Global Forum II, Nurturing the Future:
Challenges for Maternal Lactation in the 21st Century
World Alliance for Breastfeeding Action – WABA
Tanzania, September 2002
Cooperation between women’s organizations and alliances for maternal
lactation at a global scale: a strategy proposal
Dr. Ana María Pizarro
Women’s Health Network for Latin America and the Caribbean Area
SI MUJER. Nicaragua
“With legal, economic, practical and emotional support, mothers should be able to
breastfeed their infants in an exclusive way between the age of 4 and 6 months, and even
longer…” This assertion is quoted from the 8th paragraph of El Cairo’s Action Program1,
which is. Needless to say that this paragraph was not brandished by fundamentalists in
their violent campaign against women’s rights.
Furthermore, and since the pledges taken 8 years before could not be fulfilled, El Cairo
reminds us that “Governments should promote public information about the advantages
of maternal lactation; the health workers should receive training on the proper standards
for maternal lactation and countries should envisage the adequate means aiming at a full
application of the WHO’s International Code for Marketing of Substitute Products for
Breast milk”.
The International Women’s Movement, which dealt with women’s empowerment, their
political participation in decision-taking instances, sexual rights as well as reproductive
rights, education, sexuality, comprehensive health, work, migrations, lacks of capacities
and the impact of sexual, family, economic or political violence – among other key topics
– has not yet tackled the true relevance of maternal lactation up to its real extent. As a
consequence, it seems that this is a pending item on both the national and international
agendas.
The common points
However, the International Women’s Health Movement has made a series of progress on
key issues that facilitate a strategic alliance in favor of maternal lactation, since all the
1
Health, Mortality and Morbidity. Page 55. Report of the Conference on Population and Development.
September 1994.
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factors related to this right – the women’s as well as the infants’ – have been clearly
stated and advocated. This is why we are demanding the right to infants’ and women’s
survival in legal, economic, emotional and nutritional conditions that all point towards
easier reproductive, birthing, upbringing and development processes of children who are
welcomed into our societies.
A global debate on the HIV/AIDS pandemic has somewhat darkened the situation on the
maternal lactation advocacy front. In this field, the international women’s movement has
opened the way by asking firmly to the international organizations, cooperation agencies,
authorities and governments, men and women working in health programs and society as
a whole, to take an active and responsible part in the fight for the women and their infants
to exercise their:
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Right to a sustainable health and decent living standards
Right to reliable information
Right to counseling and confidentiality
Right to true access to good quality health services
Right not to be an object of experimentation
The International Women’s Health Movement has recently expressed its view in
Toronto2, on key issues that affect the living standards of women and infants. In the Latin
American Declaration against fundamentalisms and neoliberal globalization, we have
committed ourselves to:
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Explicitly opposing to the neoliberal policies and development models,
established by our governments and which appear to be detrimental to the quality
of life and to the health of women and children of the whole world.
Systematically denouncing all the attempts and policies that aim at colonizing the
bodies of women, violating their rights and depriving them of their exercise of
citizenship.
Facing up to the reforms set up in the health sector as well as their impact on the
comprehensive health of women.
Eliminating the traditional practices that go against the women’s and their
infants’ human rights.
The International Women’s Movement has been denouncing the effects of poverty and
social exclusion on women, as well as the consequences of the AIDS pandemic. Since the
issue of maternal lactation is currently acquiring specific relevance and in view of the
recommendations put forward by international organizations as regards lactation in
extraordinary cases, we think that there is a number of contradictions that need to be
solved, for instance:
 The research works report different figures about the probabilities for an HIVpositive woman to transmit the virus to the fetus or the newborn during
2
9th International Meeting on Women and Health. Toronto, Canada, bet. 12th and 16th August.
2
pregnancy, delivery or lactation, especially if the latter is protracted. The reports
show considerably different findings, since vertical transmission is ranged
between 7%3 and 45%4 in so-called “developing” countries. Some other sources
give a figure of 50% for the latter.
 Maternal lactation is said to make up for 3%5 to 4%6 of all the cases of vertical
transmission, although other sources report a 14%7 to 19%8 range.
 To this respect, in 1998, the International Communities of Women Living with
HIV/AIDS9 (ICW), hoping that UNAIDS would welcome favorably these
recommendations, expressed its stance about the priority issues which affect the
women living with the virus and that are still in need of a solution. Some urgent
research needs to be carried out on maternal lactation, since mothers have a right
to know that it can be a means of transmission as well as to be informed of the
research done to this respect. Mothers also are entitled to know about other
alternatives, excluding commercial formulas.
 The UNAIDS recommendations include an HIV screening test to all pregnant
women. The ICW Living with HIV/AIDS are totally opposed to compulsory tests
– in all theirs forms – for HIV antibodies detection. This does not mean that
UNAIDS intents to conduct compulsory tests, but that there is a risk of distorted
interpretation – actually disseminated – of health programs led in poor countries.
When the results of the screening tests are available, pregnant women can really
be discriminated against.
 There is no generally agreed recommendation applicable in relation to
breastfeeding in the case of HIV-positive mothers. A lot of programs launched by
UNAIDS in Africa and Asia promote maternal lactation since the proven risks of
neonatal death caused by diarrhea, malnutrition or respiratory conditions are both
considerable and proven to be higher. For instance, in the Philippines, research
has shown that the risk of diarrhea is 17 times as high in the case of infants aged
between 0 and 2 years who were not breastfed10.
 However, a series of agreements have also been reached in Latin America11,
compiled into an Action Agenda for the AIDS/ETS National Programs. These
3
HIV Mother-to-Child Transmission. IBFAN, 2001.
Maternal Lactation and HIV/AIDS. Global Campaign against AIDS, 1997. Source : UNAIDS.
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IBID #1.
6
Maternal Lactation and HIV/AIDS, frequently asked questions. Linkages, May 2001.
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IBID #5.
8
Overview of maternal lactation and HIV transmission in Latin America. José Izazola Licea. SIDALAC.
1998.
9
12th Global Conference on AIDS. June 1998, Quoted in Women, Vulnerability and HIV/AIDS. From the
point of view of the Human Rights. Women-Health Newsletters #3. Women’s Health Network for Latin
America and the Caribbean Area.
10
Popkin et al. 1990. IBID #7.
11
Meeting on HIV transmission through maternal lactation, Brasilia, Brazil, November 1998.
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agreements recommend to ”counter-indicate maternal lactation for HIV-positive
women and provide them with breast milk substitutes”. Such a contradiction must
be solved and the messages aimed at health workers and the mothers themselves
must be simplified and submitted to homogeneous criteria, applicable to each
local reality.
 The chances to have access to HIV screening tests are very limited in the health
services of poor countries. There is also a shortage of services aimed at
guaranteeing proper counseling to HIV-positive women. And the situation gets
even more complex when it is about counseling on lactation in the case of HIVpositive pregnant women.
 Another dilemma is the recommendation for the health services to provide HIVpositive women with antiretroviral medication. A vast majority of health budgets
does not include this type of medicines, quite costly because of the voracity of the
market. False hopes are being created surrounding health care for the affected
population. While a high percentage of infants are born HIV-positive.
 And to finish off the list of concerns, one must take into account the impact of
health programs that recommend shifting from maternal lactation to breast milk
substitutes. Generally, such programs have not the necessary resources to
distribute the substitutes, which generates dissatisfaction as well as a risk of
malnutrition and neonatal death.
 The ethical dilemmas of experimentation regarding pregnancy, HIV and lactation
must also been taken into consideration. To this respect, the ICW are opposed to
the tests using placebo-based controls, since studies have revealed the efficiency
of the drugs used in the tests. What is more, the ICW advocate for a protection
and preservation of the women’s rights as well as for the dignity of their infants
and children12.
The need to solve those issues clearly shows that priority must be given to creating an
alliance between WABA, other maternal lactation advocacy sectors and the organizations
that constitute the international health movement.
The Women’s Health Network for Latin America and the Caribbean Area, with
headquarters in Chile, as well as the Women’s Global Network for Reproductive Rights,
with headquarters in Amsterdam, are strongly committed to strengthening, developing
and creating alliances with other groups and organizations, in order to defend the rights
and fields that have been conquered, as well as to make progress towards enlarging
those rights and guaranteeing respect of democracy and citizenship for all women.”13
12
IBID #8.
Declaration made by the Latin American women’s groups and organizations during the 9 th International
Meeting on Women and Health, Toronto, August 2002.
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