Banking on Human Milk in India

Sarita, 28, was shattered when her obstetrician placed her newly-born daughter in her arms at a maternity hospital in the town of Nagda in the desert state of Rajasthan. The girl weighed 1 kilogram, less than half what a normal infant should, and in grave danger of being blighted by malnutrition if not of death.

The hospital advised Sarita, whose severe anemia prevented her from breastfeeding, to draw milk from a milk bank in Udaipur, some 22 km away. Sarita and her husband wrapped their baby in a shawl and took the first bus to the Divya Mothers Milk Bank. The frail child was admitted to the neonatal intensive care unit, fed milk and saved.

"Human milk for underweight newborns is like an infusion of fresh blood for accident victims," said Rohilla Parker, a senior nutritionist at Fortis Hotel, Noida, in Uttar Pradesh. "It not only rescues them from certain death when their mothers can't lactate, but also provides immunization to ward off life-threatening ailments and infections. It is superfood for newborns, the most effective when a baby is breastfed immediately after birth and exclusively for the first six months."

On April 6, India's 17th human milk bank was inaugurated in Rajasthan, the state's second, appropriately named Jeevan Dhara [lifeline] in collaboration with the Norwegian government. Like all such institutions, the bank will collect excess breast milk from lactating mothers, pasteurize and preserve it and channel it to infants in desperate need.

"There is no limit to the number of times a nursing mother can make donations to the bank," said S.L Dharmawat, chief coordinator at the Divya Mothers bank. "The milk is collected using breast pumps and emptied into sterile containers. A 5 ml sample is sent for bacteria testing and the remainder is pasteurised up to 56 degrees centigrade for 30 minutes. The essential proteins are not lost in this heating, but harmful bacteria are killed."

The bank is designed to deliver aid to many parents in a state that has one of the world's highest infant mortality rates - 63 per 1,000 live births – compared with the India total of 43 which, is still far worse than neighboring Bangladesh [33]. According to government records, one in eight babies is born pre-term in India and about half of mothers who deliver a baby prematurely are not able to breastfeed their babies. In most western countries, the death toll is about five per 100,000.

A survey conducted by the Rajasthan government found that 42 percent of newborns in the state were undernourished and needed mother’s milk. Through breast feeding and donated mother’s milk, infant mortality can plummet by as much as 22 percent, medical personnel say. If a child is breastfed, its chances of survival spiral sixfold.

Milk banks thus have a critical function to perform, especially in India, a country that hosts 1.25 billion people. Nearly 60 of women are of childbearing age. Despite whittling down child mortality rates - from 2.3 million deaths of children under the age of five in 2001 to 1.4 million in 2012 - India still accounts for 20 percent of infant mortality globally. Over half of these deaths were of babies under 28 days old in 2014, according to a Lancet report published in May. The main killers are infections and low birth weight.

Rampant infant mortality persists across India ironically although the concept of human milk banking in Asia was initiated by an Indian doctor, Armanda Fernandes in 1989, at a Mumbai hospital. The doctor noticed that a majority of lactating mothers had excess milk which they often express (through breast pumps or traditional methods) and throw away. Dr Fernandes encouraged them to give it to the ward nurse, who would deep freeze and preserve it. The pasteurized milk is frozen at -20 degrees Celsius and given to whoever needs it. It can last six months.

However, despite the passage of a quarter of a century since the establishment of India’s first milk bank, the service is still in its infancy. Many health experts feel this may change in the near future with the health ministry formulating guidelines to accelerate the process of setting up more such banks.

According to government guidelines for the establishment and operation of human milk banks, quality of donated breast milk has to be a safe end product. As a result, only healthy women are allowed to donate their milk and those who have enough after feeding their own babies satisfactorily. The donor should be willing to undergo blood testing for screening of infections..

The guidelines have encouraged the growth of more milk banks across the country. Last August, the first milk bank facility in the eastern city of Jaipur opened at the Mahatma Gandhi Hospital by the non-profit Inaya Foundation. A similar initiative was undertaken in Udaipur. A public sector human milk bank was also inaugurated in Calcutta in 2013 and another bank opened in Pune in September of the same year.

Cities such as Surat, Pune, Ahmedabad, Vadodara and Chennai all have milk banks today. Cama & Albless Hospitals, Mumbai, 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 150,000 to 200,000 ml of milk per year," a supervisor said, "but we never have any surplus."

Be that as it may, India still has a long way to go as far as the development of milk banks goes. The country can emulate another BRICS nation – Brazil – which has close to 200 milk banks and has been able to bring down its under-five mortality rate to 14 per 1,00,000 live births.

Health experts say there needs to be a concerted push by the Indian authorities on breast milk banking. "Milk banking needs to be part of a larger, more cohesive strategy to promote breastfeeding nationwide," says an official at the Breastfeeding Promotion Network of India, a Delhi-based non-profit.

Ironically, because the number of human milk banks in India isn't large, they have not yet been accorded "industry" status. This naturally excludes them from benefits that accrue to the organized sector like land at concessional rates and government funds.

However, to be fair, the global system of human milk banking has not seen electric progress either. While it was a popular concept in the West during the 1960s, industry dynamics changed with the arrival of infant formula milk. Further, a fear of transmission of viruses such as HIV in body fluids led to anxiety about the donation of body fluids, including breast milk, which decelerated the momentum of the milk bank movement. Despite such hurdles, there is no denying that human milk banks perform a vital function in society. According to the UN, the Millennium Development Goal For Child Survival by 2015 can't be achieved without a significant fall in neonatal deaths, which account for 30 percent of the deaths of the world's under-five children. The neonatal mortality rate, estimated at 4 million annually, has its largest share in south and Southeast Asian countries - especially India, Pakistan, China, Indonesia, Philippines and Bangladesh - according to the International Society of Tropical Paediatrics.

Neeta Lal, a New Delhi-based journalist, was a nominee for SOPA Awards and World Media Summit Awards 2014. Follow her at Twitter, @neeta_com