The Right to Bottle Feed?

There is an extremely interesting discussion going on at Harvard’s Health and Human Rights Journal about a very important debate: should HIV positive mothers in poor countries be provided baby formula to bottle feed their children, thus preventing the transmission of HIV via breast milk? Or, should mothers be coached to only breast feed their children, potentially putting them at risk of contracting HIV, but also sparing them from the potential risks associated with preparing formula with dirty water?

Agnes Binagwaho writes that we should consider the early response amongst international health experts about the notion that the poor should be treated with complex ARV regimens.

However, their progress has proven to the world the profound error in thinking committed by those who, a decade ago, assumed that poor people living with HIV in the global south would have to be sacrificed in order to protect people in the north. Their argument was based on the fear that drug-resistant HIV strains would proliferate if ARVs were widely distributed in developing countries, where neither providers nor patients could be trusted to handle these precious drugs properly…

Similarly, it is wrong to assume that poor Africans are incapable of preparing healthy formula which will benefit the health of their children.

…It suggests that wealthy women’s rights include being able to feed their children safely, while poor women’s do not.

In Claudio Schuftan’s response to this piece, he refutes the idea that the ability to prepare a healthy bottled supplement for babies is simply a matter of implementation and effective delivery strategies. Rather, he tries to link the difficulty of poor mothers to prepare nutritious and safe bottles for their children to the “economic discrimination of poor women.”

Of course we need to set the same human rights objectives for ourselves in the global South as those set in the North. However, as public health nutrition experts, it is our obligation to acknowledge the local reality of HIV and AIDS affecting important segments of the poor population in our respective milieus. That reality shows us that economic access to infant formula does not exist for vast numbers of affected women. It is overwhelmingly this reality that pushes us to aggressively promote exclusive breastfeeding for these infants given  the current context cognizant that this is not a risk-free alternative, but positively weighing it against the greater risks of bottle feeding.

Economic empowerment is central to safely providing alternative feeding to the children of HIV positive mothers.

The problem, as stated above, is fundamentally about access to economic resources, and a resulting lack of economic power. Binagwaho seems to believe that if activists would bring to bear the same political struggle around replacement feeding that they did in the issue of access to anti-retrovirals, the question would no longer be whether replacement feeding can be adopted, but rather how. Such a call would undoubtedly find its warmest reception in the milk industry which, of course, would use it in its own self-interest.

I tend to agree with both of them: the right to choose how to best care for your child should be universal but, this approach will not be universally safe until there exists some degree of economic equity in the world.

Economic equity and justice should be the ultimate goal, however I don’t believe that we need to, nor should wait for a perfect world to begin to apply principles of justice. We need to fight for the resources and begin to apply them now to providing the economic power necessary to reduce the structured risk of acquiring HIV for those in poverty. Dr. Schuftan put it well:

To use a metaphor, arguing for the right to bottle-feed is at best like arguing for access to a band-aid when faced with a hemorrhage. Poverty is the hemorrhage, and it is the dominant human rights violation endured by these women and children.