A worker pulls donations from a fridge at a breast milk bank. As of May, the national health department was busy drafting guidelines to harmonise the regulation of such banks in SA. (AFP)

Five things you didn't know about human milk banks

Pontsho Pilane
We take a look at some of the unlikely customers hitting up SA's breast milk banks.

“Breast is best” has become a mantra ever since the World Health Organisation recommended that mothers feed babies nothing but breast milk – not even water – for the first six months of life. 

The benefits of breast milk abound with numerous studies suggesting that babies who are exclusively breastfed may be less susceptible to disease and less likely to develop behavioural problems as teens.

And breastfeeding can’t start soon enough, says the WHO, which recommends that babies receive their first gulp of breast milk within an hour of being born. But what happens when infants come too soon or when mom can’t produce milk and baba is allergic to formula? That’s when one of South Africa’s breast milk banks – mostly run by non-profits – steps in.

One of these nongovernmental organisations, the South African Breastmilk Reserve, operates in 22 public health facilities in five provinces. We spoke to the body’s executive director and founder Stasha Jordan about how these banks help babies – and, in rare cases, adults too.

1. What are breast milk banks?

The South African Breastmilk Reserve operate in hospitals collecting, screening, pasteurising and dispensing breast milk. The milk is usually donated by lactating women in the same hospital.

Breast milk banks are not new. The concept of “wet nurses”, or women who would breastfeed children who were not theirs, has been around for centuries. But Jordan says the practice, along with breastfeeding in general, saw a decline in popularity with the advent of HIV - often, because women feared transmission of the virus via infected breast milk especially when antiretroviral treatment was not widely available.

HIV-positive women were discouraged from breastfeeding their children until 2009 when studies led the WHO to announce that women living with the virus could safely breastfeed if they were on ARVs and did not mix breast milk with other foods such as porridge or formula. South Africa introduced exclusive breastfeeding as a national policy in 2011.

2. When formula fails, donated milk may save the day – and a life

Premature babies typically weigh between 500 grams and 1.8 kilograms and the tiniest among them can normally consume one millilitre of milk every three hours, says Jordan.

“Preemies” are breast milk banks’ number one customers. “We use it to stabilise their guts, which are likely to become infected if they are fed with formula,” she explains.

Formula-fed premature babies are more likely to develop conditions such as necrotising enterocolitis, which can damage intestinal tissue causing it to die, according to a 2014 study published in the Cochrane Database of Systematic Reviews.

3. Breast milk isn’t always just for babies. Or is it?

Babies aren’t the only ones getting their breast milk fix from banks. Jordan says that in rare cases, the South African Breastmilk Reserve has supplied milk to adults with common variable immunodeficiency (Cvid). Cvid is a rare immune system disorder that leaves people prone to infections and can increase their risk of cancer, says the US-based nonprofit medical organisation the Mayo Clinic.

Authors note that breast milk has been suggested as a treatment for Cvid in a 2016 paper published in the journal of Current Gastroenterology Reports, but there are no studies to prove that it works.

4. Donors on some types of chronic medications need not apply

Only healthy lactating mothers who don’t smoke, drink alcohol or use recreational drugs can donate to breast milk banks. But donors on certain types of chronic medication, and who may also carry amounts of these prescription drugs in their milk, aren’t eligible.

Donated milk is screened for disease before being pasteurised. During pasteurisation, milk is heated to 62.5°C for 30 minutes before being rapidly cooled to a temperature of 4°C or below to eliminate harmful germs.

The South African Breastmilk Reserve follows safety guidelines adapted from the United Kingdom’s National Institute for Health and Care Excellence (Nice). While Nice admits that the risk of HIV transmission via breast milk is low when lactating women are on ARVs, neither Nice nor the South African Breastmilk Reserve currently accept donations from HIV-positive women.

5. It’s not about the money, honey

South Africa’s Human Tissue Act governs everything from donations of blood to embryos and even breast milk. The legislation strictly prohibits payment for these kinds of donations so if you thought you’d breast pump your way to new shoes, you’re wrong.

But if you want to become a donor out of the kindness of your heart, you can visit the South African Breastmilk Reserve’s website and fill in a form. If you live in one of the five provinces the reserve doesn’t operate in, they’ll connect you to a similar organisation in your area.  

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