CDC investigators probing a diarrhea outbreak that killed at least 532 children during Botswana's rainy season in early 2006 came to a startling conclusion: The decade-long, global push to have HIV-positive mothers feed formula, instead of breast milk, to their babies appeared to have cost at least as many lives as it saved. The nutrition and antibodies in breast milk are so crucial to developing children that the benefits outweigh the risk, about 1 percent per month, of transmitting HIV through breastfeeding.

The scientists' report noted several factors that contributed to the Botswana outbreak:

• Government clinics often ran short of formula, forcing parents to feed their infants hard-to-digest alternatives like cow's milk or porridge. Since Botswana launched its formula project, studies have found that the risk of HIV transmission to babies comes chiefly from combining breast milk with other foods, such as formula and solid food, which can damage the lining of the intestines.
• Although diamond-rich Botswana has an extensive water system, the investigators found much of it contaminated. Apparently due to flooding during the rainy season, 26 of 26 village wells tested in the country's northeast were found to be contaminated. Tests of the feces of the ailing babies turned up cryptosporidium, e. coli, and other waterborne pathogens.

In October 2006, UNICEF issued new guidelines that stressed the value of breastfeeding and said formula-feeding could be dangerous in all but the most developed settings. Botswanan health officials, however, were not convinced. Health Minister Sheila D. Tlou said the 2006 outbreak was a one-time occurrence that did not call for a new policy. Officials are working to make formula-feeding safer by encouraging mothers to boil water and use cups, which are easier to clean than bottles. Tlou said the ministry will monitor emerging studies to decide if a change in policy is justified.

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