[pronut-hiv] Relying on my husband's tribe's wet nursing practices to ensure my son was breastfed

["Danielle Pecore-Ugorji" <d_pecore-ugorji@foodgrainsbank.ca>]

I have found this discussion quite interesting, so thank you to all who have participated.  It touches my personal experience to some extent having been a breast-feeding mother in Nigeria who needed to partially rely on my husband's tribe's wet nursing practices to ensure my son was breastfed until the age of two.

What amazes me, though, is that it seems that many of you are looking for external solutions, assessed by North American standards of scientific validity, to a problem that is not new and that most communities have managed to deal with - albeit on a much smaller scale - for centuries.  Many African tribes and clans have complex social provisions for babies to be cared for in the case of a mother's death, illness or absence.  There are socially-endorsed practices in many societies on which relatives on which side of the family can serve as wet nurses and on their sexual behaviour during lactation.  While I recognize that the HIV/AIDS epidemic has greatly affected the social and familial networks that made these solutions possible in the past, it is no reason not to use these communities own systems and practices as a starting point. 

 In fact I don't see how any solution can be successful on other than an individual basis without being based on communities own socially-endorsed practices and protocols.  Yes, there is room for new ideas and practices, but these will fail if they are not closely integrated with and made complimentary to socially-accepted practices. 

>From experience I also know that sometimes these practices are not widely known or understood by men, community leaders or professionals working in a hospital setting.    

Therefore my recommendation to expatriates working to ensure infants have access to breast milk or substitutes is to spend time with older women in the communities hosting you, to build trust and to have true dialogue with them on these issues.  I think you will be surprised of the amount of knowledge and experience they have that could be adapted  - in whole, in part or in combination with other idea - to the types of situations we have been discussing.  They will not have the scientific data and they can not participate in list serve discussions such as this one, but their knowledge and experience is valid - and absolutely essential, in my opinion, to managing many of the situations created by the HIV/AIDS epidemic. 

Many development initiatives exclude this gendered knowledge or dismiss traditional experiences as irrelevant, maladapted or "primitive" - I think this is to our detriment, particularly given the added complexity of HIV/AIDS.

Good luck in your work,                 

Danielle Pécore-Ugorji
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-----Ted Greiner wrote:

Stacia,
   
  It is very expensive and demanding, especially from an ethical point of view, to do any kind of research on breast milk substitutes, especially randomized trials. I can't imagine any human ethics committee approving any study on plant sources of iron for such a trial. 
   
  I agree with the points Marie made earlier. Where the mother's milk is only partly or not at all available, solutions should be based on whether this is likely to be a temporary or permanent situation. 
   
  Finding a wet nurse is the best solution, not only for feeding the infant but for hopefully arranging long-term care in those cases when the mother is dead or likely to die in the near future. Where this can be predicted during the pregnancy and HIV testing is available, an HIV-negative wet nurse, ideally from the mother's family, should be identified before the birth; should be educated on avoiding risk of getting HIV, and provided with any support required to breastfeed two infants, to relactate, or, if expertise exists, to begin to induce lactation before the baby is born. 
   
  Second best would be to organize a local breast milk bank. An excellent example exists in South Africa (http://www.unicef.org/southafrica/hiv_aids_809.html) but more informal solutions of this type can be found even for an individual child. I witnessed such a case 27 years ago in Yemen when a mother was not willing to care for one of her newborn twins--which she was sure would die. A health care worker got her to agreed to take the baby if it could be kept alive for the first couple weeks of life. She did so by obtaining breast milk from other women in the area for those weeks--but this took a lot of work and caring for the baby. Obviously these days one would also want to be sure the donors were HIV-negative.
   
  Third best would be infant formula and fourth best home-made formula as described in WHO documents. But as Peggy Papathakis warned here and in her article in WHO Bulletin, locating the proper micronutrients is very challenging and likely to be so expensive that it's hard to imagine many scenarios where this option is going to be better than infant formula.
   
  I don't mean to sound cavalier, like any of this is easy. And I realize that there are likely to be cases where none of these solutions will work, especially in isolated African communities affected by HIV. 
   
  Regards,
   
  Ted Greiner, PhD 
Senior Nutritionist 
Director, Ultra Rice Program
  PATH 
1800 K St NW, Suite 800 
Washington DC 20006 USA 
tel +1 202 822-0033 
fax +1 202 457-1466 
tgreiner@path-dc.org 
www.path.org 
PATH: A catalyst for global health 
 
---- Stacia Nordin wrote:

All the more reason for someone to work on 
something that can be made from 
local sources ASAP.   You state 2 big problems 
below (water and plant 
nutrients -although I'm a skeptic on negativity 
of tyring formulation based on some plants), what 
solution to you lean toward?

Sounds like there is no perfect solution at the 
moment.  We need to do the 
best we can with what we have.

Stacia