Although the attainment of Millennium Development Goal 4 (MDG 4), reducing under-five mortality by two-thirds by the year 2015, depends on optimizing breast-feeding practices in resource-limited settings, there are some conditions in which breast-feeding is impossible, contraindicated, or not recommended. The overall impact of involuntary nonbreast-feeding on the attainment of MDG 4 has not been documented. In industrialized and many middle-income countries replacement feeding is affordable, feasible, acceptable, sustainable, and safe and complete avoidance of breast-feeding is the norm to prevent postnatal transmission of HIV. The situation is very different in many low-income countries affected by the HIV epidemic where infants are exposed to HIV and antiretroviral (ARV) mediation through breast milk for long periods with risk of acquiring HIV infection, development of multidrug resistant HIV and short and long term toxicity associated to ARV medications. Despite the obvious needs, there is no specific research on how to make replacement feeding safer for infants with no access to breast-feeding and for whom replacement feeding is justified. Orphans, abandoned and infants of severely ill mothers unable to breast-feed, won't benefit from the research done on making breast-feeding safer for HIV exposed infants. A child rights perspective illuminates societal obligations to provide replacement feeding with infant formula milk to such infants, and to support research to make it safer at the same time that breast-feeding is promoted and protected for the general population.
Keywords: HIV prevention; child's perspective; infant feeding.