Breastfeeding in the HIV Epidemic: A Midwife's Dilemma in International Work

Abstract

As standards develop to reduce the maternal-to-child transmission of HIV, healthcare professionals need to evaluate recommendations in the context of culturally-accepted values for the populations to be served. Breastfeeding, a central value in South African families, carries the risk of transmission in mothers that are HIV+. A dilemma faced by international workers is the sharing of information that challenges culturally-accepted practices. A nurse-midwife working with HIV positive women during the childbearing cycle in the United States is expected to implement protocols to prevent transmission of the HIV virus to the newborn. These include administration of antiretroviral medications to the women during the pregnancy and labor, as well as the policy of no breastfeeding, since breast milk contains the HIV virus and can be a source of passing the infection to the baby. Ethical dilemmas develop when the nurse-midwife is an international worker in a country which is in the midst of the HIV epidemic such as South Africa. Current South African policy regarding mother-to-child transmission recommends either exclusive breastfeeding with rapid weaning at six months, or exclusive bottle feeding. Cultural practice favors breastfeeding with the addition of cereals, in effect, mixed feeding. These practices lead to a high risk of transmission and infection in the newborn.