Azra Hoosen | ah@radioislam.co.za
21 February 2025 | 09:00 CAT
5 min read

Breastfeeding is a crucial part of infant health, providing essential antibodies and nutrients. However, during an Ebola outbreak, the lack of research leaves mothers and healthcare providers with difficult decisions. Professor Catriona Waitt, a clinical pharmacologist, highlights the critical need for better understanding in this area.

Professor Waitt stresses that breast milk is more than just food. It contains antibodies and other vital molecules that contribute to an infant’s growth and development. Additionally, it is clean, safe, and free, unlike artificial milk, which is often unaffordable and unsustainable in many parts of the world. “It is the best option for both mother and baby. There are also health benefits for the mother. So we try to encourage breastfeeding if possible,” she said.

However, disease outbreaks like Ebola pose serious challenges for breastfeeding mothers. Outbreaks often occur in East, West, and Central Africa, where women tend to have more children and breastfeed longer. The impact of an outbreak extends beyond infected mothers and babies. Women who are in contact with infected individuals or those who are offered vaccines also face uncertainty. “Whenever there is an outbreak, particularly one that people find quite scary, society becomes disrupted. People avoid healthcare facilities, and infrastructure breaks down, especially in big outbreaks. All breastfeeding women in affected regions experience some level of disruption,” she explained.

Drawing comparisons to the COVID-19 pandemic, she noted the widespread misinformation and fear that led to declining breastfeeding rates in many places. “If I offered you a vaccine, your first concern would be your baby?” she questioned. You might think it is not safe and decide to take the risk of not getting vaccinated. But by doing so, you could be taking a greater risk of contracting the disease. “There was a lot of confusion during COVID, and we want to ensure that future outbreaks are handled with clear, proactive communication,” she said.

Can Ebola be transmitted through Breast Milk?

Determining whether Ebola spreads through breast milk is challenging. Ebola is known to be transmitted through any body fluids, as far as experts understand, but breastfeeding involves close contact, sweat, saliva, and other potential sources of transmission. According to Prof Waitt, it is difficult to isolate the exact source of transmission, but they know that virus fragments are present in breast milk but do not know in what quantity. “The only way to determine this is by collecting samples from infected breastfeeding mothers during an outbreak. That is difficult, but if we prepare protocols now, we can be ready for the next outbreak,” she said.

Another unknown is whether the virus remains in breast milk after a mother recovers. Researchers need to determine how long it lingers and whether pasteurisation could make breast milk safe for consumption.

Current guidelines and their Challenges

Health guidelines present two scenarios for breastfeeding mothers suspected of having Ebola. If the infant is also infected, or if the infant is not infected, separation is recommended, and the baby is given artificial milk. “The question is, who takes care of that infant and ensures they receive proper nourishment?” Prof Waitt asked.

Even when both mother and infant are infected, separation is advised. However, this recommendation raises ethical concerns. “If both are infected with the same organism, breastfeeding may provide the best chance of survival through nourishment and immune factors. It could also be a compassionate choice for a mother in a critical condition. But the evidence supporting separation is weak,” she explained.

The World Health Organisation acknowledges this uncertainty. Its guidelines state that if artificial feeding is not available, breastfeeding may be considered, leaving room for case-by-case decisions. “These are incredibly tough choices. Ebola has a high mortality rate, especially for infants. We need clear, evidence-based guidance to make informed and compassionate decisions,” she said.

Challenges in Research and Communication

Researching Ebola and breastfeeding is complicated by the disease’s high mortality rate and its transmission through body fluids. Fear surrounding Ebola further complicates efforts to study the issue. “Interrupting breastfeeding presents challenges. If a mother stops breastfeeding for several days, she still produces milk, leading to engorgement and discomfort. Can we pasteurise the milk? South Africa has developed small devices for this purpose. Could we use these to provide safe breast milk to infants?” Prof Waitt asked.

Misinformation and stigma are also barriers, particularly in diverse regions like Uganda, where multiple languages and cultural beliefs influence perceptions of disease and breastfeeding. She said that they found that some languages lack words for key medical concepts. Explaining scientific information to communities without formal education requires careful communication. “The worst thing we can do is have communities feel experimented on or deprived of information,” she added.

The Path Forward

Professor Waitt emphasises that research should focus on vaccinations for breastfeeding mothers. Ebola vaccines exist but vary in effectiveness based on the outbreak strain. Current vaccine guidelines contain contradictions, creating uncertainty for breastfeeding women.

“If I were a breastfeeding mother in an Ebola outbreak, I would want that vaccine. The risk of dying from Ebola is real, and vaccines save lives. Yet, we lack clear evidence on their safety in breastfeeding women,” she said.

Exclusion from research studies is another major issue. According to Prof Waitt, women, particularly pregnant and breastfeeding women, are often left out of research to protect them. However, excluding them means a lack of data needed for informed decisions. “We must include them safely and systematically. Women should not be an afterthought,” she asserted.

Prioritising research on breastfeeding and Ebola is essential. While much is known about Ebola in semen, little is known about it in breast milk. Breastfeeding is essential for life. Yet, research priorities often favour men. Prof Waitt stressed that the focus needs to shift. “There are many questions, but the point is that women are not a special population. We are actually an essential part of every population,” she said.

Prof Waitt emphasised that pregnancy and breastfeeding do not reduce a woman’s ability to make informed health choices, stressing that it is time to ensure women are not left behind. She encourages people to rise up, not just in a sort of advocacy way, but with really informed choices.

LISTEN to the full interview with Muallimah Annisa Essack and Professor Catriona Waitt, Professor of Clinical Pharmacology and Global Health at the University of Liverpool, United Kingdom, on the Insight, here.