Nutrition experts recommend that HIV-positive mothers exclusively breastfeed their babies for the first six months to reduce the risk of HIV transmission, but food-insecure Kenyan mothers worry they have insufficient milk to keep their babies full and healthy.
"As much as you would want to do it [breastfeed exclusively], it is hard because I don't have enough food so I just think the milk coming from my breast isn't enough for the child," said Rose Otieno, a 35-year-old mother of six in Nyando District in Kenya's western Nyanza Province.
According to Oscar Kambona, the provincial nutritionist in Nyanza Province, women needed educating on the links between their own food security and their capacity to produce breast milk. "Mothers need adequate food to stay healthy, but the amount of food one takes has no bearing at all on the amount of breast milk and this is what most mothers don't understand," he said.
Experts say the nutritional status of a lactating mother has little effect on her ability to breastfeed, and only in extremely malnourished women is the energy and protein content of breast milk significantly affected. However, they recommend that malnourished mothers increase their food intake during breastfeeding so that they do not compromise their own nutritional status and health.
Drought and poverty
Kenya has been severely affected by a drought sweeping through East Africa; an estimated five million Kenyans require food assistance. While Nyanza is a traditionally fertile and food-secure region, extreme poverty means sufficient food is not always guaranteed.
Benta Akoth, another HIV-positive mother in Nyanza, says if it were not for her husband, she would not have been able to exclusively breastfeed her last two children until they were six months old.
"I have given breast milk without any food for six months... my husband has made it his duty to look for food," she said. "I have many friends who start children on porridge at just three months because there is no food."
|I don't have enough food so I just think the milk coming from my breast is not enough for the child|
According to a 2011 study conducted among 148 women in Kenya's Rift Valley province, women in households affected by food insecurity had significantly greater odds of believing breast milk would be insufficient for six months.
"The lived experience of food insecurity among a sample of low-income, commonly food-insecure, urban Kenyan women reduces their capacity to implement at least one key recommended infant feeding practice, that of exclusive breastfeeding for six months," the authors found.
The UN World Health Organization recommends that "mothers known to be HIV-infected and whose infants are HIV-uninfected or of unknown HIV status should exclusively breastfeed their infants for the first six months of life, introducing appropriate complementary foods thereafter, and continue breastfeeding for the first 12 months of life". It adds that breastfeeding should only stop once a nutritionally adequate and safe diet can be provided.
Charles Okal, the Nyanza Province AIDS and Sexually transmitted infections control coordinator, told IRIN that HIV-positive mothers needed psychosocial and nutritional support in order to exclusively breastfeed.
"There should be a way of involving the community so that they are able to offer support to mothers who come from food-insecure households so that exclusive breastfeeding as an HIV-prevention method becomes effective," he said. "Maybe even a health facility-based feeding programme would be useful."
But Kambona said a health facility-based feeding programme was not the solution. "If you give a woman food at the facility every time she comes, she won't eat while her children go hungry [she will give the food to her children], so it is not only unsustainable, it doesn't solve the problem at all," he said.
"The only solution is for the government to try [to] make households food-secure," he added.