Last year, the Rwandan Ministry of Health implemented the World Health Organization’s new recommendation that HIV-positive women breastfeed instead of formula-feed their infants, when certain preconditions in the mother’s health are met. At preventing mother-to-child transmission (PMTCT) clinics across the country, women with sufficiently high CD4 counts were advised to care for their babies the same way that HIV-negative mothers would.
For 44-year-old mother of eight Christine Niyonsaba, this was a relief. Christine has been enrolled in Partners In Health/Inshuti Mu Buzima’s PMTCT program for the births of her last two children, since learning she was HIV-positive. For the first child, she was given formula through the program. Since Rwanda implemented the WHO’s new recommendation, Christine has been breastfeeding the second child, 6-month-old Iratuzi.
Christine says she is happy to be in the amended program. Bottle-feeding her seventh child was a burden for her: she had to carry formula, bottles, and clean water with her everywhere she went—a challenge for any woman living in rural Rwanda.
Together with these difficulties, she felt a silent criticism and heard the whispers of other women in the community, who noticed she wasn’t feeding her baby the way other mothers did. They suspected there was something wrong with her and wondered if she had HIV. “I was ashamed,” Christine says.
Now able to breastfeed Iratuzi, feeding is convenient, and Christine feels confident within her community. “I feel the same as the other women now,” she says.
Most importantly, Christine says she sees a marked difference in her two children. Iratuzi is strong, plump, and energetic. She rarely gets sick, and she has a healthy appetite. When Christine compares Iratuzi to her preceding child, it is clear that formula-feeding failed to provide the same nutritional benefits as mother’s milk. As an infant, the child was thin and often sick, with very little appetite.
Christine can now breastfeed Iratuzi safely thanks to a virtuous cycle of high-quality care. Accompagnateurs (community-based HIV caregivers and counselors) visit Christine every day to administer ART and monitor her health and adherence. At the health center, Christine and Iratuzi regularly visit the PMTCT nurse to monitor her CD4 count and her baby’s development and to conduct periodic HIV testing.
The comprehensive care provided by her accompagnateurs and the staff at the Karama clinic is what allows Christine to breastfeed. She says that this system shows her the importance of adherence, motivating her to continue taking good care of herself and to “pay attention to the medicine.” Clearly, breastfeeding is not only the best feeding method for a growing baby’s healthy development; it is also a tool for encouraging HIV-positive mothers to take ownership of their and their children’s health.