Madam, - Dr Constantin Gurdgiev's interpretation of the WHO resolution on infant formula put to the World Health Assembly last week is very wide of the mark (Opinion & Analysis, May 24th).
Its sole purpose is to better promote, support and protect breastfeeding, which is best for the health and growth of children in the developing world, as elsewhere. The WHO should be lauded for its efforts to stem the global decline in breastfeeding rates, which is estimated by UNICEF to cost the lives of approximately 1.5 million children annually. Most of these deaths occur in the developing world.
The Aids pandemic has not diminished the importance of breastfeeding for child and maternal health. It is true the Aids virus is found in breast milk, but Dr Gurdgiev's estimate of the risk of mother-to-child transmission via breastfeeding is overstated. Current evidence suggests that babies breastfed by HIV-positive mothers have a 10 to 20 per cent chance of infection. Nevertheless, the dangers of HIV transmission must be compared with the risks of not breastfeeding. UNICEF estimates that, where water is unsafe, artificially fed children, including children of HIV-infected mothers, are up to 25 times more likely to die as a result of diarrhoea than a breastfed child.
The WHO, far from vilifying the use of artificial infant formula, recommends "the avoidance of all breastfeeding by HIV-infected mothers when replacement feeding is acceptable, feasible, affordable, sustainable, and safe". Where replacement feeding is not acceptable, feasible, affordable, sustainable, and safe, breastfeeding only is recommended for the first six months.
Dr Gurdgiev also misinterprets as "vilification" the rationale behind the recommendation that a health warning be placed on the labels of artificial infant formula products. This is specifically to address a health hazard, identified from recent evidence, of contamination of formulae with potentially lethal pathogenic organisms during the manufacturing process.
These contaminants (e.g. Enterobacter sakazakii and salmonella) have already caused serious sepsis and death in infants in the developed world.
Another recommendation debated at the World Health Assembly was for the removal of health claims on infant formula labelling because the use of inappropriate and often unsubstantiated claims. - Yours, etc,
MAUREEN FALLON,
National Breastfeeding Co-ordinator,
Department of Health and Children,
Dublin 2.