Ever heard of a game called Russian Roulette? The premise involves loading one live round into an empty revolver. The barrel is then spun and the weapon pointed at the victim. In a standard revolver the statistical chance of being shot and potentially killed is 1 in 6. Our Health Minister, bless his fast food despising soul, recently decided to play his own version of this game with our nation and its HIV infected children. As of late August 2011 he unilaterally (in consultation with a number of his ‘yes’ men) decided to change South Africa’s breast feeding policy.
In essence the government no longer supplies formula milk to any patients accessing the public health system. Thus the only option available to mothers is to breast feed or purchase formula milk privately. This is a financially unsustainable option for the overwhelming majority. The finances are however better for government, who despite announcing the NHI which will purge R225 billion from taxpayers, will be saving in the order of R200 million per year with this move.
Of course the economics of Health are such that a short term saving today is often very costly in the long term. The evidence around adopting the approach taken by the Health Department is based on research which shows that infants who breast feed are generally healthier and have better immunity. Add to this the benefit of decreased cost to the state and associated costs to patients, and the decision seems to have merit. Furthermore formula feeding requires good sterilisation techniques to avoid gastrointestinal infections. This is particularly difficult because those in poor communities have been shown to battle with these techniques due to lack of resources.
As a direct result a common killer of young children is gastroenteritis. Much like when you have a bad case of food poisoning the time spent with your toilet bowl will drain you of fluid. In children and infants this is particularly dangerous because the progression to a lethal stage of dehydration can be far quicker with parents often failing to see the danger signs. In a country like Cuba where the socioeconomics are similar but the HIV prevalence is not, the choice is simple. If breast feeding offers so many advantages and formula feeding has an increased risk of gastrointestinal infections then the 1 +1 really is equal to 2.
However in South Africa we live within the environment of a colossal HIV pandemic. Once again the research here is quite clear. A mother who exclusively formula feeds has no chance of passing HIV onto her baby. A mother who exclusively breast feeds and together with her infant is on ARV’s has such a small chance of transmitting the virus that the risk is considered negligible. The problem is mixed feeding. Infants have a gastrointestinal lining which protects them from contracting HIV and other bugs in their gut. This lining only remains intact if the child is fed strictly one type of milk – breast or formula for not less than six months as recommended by the WHO. Mixing either of these or feeding the child additional cow’s milk, maize milk or any other foodstuff before 6 months will erode the lining destroying the protection. In addition to this there are several social factors to consider. Mothers are educated by health workers but family members with whom the child may be left are often exempt from this process. In addition South African culture means that mothers are likely to feed their children something other than just breast or formula before six months. Moreover working mothers only get 4 months of maternity leave, meaning that if they start breast feeding their children the child will have to be put onto solids or other milks before 6 months which will predispose them to either to gastrointestinal or HIV infection, or both.
For all of these reasons up until recently many HIV positive mothers chose to formula feed. Now given no choice they will be forced to breast feed. At best in any town, city or province of this country 1 in 4 pregnant women is HIV positive. At worst the figure is 1 in 3. The direct result of this new policy, which has been instituted overnight, is a generation of babies born to HIV positive mothers being doomed to a potential death sentence.
Indeed much like in Russian Roulette our Health Minister has decided to load a revolver with a single round while pointing it directly at the head’s of our country’s children. We can only hope that his love of breasts helps him sleep better at night, for tomorrow and the day after may be spent digging graves just big enough to fit thousands of suckling infants.