Milk Banking in the 21st Century

Written by: Anna Petherick, Ph.D. | Issue # 39 | 2015

When historians look back on the past 15 years, they will undoubtedly characterize the period through reference to widespread use of its defining technology: the Internet. Among its many benefits, the Internet is a perfect tool for aggregating many small scale and widely dispersed suppliers, and enabling buyers and sellers of obscure products to locate one another. It has therefore facilitated the exchange of human milk. From Craigslist postings to Facebook groups, individual altruism to cooperatives with exclusive sales agreements with private companies, the online exchange of milk now takes many forms.

Elena Medo is the CEO of Medolac, one of the new for-profit human milk companies. She also founded (and left) the other main player, called Prolacta, and in doing so launched what she says was the first human milk website, where would-be donors could apply online, and those who passed initial screening then received house-calls for blood testing. Medolac sources all of its milk from a cooperative, but elsewhere in the tentacles of the Internet, it is perfectly possible for mothers to receive direct payment for milk based on peer-to-peer online exchange. This, of course, carries at least the potential risk of pathogen transfer, or that unscrupulous sellers might add cows milk or some other product to increase sales volumes.

Some people, however—including the CEO of HMBANA (the Human Milk Banking Association of North America), John Honaman—are entirely against moneymaking out of breast milk, in part because it sets up these kinds of perverse incentives. “With so much need in the environment in and outside the hospital, we believe that the best way to meet it is to be nonprofit,” emphasizes Honaman. In more precise terms, HMBANA estimates that 60,000 milk donor-mothers would be required to meet the needs of all of the infants in NICU’s across North America and the young outpatients with doctor’s prescriptions for human milk, yet at present HMBANA only has 4,000 donors signed up.

Tellingly, the entry of for-profit companies into the space has not reduced HMBANA’s overall donated milk volume, which has in fact recently shown year-on-year increases. This implies that some women, who otherwise wouldn’t give their milk away for free, are starting to provide it because they are motivated by the promise of payment. Given the substantial and unmet need, is paying mothers for breast milk the way forward?

One simple argument in favor of payment is the simple fact that milk pumping takes time and effort, and therefore lumbers women with opportunity costs. Rachel Ellen, of the much newer company, Mammalia Breast Milk, puts it succinctly, “We believe paying for breast milk empowers women by giving them the opportunity to make money from home, take more time off work, and spend more time with their baby.” A simple argument against payment is the concern that poor women might reduce the amount of breast milk that they feed to their own infant, and instead sell it. This is certainly possible, admits Medo, although the cooperative from which Medolac sources its milk has instigated various precautions, such as only accepting milk from women who have been breastfeeding for three months or more.

Honaman’s complaints are not purely based on the ideology of maintaining a culture of altruism around breast milk. He thinks that some mothers are being misled. “For-profit entities use sophisticated marketing to emulate the spirit of what we do,” he complains. “They have created front organizations that interface with mothers. These entities carry names that can be easily confused with those of the HMBANA non-profit milk banks.” Certainly, Prolacta has been accused of not making it clear to mothers that they were providing milk to a for-profit in the past, most recently in a New York Times article[1]. Prolacta did not respond to multiple requests for an interview for this article.

Some profit-seeking companies are beginning to carve different kinds of middle-of-the-road solutions, however. Mammalia Breast Milk pays according to a donor’s socioeconomic needs, for example, as well as the volume and amount of time a donor has been with the company. Medolac processes for free and gives away whatever amount of milk mothers opt to not receive payment for. When the company first introduced its ‘pay-if-forward’ scheme, as it calls this, about one in a thousand mothers volunteered, says Medo. But since it started automatically slipping an extra bag for donations into shipper packs, most of the mothers have at some point sent it back with milk. About 5% to 6% of Medolac’s total processed volume now falls under this category, Medo estimates.

This is roughly in line with the 9.1% that is processed and given away to needy mothers by the International Milk Bank, another for-profit run out of Reno, Nevada. Glenn Snow, a former real estate broker who is the company’s CEO, is intent on keeping prices down. Compared to Prolacta, whose flagship product for NICU babies sells for about $180 per ounce, he says, “We’re instead trying to bring a lot more milk at an affordable price point to the market. We’re really focused on being a high-volume supplier and making it so that every baby that needs [human] milk has access to it.”

Snow argues that his for-profit model provides the financial resources needed to screen and process milk in far more appropriate ways than non-profit milk banks currently manage. Not all milk banks use methods that kill Bacillus cereus, he says, and some don’t thoroughly test for drug use by mothers. (Although Honaman defends HMBANA’s banks against this critique.) On this point, little is known about the hazards of milk in direct peer-to-peer online exchange, but one study led by Sarah Keim of Nationwide Children’s Hospital in Columbus, Ohio, has found higher levels of Staphylococcus bacteria in peer-provided milk compared with unpasteurized samples sent to milk banks[2]. Due to these concerns, the FDA has recommended “against feeding your baby breast milk acquired directly from individuals or through the Internet,” as reported by Katie Hinde. Worryingly, one study found that even though recipients in these exchanges were largely aware of the potential for pathogen transfer, less than half of them considered the potential for other kinds of contamination, such as drugs.

The size of this online community is not clearly characterized. The most thorough attempt comes from nutritional scientist Maryanne Perrin, of North Carolina State University in Raleigh[3], who monitored three Facebook milk-sharing communities in the Eastern US, three in the Centre of the country, and three in the Western states. Perrin found that the central region had the most milk sharing compared to the number of births in the region, and that the median offer of milk was 90 ounces—which is interesting because it is less than the typical per-mom minimum that formal outfits require. In only three months of monitoring, she also observed 532 individuals offering milk on the nine web pages in her study. This suggests that the online community may rival, if not surpass, HMBANA’s total number of donors.

Perrin has an alternative solution for increasing the volume of human milk available than simply offering mothers cash. She says that the majority of milk banks in the U.S. stop accepting milk from mothers when their most recent offspring reaches 12 months old. If her findings—which are not yet published—provide evidence of little or no change in nutrient content and function, they might contribute to extending the donation or sales period per mom.

Such an extension, like the evolution of online sharing platforms, better education for potential donors, and the incentive of an income, is likely to increase the overall supply of available human milk. And that is a good thing because in spite of well known health benefits to very young infants, some of the most recent surveys report that a minority—22% to 42%—of maternity hospitals in the United States use donor milk in their advanced care units [4-6]. An increased supply also brings the potential for new products based on human milk. In next month’s newsletter, SPLASH! will report on what those are.

References

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