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Breast or Bottle - The Dilemma Continues

Living with HIV / AIDS is difficult at the best of times. There are many decisions to make regarding health, relationships, family and future, but none could be more difficult than choosing (if you have a choice) between breast-feeding and bottle feeding your child. This decision affects another life, one that is the mother's instinct to protect with her own. A Positive Woman reflects on the breastfeeding debate.


1: Where was the support when I had to hide in my bedroom to bottle feed my child so visitors would stop asking me questions on why I was not breast-feeding?


Many women in developing countries do not have the choices that we in the West do. Due to their environment the decision for them is already made. The cost of formula feeding is out of reach to many, as too is access to clean water and hygienic equipment. But even if women have access to formula, others have to battle against the stigma of bottle-feeding from husbands, family, and the community. Questions are asked. "Why is she using the bottle?" "Maybe she has AIDS!" To be known as having AIDS may result in being ostracised or beaten. The woman often gets blamed for the virus even though more often than not it is her husband who has infected her.


Several studies have been done looking at the impact of different infant feeding practices in relation to HIV transmission

  1. Exclusive breastfeeding ~no water, solids or other fluids are given.
  2. Mixed breastfeeding ~ other fluids and solids are given.
  3. Formula, or substitute feeding ~ where a breast-milk substitute is fed to a child.

It has been found that the type of feed given to a child can eitheore instinctive than putting a crying hungry baby to their breast. That privilege was taken from me and I felt like a failure. Where was the support when I had to hide in my bedroom to bottle feed my child so visitors would stop asking me questions on why I was not breast-feeding? Where was the support when in public I would get scornful looks from other mothers because I was using the bottle? I know myself I was doing the best I could for my girl but to those around me I was doing wrong.


I live in Australia where cultural issues are not too imposing. I can only begin to imagine the decisions HIV positive women from other cultures have to make in regards to feeding their infants. It hurts me to know that in most cases these women have no choices.


At the Durban conference I was struck by a comment made by an HIV positive Zambian woman. "We are told by professionals and by the community to breast feed our infants, as the milk is good for our children," she said. "But I ask you. Would you feed your child an ice-cream with cyanide in it because it tastes good?"


written by a member of Positive Women Victoria

[Editor's note: Providing all the available information together with non-judgmental support for the decisions made by women around their feeding practices is crucial to enable each woman to sort out the best risk-reduction strategy for her own specific cultural and economic circumstances. This needs to extend to HIV negative women otherwise bottle-feeding becomes a marker of HIV status. The provision of free formula and strategies for ensuring safe water supply must be in place if formula is to be a viable option in resource-poor settings. Studies in Kenya and Côte d"Ivoire have shown some useful interventions around water safety. Short periods of exclusive breast feeding seems a promising risk-reduction strategy in some instances, so long as the practice is well understood.

Story added to the site in 2000.

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