Why experts are pushing for breastfeeding, warn against formula feeding

Thirty-nine-year-old Elizabeth Aura* is overwhelmed with joy as she cuddles her two-year-old son.

In an instant, her eyes brim with tears as memories of her pregnancy and delivery journey flood back.

Elizabeth, from Naivasha, had long feared becoming pregnant. What terrified her even more was the thought of breastfeeding. She is HIV-positive.

“Would my baby be born with the virus? Would I ever be able to breastfeed safely?” Those were the questions that haunted her.

But under the close care of her doctor, Elizabeth was reassured and guided every step of the way.

She adhered to her treatment plan, successfully suppressed her viral load, and was advised it was safe to conceive.

Immediately after birth, her newborn was given prophylaxis—zidovudine and nevirapine (medicines that help prevent HIV transmission from mother to child).

Even as peers discouraged her from breastfeeding—for fear of passing on the virus—Elizabeth remained steadfast.

For the first six months, her baby received nothing but breast milk—no water, no porridge, no other foods.

After that, she gradually introduced complementary foods but continued to breastfeed until her son turned two.

Today, her youngest child is HIV-negative.

“My toughest days were during breastfeeding,” she says, overwhelmed by tears of joy. “But today, I’m the happiest person on earth, knowing my son will never have to take ARVs for life, like I do.”

Her child remains HIV-negative. ‘Living proof’, she says, that following medical guidance and exclusive breastfeeding can save lives.

“The doctor advised me to exclusively breastfeed for six months,” she recalls. “It was doable. I followed the instructions faithfully, and I was never worried because I did exactly what I was told.”

As Kenya marks Breastfeeding Week, which promotes exclusive breastfeeding, Elizabeth stands among the 60 per cent of mothers who have defied the odds—disproving myths about breastfeeding, particularly among women living with HIV.

Breastfeeding is widely encouraged to support healthy growth and development in babies. Communities are urged to create supportive environments that help mothers produce enough milk for their infants.

Laura Kiige, Nutrition Specialist at UNICEF Kenya, explains that HIV-positive mothers are encouraged to breastfeed exclusively for the first six months.

“They must continue taking ARVs to reduce the chances of their babies getting infected with the virus,” says Kiige. “There is no problem with breastfeeding, so long as mothers remain on their medication.”

She adds: “Babies born to HIV-positive mothers are also given preventive medication, further reducing the chances of contracting the virus during breastfeeding.”

HIV can be transmitted from mother to child during pregnancy, delivery, and breastfeeding.

According to the Ministry of Health’s guidelines on maternal, infant, and young child nutrition, a pregnant woman should use ART (antiretroviral therapy) while breastfeeding, as prescribed by healthcare workers. She should also adhere to scheduled follow-up visits when the baby is six weeks, six months, 12 months, and 18 months old.

Mothers are given ARVs during delivery and supported in initiating breastfeeding immediately.

“It is vital for HIV-positive mothers to breastfeed exclusively for the first six months—180 days—alongside taking their prescribed ARVs,” reads a section of the breastfeeding guidelines.

Mixed feeding puts babies at a much higher risk of HIV infection.

Introducing other foods or drinks besides breast milk can damage the baby’s gut lining, making it easier for HIV and other infections like diarrhoea and pneumonia to enter.

Kiige further explains that breast milk contains all the nutrients a baby needs for the first six months—energy, proteins, vitamins, minerals, and immunity-boosting components.

The first milk, known as colostrum, is especially rich in immune-boosting properties.

“Breast milk is sterile—it contains no germs or harmful microorganisms. Other foods often have imbalanced protein and energy content, and may expose babies to bacteria,” she says.

Babies who are exclusively breastfed, Kiige notes, are less prone to illness compared to those who are mixed fed.

“Breast milk is the baby’s first immunisation,” she affirms.

Dr Emily Njuguna, a paediatrician at PATH, agrees the benefits of breast milk are immense.

“Breastfeeding reduces deaths in children under five, especially from pneumonia and diarrhoea. It prevents malnutrition and supports brain development and IQ,” she says, adding that it also reduces the risk of breast and ovarian cancer in mothers.

Breast milk contains immunoglobulins, which protect against diarrhoea and pneumonia.

Colostrum also helps babies pass their first stool (meconium), preventing clinical jaundice—a condition marked by yellowing of the skin and eyes.

“Colostrum has fats essential for brain and nervous system development and promotes gut maturity,” Dr Njuguna explains.

After six months of exclusive breastfeeding, Kiige recommends complementary feeding.

“By 180 days, breast milk alone is no longer sufficient. Babies need additional nutrients, but food must be introduced properly to avoid contamination,” she says.

Introducing foods too early risks infections due to poor hygiene in preparation, storage, and handling.

Kiige discourages the use of formula milk, stating it lacks many essential components found in breast milk.

“Commercial infant formulas cannot match breast milk. Breast milk evolves with the baby’s needs; formula doesn’t. It’s usually made from soy or animal milk, like cow’s milk, which is designed for calves,” she explains.

She stresses that formula is only recommended in special cases—such as when the mother is deceased or on medication that prevents breastfeeding.

“Even the hygiene of formula is questionable. Some products have been recalled after being fed to infants,” she warns.

After complementary foods are introduced, breastfeeding should continue until the child is two years old.

“Mixed feeding often leads to overfeeding, causing obesity and increased risk of diabetes later in life. Weight gain doesn’t always indicate good nutrition,” Kiige notes.

She urges mothers to be aware of ‘hidden hunger’—micronutrient deficiencies that may not be visible despite weight gain.

She also debunks the myth that a crying baby is always hungry.

“Babies may cry because they’re wet, lonely, or simply following a pattern. Mothers must stay close to understand their baby’s needs,” she advises.

Dr Njuguna adds that many mothers perceive they don’t produce enough milk.

“We call this ‘perceived low milk supply’. If the baby is gaining weight and soiling nappies regularly, the milk supply is likely fine,” she explains.

This misconception leads many mothers to use formula substitutes—something only to be done under medical advice.

“Formulas are made from cow’s milk, which some babies can’t tolerate. They also lack some key immune-boosting components,” says Njuguna.

She insists most women can produce enough milk unless they have specific health issues, such as hypertension, are on certain medications, or have anxiety or mental health conditions.

To ensure adequate milk production, mothers need support.

In rural areas, mothers often spend long hours fetching water or firewood, limiting breastfeeding time. In urban settings, work schedules present similar challenges.

A visit to Kenyatta National Hospital (KNH) reveals baby-friendly facilities promoting successful breastfeeding.

Breastfeeding policies are prominently displayed in maternity, labour, postnatal wards, and clinics, ensuring mothers exclusively breastfeed.

“We ensure mothers do not use infant formula or feed expressed milk in bottles,” says Agnes Sitati, Chief of Nutrition at KNH.

“We teach mothers to use feeding cups.”

KNH does not accept donations from formula manufacturers. Any formula used is procured by the hospital for specific cases.

“Formula is only introduced if the mother is ill or deceased,” Sitati adds, citing the Breast-milk Substitutes Regulation and Control Act of 2012.

All paediatric healthcare workers are trained to support breastfeeding.

Education begins during antenatal care, where mothers learn about the importance of a balanced diet and hydration for milk production.

“The mother’s emotional and physical health is key to milk supply,” Sitati says.

Breastfeeding is initiated within the first hour after birth. This also helps the uterus contract, preventing postpartum haemorrhage.

In the postnatal ward, mothers share a bed with their babies and are trained to breastfeed while lying down or in comfortable positions.

Separation only occurs if the baby is critically ill. In such cases, mothers express milk every three hours for feeding.

Even newborns in ICU are fed using cups—or tubes, when necessary.

“Most mothers return to work after 90 days. We teach them how to express and store milk. Properly frozen milk can last six months,” Sitati says.

Mothers are encouraged to breastfeed on demand—not just when the baby cries.

Finger-sucking, for example, can be a hunger cue.

Each session should last at least 30 minutes. The first milk (foremilk) quenches thirst; the later milk (hindmilk) provides fats and calories.

“If a baby wants to breastfeed every hour, they’re likely not getting enough hindmilk,” Sitati explains.

After discharge, mothers are encouraged to attend child-friendly clinics to monitor feeding and their baby’s growth.