By Raina Paul for Youth Ki Awaaz:
“I haven’t heard of a human milk bank. I have a lot of excess milk which I usually express and throw away. This used to happen with my first kid,” says Rosemary, a mother of an eight-month old infant.
For Rosemary, a human milk bank is a novel concept. She says she would agree to donate her breast milk to a milk bank if she can save a child’s life.
PATH (a Mumbai based NGO) shares the story of Sheikh Afsana, who delivered a premature baby that had low birth weight and was diabetic. The baby was admitted in a NICU (Neonatal Intensive Care Unit) and was fed with breast milk from the hospital’s milk bank for two weeks. Afsana was handed over her child once it gained weight, and was declared healthy. Afsana later donated her own milk to the same hospital’s human milk bank.
“The scenario is slowly changing,” says Ruchika, team leader, nutrition at PATH, who believes all babies should have access to human milk. “When mothers are helped with donor milk to save their babies, they come forward the next time they get a chance to help.”
The scenario Ruchika is referring to is of the glaring need for human milk in cases where the mother is unable to lactate, or the child is orphaned. Add to that those born premature, underweight or malnourished, and the need is even more strongly felt.
“There are 27 million babies born annually in the country. Among them 13%, that is 3.6 million, are preterm, and 28%, that is 7.6 million, are born with low birth weight which increases the risk of dying in the neonatal period,” says Ruchika.
The sight of tiny baby feet moving in an incubator in neonatal intensive care units (NICU) in hospitals are heart breaking to watch. It is the same when you come across infants who are often bony or born with hands and bodies smaller than that of a healthy child.
But reports indicate that babies born this way are likely to regain health if they are fed human breast milk.
“Breast milk is not only important for providing optimum nutrition, it has immune properties, not only in terms of their immediate health or growth, but cognitive development,” says Ruchika. “A child should be initiated to breast feeding within one hour of birth.”
Many a times formula feeds and nutrition supplements that mimic the properties of human breast milk are used as alternatives. But they just aren’t good enough.
“Formula feeds have vitamins and minerals which are received synthetically. But in case of anti-infective properties like colostrum, which is naturally present in breast milk, there is no artificial source,” adds Ruchika, who has more than 17 years of experience in the field of Nutrition Programming, Policy and Clinical Research.
India loses more children under five each year than any other country in the world. And more than half of these deaths occur in the neonatal period -the time a baby needs breast milk the most.
The country’s first milk bank was established in 1989 in Mumbai. It was the only milk bank until 2005. Even today the country has only 22 milk banks, this when countries like Brazil, with less than one fifth the population of India, have more than 200 milk banks.
A human milk bank is a service which collects, screens, processes, pasteurises and dispenses human milk donated by nursing mothers, who are not biologically related to the recipient infant. Any nursing mother can donate milk if she has surplus milk and is in good health.
The donated milk from a lactating mother is preserved under 20 degree Celsius temperature in hospitals that have milk banks.
“If donor human milk is given to the child, their chances of dying from infections are less,” says Ruchika.
India at present does not have milk banks outside hospitals. In-house milk banks provide donated human milk only to babies being treated in hospitals where those milk banks are.
“There is a need for more milk banks, there always has been. When there are NICUs and sick babies, you would prefer to have more milk banks,” says Dr. Jayashree Mondkar, professor and head of neonatology at Lokmanya Tilak Medical College and Municipal General Hospital, Mumbai.
“From 2005 to 2015, there has been a rapid increase in the demand for human milk,” says Ruchika. According to a research conducted by PATH, 6 million babies stand to benefit from donor human milk. But most mothers in India are unaware of the existence of human milk banks.
With the prevalence of a nuclear family system, more women are staying alone. They do not know whom to approach if there is a requirement for breast milk.
While mothers in urban areas are still better off, young mothers in rural areas are mostly unaware about human milk banks or about donating milk.
Just ask Dr. Thalikkotti, taluk health officer, Indi Taluk in northern Karnataka.
He explains how most mothers are not in favour of accepting milk from other mothers because they fear their child might catch an infection. Also, because the person donating the milk is a stranger.
As the literacy rate is very low in taluks like Indi, lack of awareness is a major hindrance when it comes to milk banks. Due to the prevalence of traditional taboos, mothers refuse to accept donated milk.
“There are no milk banks to educate them of this alternative,” says Dr Thalkkoti. “The chances of them accepting donated milk is 50 per cent.”
Even though the need of milk banks have been reinforced by experts, especially due to their advantage over other supplements, the country has not witnessed a considerable increase in the number of milk banks.
This can be traced to many reasons.
Some of the challenges faced in setting up milk banks are: Neonatologists and paediatricians are not aware of the concept; lack of availability of lactation consultants; limited awareness in service providers and little or no involvement of the private sector.
Also, “the private sector sometimes suggests formula feeds,” says Ruchika.
A major challenge is the pasteurising machine currently used in India, the ‘shaker water bath’, which is an imported automated pasteurising machine and “not very robust in terms of quality,” as Ruchika puts it.
The good news is that the last two years have seen a rise in awareness. A model like that in place in Brazil should be set up, stresses Ruchika. We also need ‘ambassadors’ from within communities to promote this cause.
There is no justification for a lack of infrastructure and awareness being reasons why we are losing thousands of young lives every year. Mass scale advocacy is the need of the hour and the State needs to lead the charge.
India’s babies need a lot more than just help with their baby steps. Will the government please step up?
Raina Paul is a Bangalore based independent journalist and a member of 101Reporters.com, a pan-India network of grassroots reporters.