Tuesday, December 19, 2006

Three newspaper articles and an IBFAN newsletter

Several things going on at the moment.

Firstly, our leafleting at the Nestlé Book Prize was picked up by an international news agency and sent out in English, French and Arabic.

You can read it here:

There's a picture of our team of leafleters. There on the left is Sarah, our new Office Manager, next to Patti, Policy Director.

Second bit of news was a report on the US Food and Drug Administration finding Nestlé infant formula in the US had lower than permitted minimum levels of Phosphorous and Calcium. Included a reference to the boycott with: "The group is already one of the most boycotted food firms in the world because of allegations that it unfairly pushed its infant formula onto women in the developing world, discouraging them to breast feed." See:

You can see the FDA warning letter on-line. It shows Calcium levels are about 10% down on what Nestlé shows on the labels, Phosphorous about 20%. See

A third article of note was in the UK Daily Telegraph. It concerns HIV and the risks of transmission through breastfeeding. The headline is "HIV positive and forced by poverty to breastfeed." It says things like: "Ajabu is HIV positive but has deliberately not been told that breastfeeding is highly infectious and that, in effect, she risks passing on a death sentence every time she raises her children to her breast." See:

The World Health Assembly position, as I have explained in a past blog entry, is : "when replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-positive women is recommended; otherwise, exclusive breastfeeding is recommended during the first months of life; and that those who choose other options should be encouraged to use them free from commercial influences."
See http://boycottnestle.blogspot.com/2006/10/but-sometimes-journalists-get-it-wrong.html

This sensationalist 'death sentence' journalism is not only at odds with the reality, it is potentially very damaging to health if taken seriously. The fact is that the vast majority of infants born to HIV infected mothers do not get infected. While no-one should minimise the impact on the 15% of infants who are infected through breastfeeding, it needs to be put in context of the risk assessment recommended by the World Health Assembly. As UNICEF has pointed out, in the first 20 years of the HIV pandemic, perhaps 1.7 million infants have been infected with HIV through breastfeeding, but 30 million have died as a result of not being breastfed.

More recently evidence is emerging of the impact of promoting formula as the solution to mother-to-child transmission. Remember Nestlé set up a Nutrition Institute for southern Africa in 2001 with just that stated purpose. Botswana is one country where Nestlé provides formula to a government scheme. We have exposed the idealising leaflets that go with the Pelargon formula in the past. They suggest the formula helps to prevent diarrhoea, whereas formula-fed infants are more likely to die as a result of diarrhoea than breastfed infants. See

A study in Botswana evaluating different approaches to infant feeding by HIV-infected mothers evaluated child survival, not just HIV transmission. It concludes:

Breastfeeding with zidovudine prophylaxis was not as effective as formula feeding in preventing postnatal HIV transmission, but was associated with a lower mortality rate at 7 months. Both strategies had comparable HIV-free survival at 18 months. These results demonstrate the risk of formula feeding to infants in sub-Saharan Africa, and the need for studies of alternative strategies.

In other words, because infants die from the risks of artificial feeding, the strategies about balance out over 18 months from the point of view of child survival. Prior to this: "Cumulative infant mortality at 7 months was significantly higher for the formula-fed group than for the breastfed plus zidovudine group." To use the wording of the Telegraph journalist, putting a bottle in a babies mouth was more likely to be a death sentence during this period.

At 18 months the mortality rate amongst the formula-fed group was 10.7% and 8.7% in the breastfed group. HIV infection was 6% in the formula-fed group (infants being infected in utero or during birth) and 9.5% in the breastfed group.

You can find the paper on PubMed

There was a flaw with the study however. The breastfed group were not exclusively breastfed, there was also mixed feeding. Other studies suggest that mixed feeding is the most dangerous scenario and so this would have made breastfeeding look worse than if exclusively-breastfed infants alone had been considered (Coutsoudis A. Influence of infant feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa. Ann N Y Acad Sci. 918: 136-144, 2000). So if the message about exclusive breastfeeding was effectively spread in conditions where artificial feeding is life threatening we should see less HIV-transmission and far better survival rates.

If you want greater insight into the complexities of this issue, an understanding of why the World Health Assembly policy is as it is and why sensationalist and ill-informed articles like that in the Telegraph are so unhelpful to child health you need to look behond the catchy headlines. For example, see the Spring/Summer 2006 newsletter from INFACT Canada. This reports on the Botswana study and a recent HIV conference. Click here to download the pdf

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