When is it best not to breastfeed?

The best feeding choice must be made by the mother herself after counselling to enable her to understand the risks and advantages of both forms of feeding. Formula feeding is usually only advised if all the following conditions can be met:

  1. Formula is available and affordable.
  2. Clean water is available and feeding cups or bottles can be sterilised.
  3. The mother can mix the feeds correctly.
  4. It is acceptable to her family and society to formula feed.
  5. Primary health facilities are available to monitor the child’s growth.

If any of these conditions cannot be met, which is common when mothers are living in or returning to rural areas, then exclusive breastfeeding for 4 to 6 months followed by rapid weaning off the breast is probably safest. In these infants, the risk of death due to gastroenteritis and malnutrition if formula fed is often higher than the risk of HIV infection via breastfeeding.

WHO uses the acronym AFASS for acceptable, feasible, affordable, sustainable and safe.

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