It was billed as the best thing for women and HIV positive mothers who wanted to increase child survival or prevent the passage of the virus to their children. 

But now exclusive breastfeeding is encountering major troubles with the country’s rates falling sharply from 36 percent to a paltry 2.7 percent within a period of seven years, the worst in Eastern and Southern Africa.

Meanwhile, Kenya’s peers are doing well, registering between 40 and 60 percent exclusives breastfeeding success rates.                         

For the umpteenth time in recent months, doctors say the exuberance and the willingness around the practice has died as health practitioners give wrong information, fail to endorse the practice, or send conflicting messages to the public. 

Promotion of exclusive breastfeeding for the first six months has also died, with majority of women reverting to mixed feeding or formula milk. Health workers who are expected to go around the villages and in the health centres preaching messages of exclusive breastfeeding are in short supply.

Young women are on the other hand not being schooled on the ways of good breastfeeding while professional and working women are introducing their children to formula milk or mixed feeding as they juggle with demands of work or physical fitness.

UNICEF and other partners are now intensifying a campaign that is geared at doling out the benefits exclusive breasting in the first six months to both the child and mother.

In the past few decades, exclusive breastfeeding was considered as the best thing in enhancing the bond between the mother and the baby as well as providing him or her with the massive nutritional values contained in breast milk, particularly in the first six months after birth. This is no longer the case as modern women prefer to either wean their babies early or use formula milk.

Women like Jacinta Njoroge of South C estate says breast-feeding does not work well with a professional woman like her.

“All my two children have been on formula feed, which the maid can give even when I am not around.” 

Yet, such sentiments smack in the face of studies that show close to 40 percent of infant deaths are directly caused by the way a mother feeds her infant in the first two months.

The situation is worse for HIV positive mothers who one section of health workers are telling that exclusive breasting exposes their children to HIV infection, while others offer otherwise advise.

The advise is informed by new scientific data that shows children born to HIV positive women more likely to die early in life if they do not receive exclusive breastfeeding compared to those who do. The risk of HIV infection with exclusive breastfeeding is said to be 8 times lower than with mixed feeding for such children.

In study published last year in the Lancet, scientists at the Africa Centre for Health and Population Studies, South Africa, found the risk of HIV infection for infants who received exclusive breastfeeding between the age of 6 weeks and 6 months to be 4 percent.

While  the risk for those who received formula milk was about twice as this, with those getting breast milk together with solid foods being 11 times more likely to get HIV.

Breast milk is known to strengthen the mucous membrane within the intestines, providing an effective barrier to HIV infection, hence the low transmission rate. On the other hand, past research has indicated that proteins found in solid foods may result in greater damage to the linings of the stomach, making it easy for the virus to penetrate.

Other studies found that the risk of HIV transmission to the baby can be made even lower if the breast-feeding mother is on antiretroviral treatment, which is known to lower the viral load in the body.

In the developed countries, the risk of transmission of HIV from mother to child is about 2 percent due to the use of a combination of interventions: antiretroviral therapies, exclusive formula feeding regimes and excellent health care systems.

These findings are crucial since research has shows that mothers who have CD4 count of less than 200 and do exclusive breast feeding to have an increased rate of HIV transmission to their babies of more than five 7 percent. Deaths of infants born to these mothers were also high. 

Another study in Kisumu and Zambia found lower survival rates among HIV positive infants who were stopped from breast milk and weaned at four months. 

 “Although the probability of HIV infection increases with exclusive breastfeeding, the rate of survival for these babies is very high compared to those babies who are not breast feed,” says Prof Ruth Nduati, a senior lecturer at the University of Nairobi.

Research elsewhere has shown while failure to breastfeed is likely to reduce the HIV infection, the babies risk of death due to infectious diseases, malnutrition, and diarrhoea multiples. This is the dilemma HIV positive mothers face: to or not to breastfeed.

“The concept of balance of risk is the most difficult aspect of HIV that health providers are finding tricky to communicate to mothers, hence the confusion,” she adds.  

New findings of various research work are either not reaching many women and if they do, they are leaving them confused even more.  Nurses who are expected to disseminate this new information are either ignorant or cannot interpret it accurately.

Take the animal milk which HIV positive women were asked to substitute with their own breast milk. For many years, the use of such milk has been the norm for poor women who cannot afford formula milk. But now World Health Organization (WHO) and other medics are advising women not use home-modified animal milk during the first six months, terming it unsafe.

Such milk is said to not only require women to buy and add micronutrients to it, but to also contain too much protein and salts that produces an acidosis effect on the kidney and liver.

Bombarded by these messages, worried and confused HIV positive women or any other woman are preferring what they consider as the better option: not to breastfeed.

This is however being done at a huge price: in the first two months after birth, mortality among infants who are not breast feed is six times higher than those who are breast feed. Such messages do not reach the women due to the uncertainty that now exists.

“When HIV/AIDS came on board, we started sending conflicting messages to mothers. At the moment we have created a lot of confusion,” said WHO Representatives in Kenya, Dr David Okello, in his speech at a recent UNICEF meeting in Nairobi.

This confusion is working against the great benefits offered by exclusive breastfeeding, be it to HIV positive mother or any other woman. Statistics show that if 90 percent of the mothers undertake exclusive breastfeeding, then they will reduce deaths of children below five years by 13 percent.

Exclusive breast feeding is also known to give children better cognitive abilities and reduced risk of developing chronic adult diseases.

At the moment, HIV positive women who are scared of exclusive breastfeeding for fear of passing the virus to their babies are advised to use replacement feeding. But here lies another problem: many cannot afford replacement feeding. According to WHO, any replacement feeding should only be adopted if it meets what is called AFASS criteria – Acceptable, Feasible, Affordable, Sustainable, and Safe.    

Acceptability means the method has to be embraced by the family, so that the woman can cope with the cultural pressures around breastfeeding.

The option should also be one which affords the mother enough time to prepare the milk; is affordable and accessible to even unemployed mothers, and is safe. 

Health workers argue that such formula milk should be recommended only if three critical things are met: the mother is counselled about its use, mechanism to monitor nutritional status of the infant are in place; and the formula can be supplied as long as the infant needs it.

Supporting the mother on what option to take need to begin before and during the first 6 months of birth, they add.

Meanwhile, the biggest beneficiaries of this confusion and shift by women from breast-feeding to other alternatives are manufacturers of infant feeding formula, who are raking-in millions of profits. Massive advertisement by these companies is being blamed for this shift by many mothers.

Kenya is yet to domesticate a Code on Marketing of Breast feeding substitutes, which was formulated by WHO more than 10 years ago. The code among many other things was to regulate the way formula milk manufacturers advertise their products.   

For now, doctors are recommending putting in place an aggressive campaign strategy to enlighten and educate the public on importance of exclusive breast-feeding in the first six months. 

Another proposal is to have women with CD4 count of less than 200 put on anti-retroviral treatment to raise them to over 500, a level that significantly lowers the chances of mothers passing the virus to her baby during breast-feeding.

A programme where health workers will go around visiting breast-feeding mothers to encourage them on the importance of carrying-on with the practice need to be  put in place as well.

 This article was also published in the Daily Nation's Horizon Magazine  on July 10. (www.nation.co.ke)