Will donor milk save or sink breastfeeding?

Whenever there is another article about donor milk, I do a happy dance.  Last week there was a great article in Time.com about the increasing competition between milk banks and milk sharing organizations for excess milk from producing mothers.  In February, a wonderful Boston.com article highlighted the power of donor milk in intensive care for preemies, and how more hospitals are making screened donor milk the standard of care instead of infant formula. Actor  Neil Patrick Harris spoke openly about resorting to donor milk from a milk bank when his daughter, one of the twins born to him and his partner David Burtka via a surrogate, could not digest the various infant formula types they tried and continued to suffer severe gastrointestinal distress.   In fact, you could say that in the breastfeeding world, 2010 was the Year of Donor Milk.  

The explosion of media coverage can be traced back to the much-publicized shipment of donor milk to premature babies born in the wake of the Haiti earthquake disaster in January of 2010.   Although sharply (and we think wrongly) criticized, it raised tremendous awareness of donor milk at a time when most of America had never even heard of milk banks, and did not know that screened, donated human milk, not infant formula, is the next best food for babies after breastfeeding or the mother’s own pumped milk.   It underscored the great need for coordinated PR messages that call for well-meaning but misguided individuals and organizations to stop sending powdered infant formula, a practice which is terribly counterproductive in emergencies–these messages often come far too late or not at all from the disaster relief agencies that have the most air space.  (It also seems to have spurred at least one disaster relief agency, Save the Children, to launch heavily publicize* efforts to protect breastfeeding mothers in Haiti.)  After Haiti, media attention on donor milk continued.   Actress and BfB Champion for Moms Alysia Reiner shared her story of donating milk to a friend with USA Today in April 2010, actress and BfB Champion for Moms Jenna Elfman’s story of donating her milk to a baby born drug-addicted touched many hearts and underscored just how powerful our mom-made wonderfood really is.  At the same time, the mother-to-mother milk sharing group Eats on Feets burst on the scene with Facebook pages dedicated to connecting the haves and have-nots with each other in 50 states and 22 countries.   Donor milk, whether screened and pasteurized by the Human Milk Banking Association of North America, or shared informally, has truly arrived. 

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So why am I particularly happy about donor milk news? Because I believe fundamentally that from the vantage of public perception and marketing, it is a gateway to greater appreciation of breastfeeding and human milk.   In American culture, we don’t value what is normal and free; we covet that which is expensive and exclusive, a fact that was keenly exploited by formula marketing in the mid 1900’s: infant formula was positioned as a luxury item, a notion that persists even among the poorest to this day, who ask for the can with the “gold ribbon” because they think it shows status (much like a benz or gold chains–only poor people breastfeed!).  By seeing human milk as precious and valuable, even expensive, whether through the needs of NICUs, celebrities who moan about the expense, or the eyes of mothers who go to great lengths to procure and use another mother’s milk over artificial substitutes, there is hope that our culture could begin to truly appreciate the life-saving and immune-boosting powers of the fountain of health under our noses.  There is hope that instead of being seen as “closer to breastmilk than ever before”, infant formula will assume it’s rightful place in the list of acceptable breastmilk substitutes–last.   There is hope that more mothers who can not breastfeed, or suffer complications in the hospital, will demand donor milk, because unless moms start demanding it, hospitals won’t make it available.   Perhaps some day, with the exception of the 66 babies born every year with galactosemia (the extremely rare true breastmilk intolerance), all 4 million babies born in the United States every year will be exclusively breastfed or receive donor breastmilk until one year of age, instead of only 80,000 (only 2% of moms make it to a year of exclusive breastfeeding).   The media can make this possible by acting as a catalyst for change, and we thank them opening the floodgates to a greater acceptance and appreciation of the human milk.

But . . . there are potential downfalls to all this media attention on donor milk.   As last week’s Time.com article already pointed out, as informal milk-sharing becomes more popular, the supply for milk banks may dwindle, jeopardizing the sickest and most fragile of our nation’s infants.   We need more human milk banks, not less; I’d love to see as many human milk banks as there are blood banks.  Another downfall, and very distressing to us, as only one reporter pointed out, all this milk sharing circumvents addressing the root of why women are turning to other mothers for donated milk:  they are being actively prevented from achieving their breastfeeding goals, because they are being rampantly booby-trapped by health care providers, hospitals, employers, insurers and our culture.  Don’t believe me?  Just ask the hundreds of women who responded to our call for stories for the Surgeon General.   Their anguish is palpable.  If we make milk-sharing too easy and convenient, we run the risk of not turning the anguish and anger of moms into pressure on hospitals to become baby-friendly.  We run the risk of losing the opportunity to put pressure on doctors to become educated in at least the basics of breastfeeding management, even if it’s just to be encouraging (not dismissive) to moms and to refer to an IBCLC.   We run the risk of not demanding that all hospitals have donated, screened milk on hand for preemies, and that insurance companies cover the cost.   And what about public perception?   Let’s not forget that milk-sharing perpetuates a bottle-feeding culture, and does not sow the seeds for a public acceptance of the act of breastfeeding.   We need greater awareness of the benefits of donor milk over infant formula, but at the same time, we need greater awareness of the benefits of breastfeeding or even a mother’s own pumped breastmilk over donor milk, and I worry that in the media excitement over donor milk, that message gets lost.

Best for Babes believes that parents should be able to make an informed decision, and deserve greater access to donor milk whether through milk banks or through informal but informed milk sharing.  We have routinely helped raise awareness of both HMBANA, milkshare.com, and Eats on Feets (which has now split into two groups, Eats on Feets and Human Milk for Human Babies*).  However, the risks of informal milk sharing should not be minimized, and there is more than meets the eye–it’s not just the potential risk of contamination for a baby or mother (by the way, Salma Hayek was at risk for HIV contamination from the baby she nursed in Sierra Leone, unless they screened the baby before hand).  The major problem I see is that, even though the risks of intelligent and informed milk sharing are small relative to the risks of infant formula, it would only take one well-publicized case of milk sharing gone wrong to do tremendous damage to the entire breastfeeding and donor milk cause.   This does not mean we think Human Milk Banks or milk-sharing should cease, on the contrary:  we think they are incrediby important, but need to be prepared with a strategy if negative publicity does hit.

Similac was forced to issue a recall after beetle parts were found in powdered infant formula. Parents were really bugged by the lack of quality control and frustrated over not being able to find uncontaminated formula . . .

So, Similac's powerful marketing team decided to issue a coupon. Nice way to heap WHO-code violation on top of WHO-code violation, Abbott.

Unlike the formula companies, which can spend thousands on a sophisticated PR campaign following the contamination of formula with beetle parts, breastfeeding and donor milk has no PR budget at all.   We all know that it’s sensationalist news that grabs the public attention, not relative risk  (which is why we are more scared of shark attacks than pneumonia, and the rare shark attack gets far more media play).  In the event of any accidental donor milk contamination, all of the good done by informal donor milk sharing could easily be overshadowed by negative publicity–and the breastfeeding community does not have the funds to handle negative media fall out.   We applaud the grass roots efforts of all of the donor milk groups, but think they could benefit from organizational structure and fundraising, as well as a solid marketing and PR plan.  The recent, bitter scuffling among rival groups Eats on Feets and Human Milk for Human Babies also doesn’t help the donor milk image:  there seems to be a lot of eye-rolling and griping going around.**

Finally, there’s a hidden problem with hosting milk sharing groups on Facebook, as a colleague pointed out to me:  while Facebook is a great tool and has enabled the exponential growth of milk sharing, Facebook is also capricious, yanking pages like the Leaky Boob willy-nilly, a practice which could strand mothers and babies in need and damage the image and brand of donor milk. 

So, while I am thrilled that donor milk is in the spotlight, it would be even better if it led to significant, systemic changes that would benefit all mothers and babies, whether they can breastfeed or not.   We need to leverage this media attention into a fundraising gala for milk banks, who operate on a shoestring budget to help premature and compromised babies, firstly, but could grow to help more babies.  Help for Haiti raised $57 million . . . surely breastfeeding education and protection, providing the foundation of human health, and the best defense in a disaster, deserve a drop of these funds!   We need disaster relief agencies to advance consistent and immediate* breastfeeding protection messages in their “how you can help” campaigns following emergencies such as Haiti and Japan, and take a strong stand against violations of the WHO code and aggressive formula marketing.  We need better health care for breastfeeding mothers, from prenatal care to baby-friendly hospitals to insured post-natal visits by an IBCLC.  We need  less social stigma against the baby on the boob, in public, so moms don’t feel ostracized and embarrassed–no mother can put her busy, multi-tasking life on hold for months or years so she can always meet the approval of the squeamish by breastfeeding in private.  We need a paid maternity leave policy, which, unlike donor milk, probably no pump company will advocate for, because it would hurt their sales . . . but it is in the best interest of our mothers, our families, our employers, our insurance companies, and our global competitiveness.  

If donor milk can help level the playing field for all breastfeeding mothers, then it will have truly shown itself to be the milk of human kindness.

*Editor’s correction 4.19.11   **Editor’s correction 4.28.11

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28 Comments | Last revised on 04/18/2011

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