Exclusive Breastfeeding: Empowering Mothers to Keep Their Babies Free from HIV

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In honor of World Breastfeeding Week, we explore the benefits of exclusive breastfeeding and efforts to share knowledge empowering mothers living with HIV in Nigeria and Botswana.

Not long after Gorata* found out she was pregnant, she also tested positive for HIV.

Like so many other women in her shoes, Gorata was afraid—for her health, her wellbeing, and that of her unborn child. To address these fears, Gorata began taking antiretroviral drugs. But after giving birth to her son, she had a new concern—could breastfeeding negatively impact her son’s health?

The Benefits of Breastfeeding
"Only breast milk offers infants and young children complete nutrition, early protection against illness, and safe, healthy food all at once." - Rene Mary Mathew, Pathfinder Head of HIV/AIDS, NigeriaPrior to the AIDS epidemic, Gorata’s home country, Botswana, was a place where most mothers practiced breastfeeding.  For years, compelling evidence has shown breastfeeding is highly beneficial for both mother and child, especially in the first six months of life.

"Only breast milk offers infants and young children complete nutrition, early protection against illness, and safe, healthy food—all at once," said Rene Mary Mathew, Pathfinder’s Head of HIV/AIDS in Nigeria. "Breastfeeding offers triple value; it provides health benefits for new mothers, temporary contraception, and improvements in child survival rates."

But with the global spread of HIV and AIDS came fear among mothers and health workers that breastfeeding would put babies at risk of contracting HIV from a positive mother.  Many mothers lacked information and faced familial pressures and HIV stigma, which pushed them to adopt “mixed feeding”—the feeding of both formula and breast milk, the method most likely to cause transmission of HIV from mother to child.

An Expansion of Treatment
Prior to 2010, Batswana mothers only received two of the three necessary antiretroviral drugs—AZT and Nevirapine—before and immediately following birth. In 2010, to reduce the rate of transmission of HIV through breast milk, the government of Botswana introduced Triple Antiretroviral Prophylaxis (TAP)—providing all three antiretroviral drugs to mothers with HIV as long as they breastfeed their babies.

“The growing global accessibility of antiretroviral drugs means that, more than ever before, mothers living with HIV can breastfeed their infants and young children with a greater reassurance of safety from transmission,” Rene said.

Yet, despite the dissemination of antiretroviral drugs and the benefits of breastfeeding, only 38 percent of all infants in the developing world are exclusively breastfed. In Botswana, the rate is even lower—20 percent—due, in part, to 10 years of the government’s free formula program.

In Nigeria, the exclusive breastfeeding rate is one of the lowest worldwide at 13 percent. The government of Nigeria has identified improving breastfeeding rates as a national priority and recently set forth a new Infant Feeding Policy. This leaves an enormous window for improving mother and child health through information sharing and counseling on exclusive breastfeeding.

That’s where Pathfinder comes in.

Sharing Knowledge in Nigeria
In Nigeria, Pathfinder works through its Scale-Up Gender-Sensitive HIV/AIDS Treatment, Prevention, Care, and Support Interventions for Adults and Children project with support from the Global Fund, to encourage HIV-positive mothers to stay on their antiretroviral drugs. Mothers learn about the drugs’ role in protecting their newborns during breastfeeding.

Pathfinder also provides information about the advantages of breastfeeding during antenatal care health talks. We work on dispelling common myths, like the misconception that babies need water to quench their thirst. Because health care providers sometimes provide conflicting information to new mothers by encouraging formula use, Pathfinder staff work closely with providers to improve knowledge and attitudes about breastfeeding and to train them in how to impart hygienic care of the breast and other healthy practices to mothers.

The Power of Peer Mothers in Botswana
In Botswana, Pathfinder is funded by the Centers for Disease Control and Prevention for our Expansion of HIV Prevention, Counseling, Psychosocial Support and Outreach Services project which mobilizes “peer mothers” to provide peer counseling and psychosocial support for HIV-positive mothers.

The peer mother model is simple, yet powerful. Mothers living with HIV who adhere to the government’s prevention of mother-to-child transmission of HIV program are selected and trained to support their peers. These peer mothers use what they have learned—as HIV-positive women experiencing pregnancy and motherhood—to empathize, share their similar experiences, and gain the trust of other pregnant women with HIV and their partners.

“Pathfinder provides peer mothers with the training and tools they need to conduct one-on-one counseling sessions, during which they inform clients about healthy behaviors and strengthen their communication and partner negotiation skills," said Gladys Mogape, Pathfinder's Botswana Country Representative.

“Pathfinder provides peer mothers with the training and tools they need to ... inform clients about healthy behaviors and strengthen their communication and partner negotiation skills." -Gladys Mogape, Pathfinder’s Botswana Country Representative.

Shortly after the introduction of TAP, peer mothers in Pathfinder’s Botswana program began integrating information about the benefits of TAP and exclusive breastfeeding into their peer counseling efforts. Now, counseling sessions include information on safe infant feeding alongside the usual topics of HIV prevention, testing, and treatment and family planning. Peer mothers work directly with women like Garata to make sure they don’t receive wrong information and dispel commonly-held myths about breastfeeding when HIV-positive.

These initiatives are fairly new and it will take time for HIV-positive mothers to fully grasp and gain confidence around the importance and safety of exclusive breastfeeding, but we are hopeful that by improving knowledge sharing, training health workers, increasing peer support to change community norms, more women and newborns will reap the rich benefits of exclusive breastfeeding.

*Name changed due to sensitive content.

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