Working Statement on Breastfeeding and HIV

United States Breastfeeding Committee

January 1998

Human milk is the preferred feeding for all infants, including premature and sick newborns, with rare exceptions.¹ For almost all women in the United States, breastfeeding is safe and the optimal method of infant feeding. It provides impressive nutritional, immunological, developmental, economical, psychological, and ecological benefits. It is the normal and natural way to feed a baby while enhancing maternal health.

Most mother-to-child transmission of HIV occurs during pregnancy and delivery, however, a small proportion of this vertical transmission may occur postnatally through human milk. Mitigating factors may be present that increase or reduce the risk of HIV transmission through human milk. In any case, the USNBC considers a mother who is HIV+ to be an extraordinary circumstance and calls for a careful analysis of her individual risk factors and options.

All women should have access to voluntary and confidential HIV testing and counseling. The USBC suggests the following message for mothers from their health care providers

If a mother in the USA is HIV positive, she has several infant feeding options

• Mother's own modified milk (heat treatment inactivates the virus)
• Banked donor human milk (all banked milk is donated from screened mothers and pasteurized)
• Commercial infant formula

Babies of mothers who are HIV+ need not be deprived of human milk, even though their mothers do not directly breastfeed. Appropriately heat treated human milk should be considered a feeding option for infants of HIV+ mothers.

Therefore the United States National Breastfeeding Committee

• Urges access to voluntary and confidential HIV testing and counseling for all pregnant women and their partners
• Advises research into the mechanisms of vertical transmission during breastfeeding that accounts for concomitant risk factors
• Recommends HIV+ mothers receive information on the safe use of appropriately heat treated human milk (their own or donor milk)
• Encourages the creation of more human milk banking facilities which operate under the guidelines of the Human Milk Banking Association of North America
• Requests appropriate funding to support a mother's choice to have human milk available for her infant
• Cautions that in order to avoid conflict of interest, any discussion, strategy session, policy decision, and research on HIV and infant feeding not be conducted with corporations who manufacture and/or distribute infant feeding products and/or are not in compliance with the International Code of Marketing of Breast Milk Substitutes
• Recognizes use of the principles of the International Code of Marketing of Breast Milk Substitutes as a guide to assure that formula companies do not use fear of HIV in the promotion of their products 

The importance of human milk for almost all infants has been recognized by the United States government and major health authorities. We call for a thoughtful response in public and in policy that protects the promotion and support of breastfeeding in the United States.

¹ Workgroup on Breastfeeding, American Academy of Pediatrics: Breastfeeding and the use of human milk. Pediatrics1997; 100:1035-1039.

Return to Publications