Human Milk Banks (HMBs), which can help premature and seriously-ill babies to survive, is struggling to take off for want of Government financial support and human resources besides inadequate supply of donor human milk (DHM) to meet the demand, researchers have found.
By providing pasteurised DHM, HMBs play a crucial role in India which has the highest number of preterm births — 3.5 million are preterm and 7.5 million are low birth weight-in the world and breastfeeding rates are sub-optimal, just 60 per cent due to reasons such as mother’s sickness, separation, or temporary lactation issues.
HMBs collect, pasteurize, test, and store safe donor milk from lactating mothers, and provide it to needy infants.
The researchers whose study has appeared in the latest journal of Indian Pediatrician found “Facilities reported 30 per cent to 50 per cent of the babies in NICU and 10 per cent to 20 per cent babies in PNC ward required DHM for a variable period after birth. Ten HMBs reported gaps between demand and availability of DHM. Processed donor milk was used within a week or fortnight because of high demand in most HMBs. DHM was fed to low birthweight babies for 5-15 days on an average during hospital stay.”
Around 11 (69 per cent) milk banks were in Government or charitable hospitals while only 2 (12.5 per cent) were set up with Government fund.
“Half of the total HMBs studied had a dedicated technician while just 1(6 per cent) had more than five lactation counsellors,” said the study ‘A Landscape Analysis of Human Milk Banks in India’ conducted from August 2016 to February 2017.
The researchers had analysed the infrastructure, human resources (HR), funding mechanisms, operating procedures and quality assurance in order to identify gaps to be addressed to strengthen their systems of at least 16 HMBs. Overall there were 30 HMBs in India. The researchers’ team included Ruchika Chugh Sachdeva from PATH, Jayashree Mondkar, Sunita Shanbhag, Minu Manuhar Sinha, Aisha Khan from Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital, Mumbai, and Rajib Dasgupta belonging to Jawaharlal Nehru University, New Delhi.
They noted that a substantial percentage of HMBs ie 63 per cent (10 HMBs) reported gaps between donor milk demand and supply while 12 (75 per cent) used shaker water bath pasteurizer and cooled the milk manually without monitoring temperature, and 4 (25 per cent) pooled milk under the laminar airflow.
In 10 HMBs, milk was stored and pasteurized in stainless steel containers, and the remaining used polypropylene containers. Indigenous shaker water bath was used for pasteurization in 13 HMBs, and five used automated imported pasteurizer of which; two had both. Eight HMBs had a full-time technician to undertake pasteurization while in the rest, lactation counselors performed this task.
“Almost all HMBs reported that they did not collect data on early initiation, exclusive breastfeeding or human milk feeding. Fourteen HMBs adhered to a set of guidelines, two reported using the Human Milk Bank Association of North America (HMBANA) guidelines,” noted the study.
Though India’s first HMB was established in 1989, HMBs in the country gathered momentum only in the last 3-4 years. Talking about the importance of these HMBs, the National Guidelines on Lactation Management Centres in Public Health Facilities launched in 2017 noted that when expressed breast milk is not adequate or available, these newborns are usually fed with infant formula milk.
“However, feeding formula milk is associated with high risk of sepsis and Necrotizing Enterocolitis, thus significantly decreasing the chance of both newborn survival as well as quality survival. DHM if made available to thesebabies can save them from the adverse effects of formula milk,” it said.