Human Breast Milk Sharing—Limited Regulation with Social Justice Implications

February 01, 2017

by Valeria Vavassori-Chen, MS Bioethics, Clarkson University & Icahn School of Medicine at Mount Sinai (2011)

Human Breast Milk Sharing—Limited Regulation with Social Justice Implications

After the birth of both of my children I found myself producing more milk than my kids could consume. I decided to donate my extra supply to any family whose child might need it. While researching the best venue to do so, I discovered a huge demand for free human breast milk and a completely unregulated market.

The benefits of breast milk over formula have been well documented in the medical literature. Human breast milk is naturally designed to meet all the baby’s nutritional needs, and it provides early innate immunity, which, when compared to formula-fed babies, reduces infant morbidity and mortality from infectious diseases. The World Health Organization urges that caregivers should “exclusively breastfeed infants for the child's first six months to achieve optimal growth, development and health.” Additionally, some newborns with medical issues (especially premature babies whose digestive system is extremely immature) do not tolerate formula at all. Finally, there are many health risks associated with the use of formula.

Knowing the great benefits of human breast milk, many parents who are unable to produce enough breast milk have good reason to seek out private breast milk donors. There are, however, risks associated with human breast milk sharing. These include possible bacterial contamination and even transmission of HIV. Proper handling and storing are essential to reduce bacterial contamination, and a process called flash-heating can be used to inactivate the free-floating HIV virus. When a parent accepts a breast milk donation from a private individual, he or she can certainly discuss handling and storage routines with the donor (and even request information about the donor’s lifestyle) but there are no guarantees or ways to check that safety rules were followed properly.

It took me a few weeks of asking professionals as well as fellow moms to find out how to donate my extra supply. There are two organizations in the continental US who have online platforms where one can offer to donate breast milk or post a request to receive some – Human milk 4 Human Babies and Eats on Feets. The site administration reviews the requests for posts before publishing them but then the interaction and physical exchange of goods is left to the individuals.

I have donated my extra supply to at least four families and while it felt wonderful to help other babies and families in need, I also felt vulnerable. Might I be held legally accountable for any contamination that may have been passed along?

These concerns led me to investigate donating to a milk bank. But, I discovered they charge receiving families as much as $15 per 6 ounces of pasteurized breast milk. I decided to continue donating privately. To protect myself, I created my own waiver of responsibility in which I detail my lifestyle information and my handling and storing practices with the recipients (similarly to questionnaires found on local milk banks’ websites).

After I figured out how this all worked, it dawned on me how long it took me, a college educated woman with reasonable computer and life skills, a computer at home with Wi-Fi, and a smartphone to successfully donate my extra supply. I started wondering what happens to those who do not have all these resources? How can an individual with fewer resources than me find these venues?

For those families looking to receive a donation the competition is fierce. Having a computer or a smartphone and having time to spend following donor posts are essential requirements to successfully accessing donated breast milk. And even if one is lucky enough to find a donor, then travel and transportation (and possibly childcare) arrangements need to be made to actually collect the donation.

Also, donors may not be interested in ongoing donations and instead may be interested in giving away their extra supply just as a single donation.  Families seeking breast milk may be going through the process multiple times.

If families cannot find donor on the unregulated market, they could turn to a milk bank. There are 18 Milk Banks in North America. Every state determines the regulations for how a milk bank can obtain breast milk, how they handle it, and how they store it. In New York State, milk banks accept donations from any woman with extra human milk supply, but they are required by law to screen breast milk donors and use flash-heating as a method of pasteurization.

Milk banks routinely provide human breast milk to neonatal intensive care units. In these cases, the milk bank charges the hospital for the breast milk. If the breast milk request is prescribed by a doctor, it becomes medically necessary and is typically covered by insurance.

Milk banks also offer human breast milk for children who are not hospitalized, but insurance plans do not routinely cover this cost. As I mentioned above, milk banks charge as much as $15 per 6 ounces of human breast milk. Most newborns eat between 8 and 12 times a day(every 2-3 hours), with an average feed of 2 ounces, resulting in a potential average daily expense of $40-$60 (up to $1,800 a month!).

Families of limited means and resources, then, face a series of obstacles. The high prices of the only “safe” venue (milk banks) create a serious barrier for these families. The lack of regulation at the private level leaves the breast milk market open to anyone who wants to donate and sell breast milk directly without directions over price or safeguards in collection and storage. Finally, free private breast milk donations are available primarily through specialized online venues, which could be a barrier to those who do not have the technological, cultural, and practical resources to access such services.

To prevent issues of social injustice and to guarantee the quality and safety of shared breast milk, state-level regulation for private sharing of human breast milk is needed. But to allow families of limited means access, a government sponsored centralized human breast milk bank is needed to provide every child the benefits of breast milk even if their family lacks the ability to pay the associated costs.

Tags:Valeria Vavassori-Chenhuman breast milk sharingmilk banksprivate breast milk donorspasteurized breast milkbioethics

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