By Estelle Ellis, Gill Gifford and Jillian Green
Breast milk is superior to any other way of feeding infants.
It is valuable for the sustained health of babies to be breastfed for at least six months and even beyond the age of two. Partial artificial feeding can have a negative effect.
If draft regulations issued by the department of health are put into practice, these are just some of the warnings that will be contained in every story written about ways to feed babies.
The regulations will also bar the advertisement and promotion of infant formula, follow-up formula or any other milk product marketed as suitable for feeding an infant or toddler.
It is also aimed at barring the advertisement of "any other product marketed or otherwise represented as suitable for the feedings of infants up to the age of six months", feeding bottles, teats, dummies and feeding cups.
According to the draft regulations, no negative claims may be made about the nutritional content of human milk.
Information or audiovisual material about complementary foods must contain: the appropriate age at which the food can be given to a child, a warning that complementary foods are not intended for infants under six months and that the early introduction of complementary foods might have health hazards, and an expression that home-prepared foods are equally beneficial for infants from six months.
But preventing the distribution of information about the alternatives to breastfeeding is very dangerous, especially in a country where more than 26 percent of women are HIV-positive, said Treatment Action Campaign spokesperson Mark Heywood.
Dr Eddie Mhlanga, chief director of the maternal, child and women's health and nutrition unit within the department of health, said the regulations were aimed at curbing irresponsible advertisements concerning baby formula.
"There are some manufacturers who claim that use of their baby formula will make the child brilliant, while there is no scientific evidence to support this. This is irresponsible. We want to make feeding as safe as possible."
Claire Tucker, of the Sandton law firm Bowman Gilfillan, said the draft regulations contained many valuable proposals, such as that any foodstuff for infants must be free from residues of hormones, antibiotics or other contaminants.
"Nevertheless, various bodies have argued that other provisions are unduly onerous or even impossible to comply with."
"A particularly controversial provision is one which requires that the packaging of various formula products must contain the message 'breastfeeding provides the best food for your baby and reduces the risk of diarrhoea and illnesses', and 'before you decide to use this product, consult your doctor or health worker for advice'."
"This message must be placed on the container in three official languages, of which English is one. The controversy arises for various reasons, including the debate regarding whether HIV-positive mothers should breastfeed their children.
"In addition to these requirements, there must be instructions for the preparation, sterilisation and storage of the products, as well as other requirements. It has been suggested that these types of requirements are confusing,as well as difficult or impossible to comply with.
"In addition to the labelling requirements, the regulations impose severe restrictions on the marketing, promotion and dissemination of information in relation to various infant products."
Tucker explained that there may well be a legal challenge to the regulations if they are made law in their present form. Submission on the draft regulations can be made until February 26.
Kinami Ndungu, head of the Freedom of Expression Institute's anti-censorship programme, said the proposed limitations were a restriction on people to express themselves.
"But the department of health have good intentions, and for that they should be lauded," he said.
What about HIV-positive mothers?
Where an HIV-positive mother has access to clean water, the use of baby milk formula is preferable.
This is according to the Treatment Action Campaign's Mark Heywood. Where the mother has no access to clean water, "it is a question of balance".
"Breastfeeding could lead to the baby being infected with HIV, while the use of unclean water in formula milk could lead to the child developing severe diarrhoea and other illnesses, which could be fatal," Heywood said.
He added that the need to give all parents sufficient, accurate information was of paramount importance to allow them to make informed decisions regarding their baby's nutrition.
"While there is general consensus that breast is best, the HIV epidemic introduces other considerations which need to be looked at," Heywood said.
According to an article published on the online version of Mothering magazine concerning HIV and breastfeeding, the United Nations Programme on HIV and Aids announced in 1999 that it would discourage all women who are HIV-positive from breastfeeding their babies.
They warned there was a risk that breastfeeding might give the virus to the uninfected baby.
Dr Eddie Mhlanga, chief director of the maternal, child and women's health and nutrition unit within the department of health, said that in an ideal world, one would say that all HIV-positive mothers should not breastfeed.
But that was provided that the infrastructure in terms of clean water and electricity was available.
"In a developing country, this is not possible.
"Where a woman might have access to clean water, she might not have access to electricity or fuel to clean the bottle.
"An unclean bottle is a breeding ground for germs."
Mhlanga said that if a woman chose to formula-feed her baby, she should rather do so using a cup or spoon.
Studies have shown that breastfeeding by an HIV-positive woman increases the chances of infection in her baby, "but this does not mean that every child will be infected".
"The big challenge to us is that we do not know how to determine which children will be infected and which will not," Mhlanga said.
According to him, parents will be informed by health workers about the options available to them and support will be rendered, irrespective of the choice they make - breastfeed or formula-feed.