Ten Steps to successful Breastfeeding

1. Have a written breast-feeding policy that is routinely communicated to all health care staff
2. Train all health care staff in skills necessary to implement this policy
3. Inform all pregnant women about the benefits and management of breastfeeding
4. Help mothers initiate breast-feeding within a half-hour of birth
5. Show mothers how to breast-feed, and how to maintain lactation even it they should be separated from their infants
6. Give newborn infants no food or drink other than breast-milk, unless medically indicated
7. Practice rooming-in, allow mothers and infants to remain together - 24 hours a day
8. Encourage breast-feeding on demand
9. Give no artificial teats or pacifiers (dummies / soothers) to breast-feeding infants
10. Foster the establishment of breast-feeding support groups and refer mothers to them on discharge from the hospital or clinic

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Core Breastfeeding Information

• Breastmilk alone is the best possible food and drink for a baby. WHO/UNICEF recommends that all infants be fed exclusively on breastmilk from birth to six months of age, and breastmilk together with complementary food for two years and beyond.
   
• Virtually every mother can breastfeed her baby. It is helpful to have support and assistance from family, friends, health workers and employers.
   
• Babies should start to breastfeed as soon as possible after birth. Baby should be breastfed whenever he or she wants to.

• Frequent suckling at breast is normal, satisfies and comforts the baby, and causes more milk to be made. The time between feedings gradually lengthens as the baby gets older.
   
• Breastfeeding helps babies grow normally and protects them from getting sick. Other baby foods do not give protection, and can cause illness if not made up and fed properly.
   
• When a child reaches six months old, a variety of other foods can be introduced, but breastfeeding should continue well into the second year of a child's life and for longer if possible.
   
• Mothers working/employed outside the home can continue breastfeeding by expressing milk or breastfeeding during the workday. Adequate maternity leave, breastfeeding breaks, facilities, and nearby childcare are helpful.

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Breastfeeding and HIV/AIDS

HIV passes via breastfeeding to about 14 percent of infants born to HIV-infected women, at least if the breastfeeding is not exclusive. Preliminary research suggests that HIV may transmit through breastmilk at much lower levels, perhaps hardly at all, during exclusive breastfeeding (that is, when babies receiving nothing but breastmilk, not even water).

HIV in infants not given antiviral drugs nearly always results in death. But babies are also highly likely to die from diseases resulting from artificial feeding where supplies, sanitation and hygiene, and medical care are not always available. This risk is not yet quantified in many settings, including Africa. Thus it is not always possible for either health workers or mothers to know which is the wisest choice.

In general, the UN agencies advise that complete replacement of breastmilk with infant formula be undertaken only where "(1) the family has reliable access to sufficient quantities for at least six months, (2) the family has the resources - water, fuel, utensils, skills and time - to prepare it accurately and hygienically. "Other options include heat treatment of expressed breastmilk and wet nursing by a woman who has tested HIV-negative.

Key points on HIV/AIDS

• Families need to have access to voluntary and confidential HIV counselling and testing (VCT)
   

• The highest risk of HIV transmission to the breastfed baby appears to be during the early weeks and months of breastfeeding when it may be indistinguishable from transmission occurring during pregnancy or during birth. Although the risk of transmission of HIV through breastfeeding by an already-infected mother continues as long as the baby is breastfed, it appears to be reduced with increasing age, particularly the baby exclusively breastfed for the first six months of life.

• Breastfeeding should continue to be protected, supported and promoted generally, as most mothers are not infected or do not know their HIV status. Indeed, in 2001 less than 1% of women making antenatal visits in Africa for example even have access to VCT.
   

• The provisions of the International Code and the BFHI should continue to be implemented even in areas with a high prevalence of HIV/AIDS.
   

• The best way to protect babies form becoming infected is to protect their mothers from being infected with HIV by their sexual partners.