[pronut-hiv] soy formula and wet nursing

["Ted Greiner" <tedgreiner@yahoo.com>]

I am happy to read Danielle's input on wet nursing because in my experience it tends to be quickly ruled out as a viable option based on simplistic assessment of community attitudes toward it. I suspect that what she describes, its traditional use when babies die, was present in almost all cultures. However, in ones where infant formula availability and widespread use came decades ago, this may be largely forgotten.
   
  Tim Quick and I discussed the wording of my earlier input on wet nursing and I want to point out that I was not intending to imply that wet nursing was the best choice under "normal" circumstances. I was referring to what I understood originally was a question referring to a situation in which economic and other constraints were extreme. Listing infant formula as the lowest priority option was then in recognition that there would be a great risk that it would at times be unavailable or unaffordable--ie that the "sustainability" part of AFASS is unlikely to be fulfilled. (The still unpublished Good Start cohort study of three pilot PMTCT sites in South Africa found that even in a case like RSA where formula is purchased by the State, nearly all beneficiaries had periods of time when formula was unavailable and usually their babies were fed for at least a few days on sugar water or some other harmful foods.)  
   
  We do need to keep in mind that wet nursing also includes some risks, including the wet nurse becoming HIV infected and, if the infant IS already HIV infected, of HIV passing from infant to wet nurse, though this is likely to be a very rare occurance. 
   
  Soy formula was developed by commercial interests who were willing and able to make an enormous investment in developing it. I have never seen a trial of new formulas financed by anyone other than private companies. Nevertheless, soy formula continues to be somewhat controversial and I believe is not allowed in New Zealand and possibly Australia, as research on all possible effects and side effects has taken decades to complete. 
   
  In relation the point I was making about plant sources of iron, soy, like other formulas, does not rely on the nutrients in the foods it is based on--they are added as fortificants. And many of the natural "anti-nutritional" substances are removed from the soy when it is used in formula. Please do not assume that any infant formula is anywhere close to being a "natural" product--they are highly industrialized and "artificial" foods.
   
  In general, formula trials are done on babies whose mothers have decided not to breastfeed and thus compare only one formula with another; it would never be ethically allowed to randomly assign babies to be breast or articifially fed under "normal" circumstances. A couple such randomized trials have however been run among HIV+ women in Africa because ethical committees could be convinced that we did not in advance know which group would have the highest rates of HIV-free survival. But these were of course not "trial formulas" being tested, but established formulas.
   
  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 

   
------Stacia Nordin wrote:
   
  Ted,

But what about the use of soy formulas?  Someone 
took the time and energy to run trials on it, and 
it is a leguinous plant food.  I admit to being a 
non-expert in the area of making an infant 
formula, but I believe that if we wanted to develop 
something based on local resources to assist 
children 
without breastmilk options to eat, that we can do 
it.  We need to work with groups like INFOODS / 
FAO to test the chemical composition of our local 
foods so that we can assess the options we have, 
and then work with food science professionals and 
researchers to do proper testing of various 
formulations.

I agree with all you lay out below and especially 
what Danielle contributed (culture, build on 
local knowledge).  Our local cultures and beliefs are 
a place to start fostering positive changes as we 
evolve new cultures.  To do this, identifying our 
unhealthy and healthy cultural activities is part 
of our work and lives.  Wet nursing is still very 
popular in portions of Malawi and when I was 
breastfeeding my daughter, I had to repeat many times 
to my friends and neighbors that no one else was 
to breastfeed my daughter when I was away as my 
community uses the practice to assist each other.  
If I could have found a healthy, non-HIV infected 
woman to help me breastfeed my daughter I would 
have welcomed it, but it was not an option in my 
community.

I hope that some of the people on this list are 
in a position to continue to work on finding 
solutions with local cultures on this issue.

Stacia

~~~~~~~~~~~~~~~~~~~~~~
Stacia Nordin, RD
International Nutrition Consultant
Specialist in Sustainable Food & Nutrition 
Security
~~~~~~~~~~~~~~~~~~~~~~
Personal contacts:
Post Dot Net X-124, Crossroads, Lilongwe, Malawi
Physical Location:  Chitedze Trading Centre, 
Lilongwe, Malawi (Africa)
+265  1-707-213  (home)
+265  9-333-073  (home cell)
nordin@eomw.net
~~~~~~~~~~~~~~~~~~~~~~