He told delegates that South Africa was going through a ‘€œrough patch’€ with child mortality increasing at a disturbing rate.

He said there were a number of interventions that needed to be taken to decrease child mortality, one being a review of the evidence on breastfeeding especially in the context of HIV.

Public health experts have for a long time warned that many gains at birth, including the prevention of HIV transmission from mother to child, were being reversed by the lack of a proper national policy on infant feeding.

‘€œThere are very few medical conditions that make it necessary for formula feeding. Most if not all mothers can breastfeed. In the past all mothers breastfed their children, in fact this was the tradition. I don’€™t know what changed ‘€“ but by actively promoting formula feeding, manufacturers portrayed those that breastfed as not being worthy pretty much as those that sold skin whiteners to us did ‘€“ unless you had fair skin you were not a worthy human being.

‘€œI propose that infant formula should only be used when prescribed by a doctor,’€ said Motsoaledi.

He said he did not wish to pre-empt the outcome of the meeting, but believed that the country needed to ‘€œreposition, promote, protect and support’€ breastfeeding as a key child survival strategy.

South Africa, is one of the countries with low prevalence of exclusive breastfeeding at 8% according to the 2003 Demographic and Health Survey. A dramatic drop in exclusive breastfeeding rates was reported in the age group four to six months, where only 1,5% of infants were exclusively breastfed. This is one of the lowest rates of exclusive breastfeeding in the world.

Data from the Human Sciences Research Council national survey suggested that among infants 0 to 6 months, 25,7% were reported to be exclusively breastfed whilst 51,3% were mixed fed,   with solids and formula being   introduced far too early in life.

Breastfeeding has profound impact on child’€™s survival, health, nutrition and development with these benefits lost when formula feeding is given.

Motsoaledi said he had identified some barriers to breastfeeding incuding the ‘€œaggressive promotion’€ by manufacturers or distributors of formula milk; practices in health facilities that are not supportive of breastfeeding and working mothers often stopping breastfeeding once they return to work.

Public health experts have for years called for a proper policy on breastfeeding in South Africa.

Earlier this year public health expert Professor David Sanders claimed that the issue of infant feeding was always ignored in AIDS discourse.

‘€œ35% of SA under-5 deaths are associated with HIV. This leaves 65% of child deaths due to other conditions. South Africa’€™s under 5 mortality rate of 67/1000 live births is worse than Bangladesh (54/1000),’€ said Sanders.

He said diarrhoea and pneumonia were the top two killers (as well as newborn problems) and that all of these causes were much higher in a non breast-fed population.

‘€œHIV has further undermined breastfeeding in this country. We find in our research that most infants (HIV positive and HIV negative) are being given formula from very early. Most HIV positive women  practice mixed feeding (77% by 12 weeks post partum) despite receiving free formula through the health service (except KwaZulu-Natal which has recently decided to phase out free formula).’€

Sanders said this meant many children were dying unnecessarily from infections and that the HIV community had unwittingly contributed to this.

Dr Tanya Doherty, an expert researcher on Prevention of Mother to Child Transmission at the Medical Research Council, said in July that there had to be an unequivocal message that breastfeeding was best. ‘€œIt is concerning that South African PMTCT guidelines still recommend the provision of free formula milk through public health facilities despite WHO recommendations that governments should promote a single feeding method that is likely to provide the greatest chance of child survival. In South Africa, this is breastfeeding,’€ said Doherty.

‘€œThe current lack of a clear message about breastfeeding could reverse the gains made in the PMTCT arena,’€ she warned.