Posted on allafrica.com
As the world commemorates the world breastfeeding week, Uganda's readiness to promote breastfeeding in emergency settings comes under scrutiny.
Although we know that breastfeeding is a life saving practice, we also know that it was declared a conduit of death for many infants born to HIV positive women; research studies having shown that the risk of mother-to -child transmission (MTCT) of HIV was 15 per cent during breastfeeding (Journal of American Medical Association, 2000)
When MTCT was estimated to lead to approximately 20,000 new infections in Uganda in 2000 (Policy for reduction of mother-to-child HIV transmission in Uganda, MoH) the Prevention of Mother-to-Child transmission of HIV (PMTCT) program was quickly introduced. But inspite of the knowledge that MTCT occurred during pregnancy, delivery and breastfeeding, the PMTCT program was steered to focus mainly on providing ARVs to pregnant women to prevent transmission of HIV from the mothers to their infants during delivery.
Therefore, over the last eight years while the focus of the PMTCT effort was on provision of prophylactic ARVs, huge gaps remained in the provision of safe infant feeding options. This occurred even though WHO and UNICEF recommended avoidance of all breastfeeding by HIV infected mothers where replacement feeding is acceptable, affordable, feasible, safe and sustainable.
As such, many HIV infected women today find themselves unable to meet any of these criteria given widespread poverty and prevalent traditions, beliefs and norms. One such woman is Sarah a housewife living in Kayunga District. When carrying her first pregnancy, Sarah discovered documents in her husband's closet indicating that her husband was enrolled on the TASO (The AIDS Support Organisation) programme and was receiving ARVs. When her husband arrived home from work at the end of the day she enquired about the meaning of the documents and all her husband had to say was that whatever she had read was it.
Sarah, crushed and anxious to know her HIV status, went to the health facility where she had heard about the PMTCT programme. Sarah's HIV test result turned out positive. She was then enrolled on the PMTCT programme and at the time of delivery Sarah was given a dose of Nevirapine, and later her infant to avert MTCT.
At the time of our visit five months down the road, she was faced with the difficult decision whether or not to breastfeed. Her dilemma was that her husband, who was employed, was non-communicative about the HIV status of his wife, or his child, and about future plans for the infant's feeding. The support she was receiving from her husband was barely enough to sustain her. Sarah felt powerless to confront her husband, and afraid to discuss her situation with her community.
Although anyone in a dilemma like Sarah should continue to breastfeed, this week, as we review Uganda's readiness to promote breastfeeding in emergency settings, we must stop and note that the highly vulnerable HIV positive women and their infants are amongst us and they too are living in an emergency each passing day.
