Milk of human kindness
Human milk banks are poised to sprout nationwide. Against the backdrop of world breastfeeding week (August 1-7), Smitha Verma explains why
This is the human milk bank at the Lokmanya Tilak Municipal Medical College and General Hospital (LTMMCGH) in Sion. Every day it saves the lives of over three dozen newborns in the hospital.
"A human milk bank is vital for premature babies who require temporary intervention in cases of delayed lactation, illness of the mother or even abandonment," says Jayashree A. Mondkar, professor and head, department of neonatology, and director of the Human Milk Bank. Equipped with two pasteurizers, a hot air oven and half a dozen electric breast pumps, the milk bank collects around six litres of milk from lactating mothers every day.
The bank, Asia's first milk bank, is 25 years old. Yet, milk banking is still in its infancy in India, with the concept of donating milk never having really taken off. This may change in the near future, though, with the health ministry finalising guidelines in June this year for setting up more such banks.
A few are already functioning, and some more are on the anvil. Later this month, the first milk bank facility in Jaipur will be opened at the Mahatma Gandhi Hospital by the non government organisation (NGO) Inaya Foundation. In June, Jaipur's JK Lon Hospital, the state's biggest child specialty government hospital, signed a memorandum of understanding with Norway's Oslo University Hospital to open a human milk bank. Earlier this year, a similar initiative was undertaken in Udaipur. Last August, a public sector human milk bank was inaugurated in Calcutta and another bank opened in Pune in September.
Mother's milk, experts stress, can save a newborn's life. And India accounts for 20 per cent of infant deaths globally. Over half of these deaths are of babies under 28 days old. The World Health Organization recommends breastfeeding within the first hour of birth as one of the measures to combat infant mortality. "Breast milk provides an infant with unique antibodies for fighting infections," Mondkar explains. "Formula feed will rarely be required if we have milk banks in all hospitals," she adds.
In many developing countries, milk banks are being promoted to combat infant mortality. Brazil, which has close to 200 milk banks, had an under-five mortality rate of 14 per 1,00,000 live births in 2012, as opposed to India's 56. "Ideally, every neonatal intensive care unit in a hospital should be equipped with a milk bank," says Armida Fernandez, retired professor of neonatology and founder of the milk bank at LTMMCGH.
It was while on a fellowship trip to the United Kingdom in 1987 that Fernandez spotted human milk banks in Birmingham and Oxford. "I learnt how scientifically they store the milk and promote breastfeeding. I pledged to open a similar unit in Mumbai," she says.
It wasn't an easy task. The initial funding for the project came from the Taj Group of Hotels but when the funds ran out Fernandez approached the Municipal Corporation. "A corporator asked me, how can one woman's milk be given to another's child? I asked, 'How can milk of another species (animal) be given to a human?' The corporator was speechless and I got my funds sanctioned for setting up the facility," Fernandez recalls.
But for close to two decades no other hospital thought of opening a milk bank. Then, in 2005, Mumbai's KEM Hospital opened one which was soon followed by similar facilities in cities such as Surat, Pune, Ahmedabad, Vadodara and Chennai. Today there are 14 milk banks — five of them in Mumbai alone.
"This facility is a boon for mothers who can't breastfeed," says Rajshree Dayanand Katke, medical superintendent, Cama & Albless Hospitals, Mumbai, which started a milk bank in 2007. In 2010, around 4,000 women donated milk which benefited close to 5,000 infants. "On an average we are able to collect 1.5 to 2 lakh ml milk per year," Katke says.
The milk collected (with the help of breast pumps) from donor mothers, who are pre-screened for various diseases such as HIV and hepatitis, is pooled, cultured and then pasteurized for half an hour. It is then frozen at minus 20 degree Celsius, for milk thus stored can be used for six months. "But usually our stocks last not more than 10 days. We never have any surplus," Mondkar says.
Though not a cost-intensive project, the limitations of setting up a milk bank arise from finding donors — and in convincing mothers to give another woman's milk to their infants. "Often lactating mothers are worried that milk for their own child will be less if they donate," says Sunanada Suryavanshi, a lactation management nurse at LTMMCGH. Suryavanshi counsels close to 200 lactating mothers a week about the benefits of donating milk.
One such counselling session prompted Mumbai resident Nirmala Jogu to donate milk voluntarily for close to a year while she breastfed her child. "I used to express the milk and keep it in a deep freezer. Then once a week my husband used to deliver it to LTMMCGH," says the 31-year-old event manager. "I have counselled many of my friends about this noble endeavour," Jogu says.
Many women need to be counselled even for accepting another woman's milk. "Some people are apprehensive about taking milk from a woman belonging to another community," Nitisha Sharma, general secretary of the Inaya Foundation, says. "So we have to make them understand the benefits of a breastfeed over formula milk," Sharma says.
To create awareness, the Divya Milk Bank in Udaipur has started organising camps in colleges. "The government is yet to take this up as priority. And for corporate hospitals, this is not a money-making venture," says Devendra Aggarwal, founder of Divya Milk Bank, rueing the dismal number of milk banks. The bank's staff also asks lactating women in nearby areas to donate their surplus milk.
"We believe donors can persuade other mothers to donate," adds Aggarwal, whose NGO spent Rs 20 lakh to set up the facility.
The NGO followed the guidelines of the Human Milk Banking Association of North America, because India had no rules in place when the Divya Milk Bank was set up. But now, India is on its way to forming its own guidelines for establishing and operating human milk banks.
In June, the Infant and Young Child Feeding Chapter, Indian Academy of Paediatrics and the Union ministry of health and family welfare organised a consultative meet with various stakeholders for framing guidelines. These deal with various aspects of human milk banks such as their location, infrastructure, equipment, administrative staff, donor population, collection of breast milk and storage.
Fernandez hopes that more milk banks will open with the government showing an interest in the sharing of human milk. "We should have human milk banks just like blood banks," she says.
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