“Young people have a critical role in the future of this field. It is imperative to have current policy scrutinized through fresh and critical eyes. Sometimes the solution is right in front of us, and yet we are blinded by what we “know.” Enthusiastic, dedicated people will be important in continuing to liaise between communities, researchers and policy makers.”

– Kiersten Israel-Ballard MPH – Researcher UC Berkeley School of Public Health

This second issue of the YOUth-4-Breastfeeding Newsletter highlights the importance of current Breastfeeding and HIV/AIDS research at the same time it acknowledges young people as a vibrant force in the field. For decades the intersection of Breastfeeding advocacy with HIV/AIDS prevention has been shrouded in controversy. Recently, exciting new studies have been released which offer promise for more collaborative thought and policy in the attempt to increase infant survival worldwide.

Just as with advocacy and activism in breastfeeding, the youth of the world are elemental to advancing research. As Ms. Israel-Ballard notes, those young people who are actively involved in research are astute critics and thus catalysts for change. Of course, the role of youth does not stop at the lab-room door; young people who are aware of and engaged with current research are pivotal in disseminating and communicating this powerful knowledge.

As the youth continue to contextualize breastfeeding as a Human Rights issue, the role of HIV and AIDS becomes unavoidable. Young people and mothers are two sectors of society that are among the most affected by the epidemic. Given this, in alliance with the efforts towards HIV prevention, a global youth commitment to breastfeeding promotion becomes central to advancing the rights of Youth and Women. As research and advocacy converge, so do the roles of young advocates throughout the world. The challenges presented are sobering but the youth are the world's most dynamic resource. As young advocates form alliances and draw knowledge and inspiration from one another, they become a powerful source of hope.

- Brie A. Abbe, Editor, Issue No. 2

• World Breastfeeding Week 2007: The 1st Hour – Early Initiation & Exclusive Breastfeeding for 6 Months Can Save More Than One Million Babies. Please visit the new independent website for more information about this WABA-sponsored event during the first week of August-. http://worldbreastfeedingweek.org/

• Tribute to Patrice Jelliffe : WABA mourns the loss of one of its founders and icon of the global breastfeeding movement. Learn more about this great woman and the lives she touched - http://www.waba.org.my/pat_jeliffe.htm
  

The project focused on women in their reproductive years – pregnant, single mothers, mothers with children under the age of two years – in addition to any parent interested in infant and child nutrition. San Miguel del Soldado is a community, among other Mexican communities, that has suffered from the cultural and systematic propagation of inaccuracies and myths about breastfeeding.

The project was conducted in two phases. The first phase provided workshops for mothers and children and served as both a venue to facilitate dialogue among mothers and an opportunity for education to address popular misconceptions about breastfeeding. These workshops are currently ongoing and have been offered on a weekly basis.

The second phase of the Project, which is also still ongoing, addressed the health worker community of San Miguel del Soldado, providing education and updates about infant and child feeding. Research showed that among the traditional health community, practitioners were both reticent towards shifting their current awareness of infant nutrition and resistant to encourage and implement proper breastfeeding techniques. This phase recognized the importance of education of health workers in a community. Ultimately, when the project has completed, the health workers will remain as the primary source of information, education and encouragement to mothers and families and therefore their engagement with current knowledge of infant nutrition is vital

In conclusion of the initial parts of Phase 1, the project sponsored a nutritional fair where mothers were able to play different interactive games in order to display the breastfeeding and nutritional knowledge which they had acquired from their participation in the workshops.

The 50th Anniversary La Leche League International Conference will be held from 17-23 July in Chicago, IL, USA. Alongside the event, WABA and LLLI will co-sponsor The State of the Art of Mother Support Summit. Several representatives from the WABA YOUth Initiative will be present at both the Summit and the Conference: Liew Mun Tip, Koh Kah Ling, Brie Abbe, Diogo Mboa, Santiago Vallone (RUMBA-Latin America) and Jose Quiros (RUMBA-Latin America); from Malaysia, USA, Mozambique, Argentina and Costa Rica.

During the Summit, these participants will highlight the role of young people in the practice and implementation of Global Mother Support. Some exciting plans for the conference are lined up:

Global Session on "YOUth and Code Awareness" Activities and YOUth networking at the La Leche League Teen Lounge Exhibition and displays at the WABA booth Recording testimonials about the significance of YOUth engagement in the Breastfeeding Movement

WABA Youth will be there to show other participants the power of YOUth!

Research Updates

March 2007 was an important month for high-profile research and evidence that favoured breastfeeding in resource-poor settings and called for a global re-assessment of policy surrounding safe infant/child feeding and the prevention of postnatal paediatric HIV.

In Los Angeles, at the 14th Conference on Retroviruses and Opportunistic Infections (CROI), several presentations and reports addressed the dangers of formula feeding for HIV-exposed babies in sub-Saharan Africa. HM Coovadia was quoted starkly juxtaposing risks in saying “If you choose breastfeeding, you would of course have HIV infection….About 300,000 per year in the world. But if you avoided breastfeeding, the mortality would be about 1.5 million per year. So, on the balance of probabilities for poor women in the developing world, there is no other choice than to breastfeed their infants(1).”

In October 2006, for the first time in six years, the WHO revised their recommendations for infant feeding and the prevention of HIV(2). Many of the revisions were based on evidence which was presented at the 14th CROI. Some important observations were:

• Increased cases of malnutrition and diarrhoea in formula-fed infants in Botswana (3)
• A connection between rapid weaning and the increased risk of hospitalization and death (4)
• From the Zambian Exclusive Breastfeeding Study - the conclusion that programmes should encourage breastfeeding for HIV infected infants (5)

Just days after the Conference closed, The Lancet published a study organized in South Africa which tracked 1,372 HIV-infected mothers and found that exclusively breastfed infants had a 4% postnatal transmission rate. This is one of the first studies to accurately focus on exclusive vs. mixed feeding of infants. In addition, the study showed that the death rate of infants under 3 months who were exclusively breastfed was halved from that of formula fed infants(6).

The presentation of these new findings offers hope that future policy for prevention of postnatal paediatric HIV transmission may be framed in a less reactive way and balanced with the important promotion of breastfeeding. However, advocates for Maternal and Child Health still face the complex challenges of redressing communities that have adopted unsafe formula-feeding practices and promoting the revised WHO recommendations so that they may be effectively implemented to ensure the safest programmes for mothers and children throughout the developing world.

____________________________________________

(1)Smart T,: Infant feeding policy debated at the 14 th CROI – AIDSMAP HATIP#82, 13 th March 2007. http://www.aidsmap.com/en/news/1F9F2D35-099B-42A5-94EA-OFEC977756E6.asp

(2)WHO HIV and Infant Feeding Technical Consultation, Consensus Statement (Oct. 2006 in Geneva) http://www.who.int/child-adolescent-health/publications/NUTRITION/consensus_statement.htm

(3)Creek T, Arvelo W, Kim A, Lu L, Bowen A, Finkbeiner T, Zaks L, Masunge J, Shaffer N and Davis M. Role of Infant Feeding and HIV in a Severe Outbreak of Diarrhea and Malnutrition amoung Young Children, Botswana, 2006, Poster session 137, 14 th CROI, Los Angeles 25-28 February, 2007. http://www.retroconference.org/2007/Abstracts/29305.htm

(4)Ref: Thomas T, Masaba R, van Eijk A, Ndivo R, Nasokho P, Thigpen M and Fowler M. Rates of Diarrhea Associated with Early Weaning among Infants in Kisumu, Kenya, Poster Session 138, 14 th CROI, Los Angeles, 25-28 February http://www.retroconference.org/2007/Abstracts/29105.htm

(5)Sinkala M, Kuhn L, Kankasa C, Kasonde P, Vwalika C, Mwiya M, Scott N, Semrau K, Aldrovandi G, Thea D and Zambia Exclusive Breastfeeding Study Group (ZEBS). No Benefit of Early Cessation of Breastfeeding at 4 Months on HIV-free Survival of Infants Born to HIV-Infected Mothers in Zambia : The Zambia Exclusive Breastfeeding Study, Session 136, Poster Session, 14 th CROI, Los Angeles 25-28 February, 2007. http://www.retroconference.org/2007/Abstracts/28331.htm

(6)Coovadia HM, Rollins NC , Bland RM, et al. Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. Lancet 2007; 369: 1107-16.

Interview with Kiersten Israel-Ballard:
The Importance of Young Researchers in HIV and Breastfeeding

Kiersten Israel-Ballard is a young PhD candidate at the UC Berkeley School of Public Health. Much of Ms. Israel-Ballard's research has centred on Breastfeeding and HIV in Kenya and Zimbabwe . Her most current study, to which she is the lead author, will be featured in the July 1, 2007 print issue of Journal of the Acquired Immune Deficiency Syndromes. This ground-breaking study has shown that flash-heating HIV-infected breastmilk will eliminate the presence of the virus without compromising the benefits of the milk. Perhaps most importantly, this pasteurization can be done very simply with tools readily available throughout resource-poor regions.

Kiersten took the time to discuss with the WABA YOUth Newsletter the focus of her research and the signifance of youth in its innovations.

2. Briefly, how has your professional or personal journey brought you to researching Breastfeeding and HIV?

My science interest was initially lab-based in molecular, cellular and development biology. But while I was doing a Master of Public Health program in Infectious Diseases at UC Berkeley, I became increasingly interested in the plight of HIV positive mothers and the issues surrounding prevention of mother-to-child transmission (PMTCT) of HIV. To me it seemed that these mothers and babies were the ultimate victims of this pandemic. Infant feeding seemed particularly complex given the resource disparities that exist between the developed and developing world. While reading one article on PMTCT, heat treatment of breast milk was mentioned; an option I had never even heard of even in a graduate program focused on preventing infectious disease. My first assumption was that heat treatment must not be a viable option, but I soon came to realize that there were major gaps in knowledge since it had received such little research attention. My reaction at that point was “how was this even ethical?” Heat treatment was a WHO recommendation and yet HIV positive mothers were not being told of it as an option. These mothers have a right to be fully informed of ALL possibilities to save their babies; only they have the right to decide what they will or won't do for their babies. This human rights framework has been the driving force behind all of our research to date; we hope that as a result of our work, heat treatment soon will be part of usual infant feeding counselling practice.

3. The intersection of infant feeding and HIV/AIDS has been and continues to be such a charged subject in Public Health. What are some of the obstacles that you face and how do you work with them?

I feel that the primary obstacle is the paternalistic approach to prevention. Decisions are often made for the mother, not giving her the opportunity to decide for herself what is best for her personal circumstances. I believe that these mothers are grossly underestimated – they are strong and absolutely dedicated to saving their babies. We have heard such anger from these mothers – “why weren't we told about this option?” Many infant feeding decisions have been made by western researchers sitting behind a desk with little to no involvement from those within the very communities who are impacted by such decisions. Communities should be a party of policy making discussions from the start when it affects something as culturally charged as infant feeding. Transdisciplinary research should be promoted since it allows different perspectives and could alleviate inappropriate prevention methods. Bringing together nutritionists and PMTCT experts is just one example of what is necessary for developing effective infant feeding strategies. After all, the goal should be a shared one: improving infant survival.

Our research project addressed these issues from the very beginning. The first phase of our study involved talking with mothers, community health workers and others within the community to gather opinions and suggestions. They are the experts when it comes to practical implementation – what will or won't work in their communities, and how to overcome challenges. We also created a transdisciplinary research team to address the multifaceted issues of infant feeding, particularly heat treatment of breast milk. This team included experts in paediatrics, nutrition, child health, epidemiology, virology, immunology, microbiology, food science, thermal kinetics, medical anthropology, and sociology. We have worked closely as a group, meeting often or on conference calls together, working to design appropriate methods to take this study forward. The diversity of the opinions and strengths of this team has helped to maintain the focus of this project with the goal of transferring this technology to field settings.

4. What elements of the current research in HIV/AIDS and Breastfeeding do you find draws young researchers? What aspects of the field prevent new engagement?

Given how much we are learning and the constant change, I think this is a very exciting field to be in. There is much still to learn and as a result, it is a very dynamic field drawing an enthusiastic group of researchers. Due to the very nature of infant feeding, it requires a variety of expertise, which means there is “fresh blood” providing diverse perspectives. There is also constant dialogue about how to improve upon ever-changing policy based findings from recent studies.

As in many fields, new engagement can be stifled when others are resistant to change. As researchers, it is vital to maintain open-mindedness to new data, theories, and intervention methods yet often, it seems challenging for policy makers to be familiar with what may be appropriate at the grassroots level.

5. How do you see the future of research in this field? And what role do you see young people playing in the advancement of this part of Maternal and Child Health?

I think we have a very optimistic future ahead. Even with the rampages of HIV still occurring in many parts of the world we are becoming better equipped with practical ways to prevent transmission. Young people have a critical role in the future of this field. It is imperative to have current policy scrutinized through fresh and critical eyes. Sometimes the solution is right in front of us, and yet we are blinded by what we “know”. Enthusiastic, dedicated people will be important in continuing to liaise between communities, researchers, and policy makers. Researchers new to the field have a unique ability to better facilitate communication at the grass roots level and to ensure that interventions are appropriate to the needs of the mothers and babies we strive to serve.

(Photo:Kiersten Israel-Ballard)

If you would like to receive this newsletter, please join the YOUth-4-Breastfeeding Yahoo! Group, or send an email to YOUth4breastfeeding-subscribe@yahoogroups.com

Please share this newsletter with your friends and colleagues. For more information about this newsletter, write to YOUth4breastfeeding@yahoogroups.com

If this newsletter has been sent to you in error, or if you would like to be removed from the list, please unsubscribe here: YOUth4breastfeeding-unsubscribe@yahoogroups.com

The opinions and information expressed in the articles of this issue do not necessarily reflect the views and policies of WABA, the Youth Working Group and the Newsletter Editors. For further information or topic discussion, please email us.
           
The World Alliance for Breastfeeding Action (WABA) is a global network of individuals and organisations concerned with the protection, promotion and support of breastfeeding worldwide based on the Innocenti Declarations, the Ten Links for Nurturing the Future and the WHO/UNICEF Global Strategy for Infant and Young Child Feeding. Its core partners are International Baby Food Action Network (IBFAN), La Leche League International (LLLI), International Lactation Consultant Association (ILCA), Wellstart International and Academy of Breastfeeding Medicine (ABM). WABA is in consultative status with UNICEF and an NGO in Special Consultative Status with the Economic and Social Council of the United Nations (ECOSOC).

[Close this window]