The rising cost of food in northern Uganda is forcing HIV-positive new mothers to turn to risky alternatives to formula milk or exclusive breastfeeding, as recommended by health professionals.
Despite the insecurity caused by a two-decade-long war in the north, prevention of mother-to-child transmission (PMTCT) programmes in the region are reported as largely successful.
The Italian NGO, the Association of Volunteers in International Service (AVSI), says that in its programmes in the districts of Kitgum and Pader, HIV testing and counselling acceptance rate are above 90 percent; more women are also coming to health centres to deliver their babies.
However, health workers and local NGOs trying to provide post natal support are finding it increasingly difficult to ensure that the women continue with safe feeding methods.
Health Alert-Uganda, a local NGO that provides funds for HIV-positive mother's to buy milk, is struggling to meet the demands on its services. The NGO usually provides women with enough money for a month's supply, but the price of milk recently jumped by more than 50 percent, which has forced cuts to its programme.
Powdered milk, while available in local grocery stores, is unaffordable for the vast majority of mothers in the country.
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Ignoring the guidelines
World Health Organization (WHO) guidelines recommend that HIV-positive mothers opt for replacement feeding if it is affordable, feasible, acceptable, sustainable and safe; if not, it recommends exclusive breastfeeding for the first six months of the infant's life.
"The problem has been that some of the mothers breastfeed their children while giving replacement feeds," said Walter Anywar, a project officer with Health Alert. "We can reduce transmission of HIV to babies if support towards baby feeding is provided to these mothers who can't afford the costly replacement feeds."
Grace Adong gave birth eight months ago and was lucky enough to find a local NGO to supply her with a daily litre of cows' milk, but her baby now requires more than a litre a day. Adong can't afford to buy more milk, so dilutes her ration with water.
"I add half a litre of water to the milk so that it can take the baby through the day," she said.
Uganda's PMTCT policy follows WHO guidelines, but acknowledges that the majority of Ugandan mothers cannot formula feed because of high levels of poverty, the low status of women, stigma and an almost universal breastfeeding culture.
"The fact is that most mothers in Uganda, and especially those in post-war northern Uganda, currently cannot afford infant formula," said a recent report on the failures of PMTCT, Missing the Target, by the International Treatment Preparedness Coalition. "There was a feeling among pregnant women that their breast milk was insufficient due to moderate malnourishment, and they were likely to try to supplement it with other feeding, a step that eliminates the risk-protective factor of exclusive breastfeeding."
"The Ministry of Health and non-government service providers should mobilize resources for nutritional support for replacement feeding for babies born to HIV-positive mothers who have registered for prevention of vertical transmission services," the report recommended.