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Should providers discuss breastfeeding with women living with HIV in high-income countries? An ethical analysis

  1. Janet Malek2
  1. 1Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
  2. 2Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
  1. Contact information: Corresponding author: Grace Johnson, MD, Baylor College of Medicine, c/o Dept of Obstetrics and Gynecology, One Baylor Plaza, BCM 610, Houston, TX 77030, Email: grace.jamail{at}bcm.edu, Phone: 512-589-8411

Abstract

As men and women with HIV are living longer healthier lives and having children, many questions regarding reproduction in the context of HIV arise. One question is whether or not breastfeeding is an option for mothers living with HIV. The established recommendation is that women living with HIV in high-income countries avoid breastfeeding. However, some women may still choose to breastfeed for a variety of personal, social, or cultural reasons. Non-maleficence ("do no harm") must be weighed against maternal autonomy. We propose that providers caring for women in this situation are ethically justified in discussing breastfeeding as a reasonable, though inferior, option. Providers should pursue a shared decision-making approach, engaging in open conversations to learn about the mother's preferences and values, providing education about risks and benefits of various feeding options, and together with the mother formulating a plan to ensure the best possible outcome for the mother and baby.

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