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Is this the next revolution?


Last year, Mamta (name changed) from local hospital in Maharashtra lost her two-month-old son following a surgery to fix a hole in his heart. Amid the grief and loss she found a purpose that kept her going. After losing her son, Mamta decided to continue donating her milk rather than taking medication to stop lactation. She had started going to a human milk bank and donating her breastmilk. Women like Mamta are the backbone of India’s human milk bank network.

Breastmilk is the baby’s “first vaccine”. Donated breast milk (DBM) is the next best alternative when a mother’s milk is not available, as recommended by WHO- UNICEF. DBM as a nutritional source provides similar immune protection and may prove revolutionary in reducing neonatal morbidity and mortality. When mothers don’t have enough milk (MOM) especially when they have had difficult birth or premature birth – baby still needs food. In the olden days they would have had “wet mothers” – who would have breast fed the babies or the babies would have been advised to be given many things as part of the “customs” – sugar water, barley water, tulasi water, honey or even janam gutti – depending on the region of the India one comes from or the background they are in.

Many mothers used to be helped by extended families or Asha workers or midwives depending on the local facilities or the places they live in. But with the globalization and nuclear families being the norm nowadays, many mothers are dependent on support from their obstetricians or neonatologists or the place of birth of the baby. Our own unpublished data shows 95% rate of breastfeeding with encouragement, support, and persistent help – the new mothers need from lactation consultants as opposed to the national average of 52% per NFHS-5 data. The question that arises is what to do with the remaining 5% of mothers who struggle to produce enough breast milk for the baby or there is a premature birth especially babies born less than 28 weeks, when the mothers take longer to produce enough breast milk?

Generally, mothers who deliver premature babies produce milk which is richer in protein compared to mothers who deliver term babies. We know that premature babies require more protein than term babies for growth anticipated to be normal for that age. Unfortunately, most donor breast milk that is available is “term baby milk” – so in essence we are giving less protein than the babies require – which is not ideal.

Pasteurization of DBM reduces many of the protective elements, including immunoglobulins, lactoferrin, lysozymes, anti-inflammatory cytokines (believed to decrease prematurity-related complications related to an infant’s immature immune system), and growth factors, and destroys the commensal microbiota we call probiotics (that confers protection against neonatal morbidities including NEC). Also, due to diminished protein content and decreased fat absorption from inactivation of bile salt-stimulating lipase by pasteurization, infants fed DBM are at risk for suboptimal growth.

Studies have confirmed that DBM is lower than MOM in protein, energy, and fat content, which are all crucial to preterm growth.15 The benefits and protection against morbidities appear to be limited and not dose dependent in DBM. Furthermore, compared with MOM, DBM is not associated with a reduction in sepsis, chronic lung disease, or neurodevelopmental morbidity in very premature infants. The trend toward an increased utilization of DBM is concerning because DBM exposure is intended to minimize use of preterm infant formula (PIF) and the risk for severe disease for which MOM has demonstrated superior protection.

I feel the “realistic” picture need to be given to the parents especially mothers who are already feeling “guilty” and suffering mental issues – and added to that recommending DBM may make her feel more inadequate.

Where does India stand?

India is yet to see large scale roll out of Human breastMilk Bank (HMB). While the first human milk bank was established in 1989 at Sion Hospital, nearly 3000 to 5000 babies benefit from the services of this milk bank every year. But we need more and this not enough. Several factors have slowed down the growth of human milk banks in India :

Financial – This needs to be done by NGOs or other agencies as it is a not a profitable venture. To add this – it is quite labour intensive, someone needs to take the initiative. Since there are no visible financial returns and there are many health priorities in India, it has taken a back seat.

Myths – there are several myths associated with human milk banking. Firstly, this has been popularly called “witch’s milk” in the past and also mythologically demons have tried to kill the god/goddesses by poisoning their breastmilk – so a common man attributes things differently. Secondly, several religious groups think by giving breast milk they ‘become related’. For example: In Malaysia, they had to get the Imaams to issue a FATWA to start a HMB to say it is for medical reasons. Thirdly, many people believe breastmilk is equivalent to genetics – they think giving breastmilk from unknown person can transmit the traits from them!
Logistics – this needs a dedicated facility within a hospital network and maintaining body fluids like milk is an issue of biological safety. Not many people want to get into these logistics.

Benefits of HMB – there have been contradictory reports from various professional people themselves about the benefits of HMB. Hence this adds to the uncertainty.

Do we have enough regulation

Regulations are only to govern people. If people are ethical and non-exploitative, we don’t need any regulations. Unfortunately, poor women can get exploited – hence everyone interested in this breastfeeding feels that breast milk and HMB should not be made commercial – so any laws to that effect will be beneficial. Neither milk should be paid for – meaning it should be voluntary donation – nor the milk should be charged – meaning only the processing fee should be collected. Laws to that effect will ensure it will not be commercialised. Mothers at levels need to be encouraged to come forward. Some women produce more breast milk than their babies need – such women should be encouraged to donate the milk too. Educational leaflets, educational videos to that effect will help and encourage mothers to come forward and participate in HMB. The benefit of donor breast milk on babies receiving them – should be made public and information regarding this should be made available in women’s forums for their understanding. Always remember donating milk does not compromise the supply of milk for own baby. More you express, more milk will be produced to help you feed your baby without hindrance.



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Disclaimer

Views expressed above are the author’s own.



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