Specific issues regarding replacement feeding
Q.41 Are there times when infant formula should be provided?
The provision of free or subsidised infant formula by a national authority may be appropriate in particular circumstances:
1. If a national authority decides to promote formula feeding as the primary infant feeding method for HIV-infected mothers, despite the availability of ARVs. National authorities should only make this decision after establishing that formula feeding will lead to greater survival of HIV-exposed infants, taking into account:
- socio-economic and cultural contexts of the populations served by maternal and child health services;
- availability and quality of health services;
- local epidemiology, including HIV prevalence among pregnant women;
- main causes of maternal and child undernutrition; and
- main causes and levels of infant and child mortality.
In these circumstances, the ability of an individual woman to safely provide formula to her infant should be assessed against the conditions listed in Recommendation 5 of the 2010 Guidelines (e.g. safe water and sanitation, ability to prepare it safely and in sufficient quantities, etc.).
2. Mothers who cannot breastfeed, after a period of trying breastfeeding with full counselling and support.
Many women believe they don’t have enough milk for their infants, often because their baby cries, but nearly all women can breastfeed successfully. Health workers should assess whether the mother can be helped to improve her breastfeeding technique, or whether there is another problem. Caution needs to be exercised in this assessment, especially in cultures where formula feeding has become a norm.
3. Where there are acceptable medical reasons for the use of breast-milk substitutes3 (i.e. infant formula), such as:
- infants who have galactosemia, maple syrup urine disease or phenylketonuria;
- infants who may need other food in addition to breast milk for a limited period because they are born weighing less than 1500 g or at less than 32 weeks of gestation or who are at risk of hypoglycaemia because of specific conditions;
- certain maternal medications (see WHO Breastfeeding and maternal medication);
- herpes simplex virus type 1 lesions on the mother’s breasts or the infant’s mouth.