here 45 000 children becoming infected from breastfeeding.

Nompumelelo Buthelezi: Uyabona lokho ukuthi ingane ndingayincelisi ibele, kwabanzima kumama zala wam. Wathi mina bengingafuni ubanengane, ngenza ama-expenses amaningi ngincelisa ibhodlela. Abantu sebeyazi ukuthi ubisi lwani lolo lutholakala makwenze njani, litholwa ngumuntu onjani. Usho ukuthi uma uphethe lolobisi wena u-positive. {isiZulu} [It became problematic to my mother-in-law when I didn’t breastfeed because she would say that I didn’t want the children and that I was creating an expense by bottle feeding. And people also know that when you use formula milk, you are probably HIV positive.]

Prof. Anna Coutsoudis: If formula feeding is not acceptable in a normal community and HIV infected women are going to be formula feeding when they are on their own but when they’re with other people, because it’s not acceptable, they’re going to land up breastfeeding as well, then that is not the best route to go. In other words, wherever women are going to be formula feeding and breastfeeding, it’s not a good idea because that is very risky in terms of breastfeeding transmission.

Nompumelelo Buthelezi: Azeze zigule ntlobo kwaze kwafika is’khathi la kufanele ngize ngihambe ngiyozitesta then ngayitesta sezinonyaka, zaba-negative nje. Ku-right ukuncelisa ngebhodlela. {isiZulu} [The twins haven’t had any serious illnesses. They were tested at the age of one and their tests were negative. I advise bottle feeding because it’s alright.]

Support Group

Jason Wessenaar: {Sesotho} We just heard Nompumelelo’s story that after formula feeding her twins and they tested negative. What are the disadvantages and advantages of formula feeding?

Dr Ullah Mothibi: {Sesotho} The government protocol says when you choose formula feed, and preferably it must be cup feeding because you can give formula in many different ways. But the preferred way is cup feeding not bottle feeding means you’re going to use the tit and that tit inside with milk is difficult to clean and if it’s not properly cleaned the bacteria stays there and will make the baby sick. If you’re using a cup, it’s easier, you clean it and then you boil to sterilise it, it’s much easier to handle the cup.

Busisiwe Maqungo: Into eyayisenzeka kudala, oomama pha emakhaya babesetyenzelwa ngootata. Babengenangxaki, babehlala aph’ekhaya, benalo lonke elaxesha lo-breastfeeda abantwana. Kulemihla siphila kuyo oomama kufuneka bahambe bayophangela. Kangangoba ubeleka umntwana wakho namhlanje, ngomso enosuku olunye umsa e-creche uhambe uyophangela. Lomntu umshiye nomntwana ozodikwa ngulomntwana ukhalayo ngoba akonelanga lolubisi lwebele, amnike amanzi, angakuxeleli wena uba kwenzeka lento, uyabuya u-breastfeeda umntwana wakho. Kanti umntwana wakho ebetyiswe ngecephe emini wane-cuts aph’emlonyeni, ngoku elabisi lebele linengculaza lingena pha atsho umntwana abe-infected. {isiXhosa} [In the old days, the men used to go out and work for the women. So mothers had no problem breastfeeding because they were at home. But nowadays women have to go to work as well. Women give birth today and a few days later the baby has to go to crèche because mothers have to work. I’m looking at exclusive breastfeeding, where a baby can’t be left behind. Nannies get impatient with crying babies who want breast milk and therefore end up giving the babies water. They won’t even tell the mother. So the mother will come from work and breastfeed the baby. And maybe earlier the baby was fed with a spoon that may have cut her in the mouth therefore the HIV positive mother’s milk will enter the cut and infect the baby.] That’s one of the risks. When I gave birth umntwana wam ngo-2002 {IsiXhosa} [to my son in 2002,] I decided not to breastfeed him because there was still a chance that my baby could be infected with HIV. I’m a working woman and funeka ndinshiy lomntwana nomntu abonomnika enye into noba ndibacacisele ningamtyisi enye into. Abantu abasinyamezeli isikhalo somntwana. {IsiXhosa} [I would have to leave him with someone else, who may give him something else even though I’ve explained to them. Because I know that some people are very impatient when a baby cries.] So I chose to bottle feed or to formula feed ngenxa yezozizathu. {IsiXhosa} [because of those reasons.

Dr Ullah Mothibi: Uba oomama abanokwazi u-breastfeeda, bafanele ukuthi bayosebenza. I-choice yalomama, yena kuzofanele azazi uba i-position yakhe injani. Uzawuya ayophangela nini, ngubani ozakumgadela umntwana {IsiXhosa} [Those are the challenges against exclusive breast feeding, that mothers are unable to breastfeed because they have to go to work. That is why I’m saying it’s the mother’s choice because she knows her position. She knows when she has to go to work and who’ll look after the baby] and then from that umama uza-choose uba into e-right for yena nomntwana wakhe yeyiphi? [the mother will choose what’s right for her and her baby. The health workers abakwazi uku-choose ukuthi wena mama breastfeed, wena formula feed, yi-decision yakho mama.{IsiXhosa} [can’t decide whether mothers should breastfeed or formula feed. The decision lies solely on the mother.]

Jason Wessenaar: I think that i-formula feed ingcono ke kune-breastfeed [formula feeding is better than breastfeeding] especially in cases mhlambe lomama lo aka-disclose i-status sakhe, uyasaba u-disclose i-status sakhe. Ibonakala ngathi i-formula. {IsiZulu} [where a mother hasn’t disclosed her status because she’s afraid to do it. For me it seems like that decision to formula feed is much better, given those reasons.

Lihle Dlamini: Mina I’m HIV positive, nginama-ARVs, i-CD4 cell count yam [I’m on ARVs, my CD4 cell count] is above 500 and my viral load has been undetected for more than a year and I want to have a baby. I feel ukuthi uma ngabe ngiba nomntwana kumele ngimncelise kuze athole onke lama-nutrients awatholayo nama-antibodies [that when I have a baby I will breastfeed so that she can get all the nutrients and antibodies. And I also feel ukuthi fanele ngibhonde naye [that I must bond with the baby.] And also I know that ubisi lwebele lu-nutritious. Siyazi ukuthi umntwana webele akaguli , angaze aze adinge ukuya es’bhedlele [breast milk is nutritious and a baby who drinks breast milk is never sickly and won’t need to visit the hospital] within that six months if ngimncelisa ngendlela. {IsiZulu} [I breastfeed her properly.]

Busisiwe Maqungo: Gqirha ndiyayive uba u-Lihle uthi yena uba anganomntwana ngoku angamncancisa [I understand that Lihle says if she has a baby, she’ll breastfeed] because she’s on ARVs. I’m not on ARVs, I never breastfed my child because I’m not on ARVs. Although my CD4 cell count is high, i-viral load yam nayo inoba i-high. I-viral load yakhe ayibonankali i-virus emzimbheni wakhe, iCD4 cell count yakhe i-high. Lonto leyo ithetha uba angayithatha la-chance a-breastfeed umntwana wakhe, lonto yenza uba mazihle ii-chances uba am-infecte umntwana wakhe. {IsiXhosa} [my viral load is also probably high. Lihle’s viral load is undetectable and her CD4 cell count is high. So that means she can take the chance of breastfeeding her baby. Therefore chances of her infecting her baby with HIV are lower but that does not mean her chances are zero percent.

Dr Ullah Mothibi: What actually is becoming better now is that if umama uthatha i-ARVs, i-viral load yakhe iphantsi [a mother is taking ARVs, the mother is on treatment and her viral load is undetectable,] so we know that pha egazini lakhe lincinci. [the amount of virus in her blood is very little.] So you can even see that the 5% chance will even be smaller if you’re going to breastfeed or that 15% will even be smaller. Ziyanceda ukuthi [So adding antiretrovirals will help] lower a mother’s chances of infecting her baby with HIV. However, as Busi said, there is still the chance so in the end, nguwe umama ozawu-choose uba [you as the mother will choose which way you will go.]

Jason Wessenaar: We wrap up our discussion on exclusive breastfeeding and formula feeding after this break. Don’t go away.

Jason Wessenaar: Welcome back to Siyayinqoba Beat It! We’re talking about exclusive breast and formula feeding for positive mothers.

Vuyani Jacobs: I like this thing of advice and choice doc, because you talk about choice; bottle, the breast and we’ve got condoms which are choices and counselling. Why is this whole thing not including preventing pregnancy first?

Dr Ullah Mothibi: I think you bring up a very important aspect to this whole discussion around HIV, sexuality, whether people who are HIV positive should still be engaging in intercourse and females; again choice, whether HIV positive females should choose. I see Busi is smiling but I’m purposely saying that when it comes to HIV positive women, you can hear sometimes in the radio talk shows, they are asked: “Why are you having a baby, you’re HIV positive, you know that you will infect the baby.” It brings that topic into being as well. And what the support group needs is to go out there and even challenge the Department of Health to say: “Where are the health promotion messages?” We need all the information so that we are able to make better choices.

Jason Wessenaar: Messages on reproductive health are very important but I disagree, that they should only be specifically for women living with HIV. But then on the other hand, there are messages that promote breast milk and say it’s the best. But then they don’t seem to be accommodating women living with HIV in terms of you have a choice to do either of the two.

Busisiwe Maqungo: But I still would like to see on posters in our clinics; that say “Breast milk is the best but if you’re HIV positive, you might infect your child with HIV.” Do you see what I mean? But the posters we have now only say breast milk is best. And that makes you feel guilty as a HIV positive mother who has chosen to formula feed, that I’m depriving my child something that is best for them.

Jason Wessenaar: {Sesotho} Thanks to Dr Ullah, the support group and the viewers at home. Today we learned that we have a choice to exclusively breastfeed or formula feed for the first six months of the baby’s life. One of the advantages of formula feeding is that you can give the baby other food, as long as you don’t breastfeed. If a mother chooses to breastfeed, she can’t give the baby any other food, she must exclusively breastfeed. The Department of Health offers mothers the choice to either breast or formula feed. They also give formula milk to mothers who choose this method of feeding. We hope that you enjoyed the show and are feeling the Siyayinqoba Spirit, that together we can Beat It! Please join us again next week on the Siyayinqoba Beat It! Support Group. Stay healthy and be blessed.

< previous episode | next episode >