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make a fully and fairly informed choice on how to feed their infants. The main
task is not to prescribe to women what they should do but to remove all the ob-
stacles to feeding their infants in accordance with their own well-informed
choices.
Thus, the solution to the dilemma proposed here is that the mother and child
together should be understood as a dyad, having a type of group rights. Breast-
feeding is the right of the mother and the infant together. This might be expressed in
an additional principle, to be added to the seven formulated by the online Con-
sultation on Human Rights and Infant Nutrition:
8. Infants have the right to be breast-fed, in the sense that no one may
interfere with women s right to breast-feed them.
This means that the pair taken together have rights in relation to outside par-
ties, such as rights to certain kinds of information and services and the rights to
be protected from undue influences from outside interests. It does not say that
women are obligated to breast-feed their infants. It does not invite the state to in-
tervene in the relationships between women and their infants.
The eight principles proposed here do not give priority to the woman or to the
child but instead try to forge a sensible balance between their interests. They are
based on the concept that women should not be legally obligated to breast-feed,
but rather women should be supported in making their own informed choices as
to how to feed their infants. Women should be enabled to make their choices with
172 applications
good information, and with the elimination of obstacles to carrying out their
choices.
There is widespread concern that mothers might make unwise choices with
regard to feeding their infants. We then have two basic options: Either have soci-
ety override the mother s choice, or find ways to support the mother so that she
makes wise choices. In my view, the first approach is disempowering, while the
second is empowering for women. If women are given good information, and
have all the obstacles to breast-feeding eliminated, they are likely to make a good
choice.
Rather than have the state make decisions for them, citizens in a democracy
prefer assurances that nothing impedes them from making their own deci-
sions. To the extent possible, we should be free to choose, and that includes be-
ing free to some extent to make what others might regard as unwise or subopti-
mal decisions.
chapter 12
Feeding Infants of hiv-Positive Mothers
The preceding chapter discussed the application of the human right to adequate
food in the special case of infants. Here we examine a still more special case, the
right as it applies to infants of mothers who have been diagnosed as having the
human immunodeficiency virus (hiv). There has been serious debate regarding
the feeding of such infants, arising out of the fact that under some circumstances
the dangers of breast milk substitutes may outweigh the risk of being infected
with hiv through breast-feeding.
Oªcial Guidance on hiv/aids and Infant Feeding
There is a risk of transmission of hiv from mother to child in the uterus dur-
ing pregnancy, during the birth process, or through breast-feeding. The risk of
transmitting the virus through breast milk has raised concern about whether
mothers who are hiv-positive should breast-feed their infants. If there is some
chance that hiv can be transmitted through breast-feeding, how should mothers
who are hiv-positive feed their infants? How does this relate to the human rights
of the mother and of the infant?
In 1998, the World Health Organization published three manuals titled HIV
and Infant Feeding (World Health Organization 1998). They provided a compre-
hensive overview of the issues but focused on the objective of preventing hiv
transmission through breast-feeding. With qualifications, the approach advo-
cated in these manuals centers on finding ways to provide breast milk substitutes
to infants of hiv-positive mothers, possibly with the support of government sub-
sidies. The health risks and the economic plausibility of this approach were not
assessed. The manuals remain the basis for policymaking at the international
level.
In October 2000, the World Health Organization convened an interagency [ Pobierz całość w formacie PDF ]
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