6 Apr 2012

SOUTH AFRCIA / HIV BREASTFEEDING

For over a decade, HIV positive pregnant mothers in South Africa were assured that they would stop the transmission of HIV to their babies by not breastfeeding and instead feed their infants formula. But by not breastfeeding, they were exposing them to other deadly childhood killers like diarrhea and pneumonia. The government is now rolling out a new policy that aims to bring down the stubbornly high levels of infant and child mortality. UNICEF

Posted at: April 6, 2012 12:01 am

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STORY: SOUTH AFRICA / BREASTFEEDING
TRT: 4:20
SOURCE: UNICEF
RESTRICTIONS: NONE
LANGUAGE: ENGLISH / NATS
 
DATELINE: DECEMBER 2011, KWAZULU-NATAL, DURBAN, SOUTH AFRICA

SHOTLIST:

1. Tilt down, clinic waiting room
2. Med shot, mother feeding child formula to her baby
3. Close shot, infant being fed formula 
4. Close shot, infant sleeping
5. Med shot, infant sleeping in mother's lap
6. SOUNDBITE (English) Chantell Witten, Nutrition Specialist, UNICEF South Africa:
"In the context of HIV, we've had an inquiry into why children are dying and we know they die in the first 28 days, called the neonatal stage, and from those children who have died 60 per cent of them died because of malnutrition specifically going back to diarrhoea and the reason why children die of diarrhoea is because their immune system is not developed, they have an immature immune system and then the feeding options mothers are choosing specifically around formula feeding is that we have introduction of contaminates."
7. Med shot, sign of maternity ward
8.Pan left, maternity ward
9. Close up, baby sleeping
10. Pan right, Durban conference centre to city
11. Wide shot, traffic
12. Close up, baby being breastfed
13. Close up, mother breastfeeding baby
14. Close up, baby being breastfed
15. Pan right, "exclusively breastfeeding sign"
16. Wide shot, Nurse speaking to mother
17. Close up, baby being breastfed
18. Med shot, woman breastfeeding in hospital
19. Close up, woman breastfeeding
20. Wide shot, maternity ward
21. Med shot, mother breastfeeding
22. Close up, mother breastfeeding
23. Med shot, mother bottle feeding baby
24. Close up, baby being bottle fed
25. SOUNDBITE (English) Professor Anna Coutsoudis, KwaZulu Natal University: 
"When the WHO issued their international guidelines, they were basically saying we've looked at the evidence, we've weighed up the risk, yes, there is a small risk of transmission of HIV through breastfeeding but we know how to make it safer if the mother is either on treatment or if the baby gets prophylaxis. We can reduce that transmission down to one to two percent. And we know on the other hand, very strong clinical evidence that not breastfeeding or breastfeeding for a very short period of time increases the infant's risk of infant mortality."
26. Wide shot, breastfeeding training
27. Med shot, breastfeeding training, woman holding toy
28. Close up, toy in woman's arms
29. Wide shot, healthcare worker talking to mothers with toys in the foreground
30. Close up, nurse pulls out injection
31. Med shot, nurse gives child vaccination
32. Close up, nurse writing and making notes
33. SOUNDBITE (English) Mnguni Nompumelelo, Nurse:
"It was very, very difficult because people were not understanding. You had to really talk to them…intensive counselling and sit with them and explain how important the breast milk is."
34. Close up, breastfeeding poster
35. Zoom out, breastfeeding poster
36. SOUNDBITE (English) Lenore Spies, Department of Health, KwaZulu Natal
"We are now unifying the message and we are simplifying it. There's one message for all mothers regardless of their HIV status, whereas in the past it was – if you're positive it's different, if you're negative it's different, it became very complicated in terms of what the actual message is."
37. Close up, sign of KZN Midwives committed to reduce child mortality
38. Med shot, midwife talking to mother with baby
39. Close up, midwife talking to mother with baby
40. Close up, mother with baby
 
STORYLINE:
 
For over a decade, HIV positive pregnant mothers in South Africa would rest assured that they would stop the transmission of HIV to their babies by not breastfeeding and instead feed their infants the free formula provided by the Government's Prevention of Mother To Child Transmission Program (PMTCT).

What they didn't realize was that they were very often exposing their infants to other deadly childhood killers like diarrhea and pneumonia.

SOUNDBITE (English) Chantell Witten, Nutrition Specialist, UNICEF South Africa:
"In the context of HIV, we've had an inquiry into why children are dying and we know they die in the first 28 days, called the neonatal stage, and from those children who have died 60 per cent of them died from malnutrition specifically going back to diarrhoea and the reason children die of diarrhoea is because their immune system is not developed, they have an immature immune system and then the feeding options mothers are choosing specifically around formula feeding is that we have introduction of contaminates."

This is about to change as the government takes the first step in rolling out a new policy that aims to bring down the stubbornly high levels of infant and child mortality. Despite being Africa's biggest economy, South Africa is not on track to meet the millennium development goal of reducing child mortality.

The World Health Organization (WHO) says that breastfeeding is one the critical ways to improve child survival. In South Africa though, only an estimated 8 percent of children under six months are exclusively breastfed. So in line with a shift in global policy, the government will now endorse exclusive breastfeeding for the first six months of a child's life and continued breastfeeding two years or beyond. In addition, the transmission of HIV during breastfeeding can be drastically reduced by providing anti-retrovirals to mothers or their infants

As part of this move, the government will stop the free distribution of formula in the PMTCT program in all public health facilities.

Free formula will only be provided under exceptional circumstances and for special medical cases

SOUNDBITE (English) Professor Anna Coutsoudis, KwaZulu Natal University: 
"When the WHO issued their international guidelines, they were basically saying we've looked at the evidence, we've weighed up the risk, yes, there is a small risk of transmission of HIV through breastfeeding but we know how to make it safer if the mother is either on treatment or if the baby gets prophylaxis. We can reduce that transmission down to 1 to 2 %. And we know on the other hand, very strong clinical evidence that not breastfeeding or breastfeeding for a very short period of time increases the infant's risk of infant mortality."

Leading the way in this policy shift is KwaZulu Natal, a province with the highest HIV prevalence among pregnant mothers

It's already rolled out the change in policy though an extensive training programme among health workers and community care givers to promote the benefits of exclusive breastfeeding.

But changing a policy is one thing, changing mindsets is another

SOUNDBITE (English), Mnguni Nompumelelo, Nurse:
"It was very very difficult because people were not understanding. You had to really talk to them…intensive counseling and sit with them and explain how important the breast milk is."

And what makes it easier is that the message is finally clear cut.

SOUNDBITE (English) Lenore Spies, Department of Health, KwaZulu Natal:
"We are now unifying the message and we are simplifying it. There's one message for all mothers regardless of their HIV status, whereas in the past it was – if you're positive it's different, if you're negative it's different, it became very complicated in terms of what the actual message is."

And the message from the evidence available and KwaZulu-Natal's experience is that breastfeeding is without a doubt the best option for all mothers.