Milk Banking in the U.S. and Brazil

In 2014, Anna spent four months interning in human donor milk banks in the United States and Brazil while an M.P.H./M.A. student at the University of Michigan (UofM). UofM has a vibrant collaboration with Brazil. Here are two stories (story 1, story 2)about the work UofM has done with brazilian milk banks. The information in this blog post is taken, in part, from Anna’s M.A. thesis in Russian, Eastern European, and Eurasian studies.

United States

In the United States, human donor milk banks exist to provide safe pasteurized human milk to the most fragile infants in the NICU. According to the 2013 Human Milk Banking Association of North America (HMBANA) Guidelines, a human donor milk bank is “a service established for the purpose of recruiting and collecting milk from donors, and processing, screening, storing, and distributing donated milk to meet the specific needs of individuals for whom human milk is prescribed by licensed health care providers.”[1] In the United States, there is no federal oversight or national legislation for donor milk banking. Lactation benefits for the underserved vary greatly from state to state because each state administers its own Medicaid policies. The Affordable Care Act (ACA) covers the cost of a breast pump, but does not offer reimbursement for donor milk.

HMBANA was founded in 1985 to establish standards and guidelines for the operation of milk banks in North America.[1] In December 2014, there were 18 functioning and 10 developing non-profit milk banks in North America that were affiliated with HMBANA. HMBANA milk banks are all non-profit; they can be independent, community-based or hospital-based. In order to be a HMBANA member, milk banks must follow current HMBANA Guidelines for the Establishment and Operation of a Donor Milk Bank and undergo an annual assessment.[1] All HMBANA milk banks must adhere to these minimal guidelines, but many go above and beyond the requirements. Thus, there is a lot of variation among the milk banks.

HMBANA does not own the term “milk bank,” and thus, for-profit and cooperative models can also use this term for their own human milk activities. Thus, mothers, lactation consultants, and physicians often do not know the difference; this creates confusion. There are two for-profit donor milk distribution systems in the United States—Prolacta and Medolac, both originally founded by the same woman, Elena Medo. The HMBANA definition of a milk bank does not apply to these two companies; nevertheless, Prolacta uses the term “milk bank” to describe the organizations that collect the donor milk (by paying the women who “donate” the milk) before sending it to Prolacta for processing. Prolacta creates human milk fortifier out of human milk in order to provide extra calories to very fragile babies at the NICU. Medolac Laboratories developed a milk processing method that eliminates B. cereus, among other pathogen threats, to create a sterile shelf-stable milk.

Brazil

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A freezer full of pasteurized breast milk in Brasilia, Brazil.

The Brazilian system is often mentioned in discussions of successful milk banking systems. PATH, a non-profit organization based in Seattle, created an entire framework for developing a milk bank that is, at its core, based on the strategies used in Brazil. Lois Arnold, a milk banking historian and policy researcher, wrote in her dissertation that the donor milk banking system “thrives” in Brazil.

The first Brazilian milk bank (BMB) was founded in 1943 in Instituto Nacional de Puericultura, today called Instituto Fernandes Figueira (IFF) in Rio de Janeiro. Then, the main objective of the BMB was to collect and distribute human milk specifically for premature babies, infants with nutritional issues, and allergies. Between 1940 and 1980, the BMB system grew and by 1985, six milk banks existed. In 1985, the Programa Nacional de Incentivo ao Aleitamento Materno (National Breastfeeding Incentive Program) was created and the BMB assumed a new role in Brazilian public health promotion. The BMB was transformed into an entity that promotes, protects, and supports breastfeeding. In 1998, the Rede Nacional de Bancos de Leite Humano (REDEBLH; the National Human Milk Bank System) was created and the Fundacao Oswaldo Cruz (Fiocruz) in Rio de Janeiro became the central governing body—a national reference bank. With Fiocruz at the top of the hierarchical milk banking network, each region/state has its own central milk bank. This system of graduated geographic responsibility is part of the reason why, since 1985, the BMB system has grown to 218 milk banks and 162 collection depots.

The BMB, today, is an institution dedicated to the protection of public health, firmly entrenched in the health care delivery system. The definition of a milk bank in Brazil is a “service specifically linked to a maternal and child health hospital. The [BMB] is responsible for the promotion, protection and support of breastfeeding; for the collection, selection, classification, processing, quality control, and distribution of donor milk for free.” The BMBs require all employees to complete a training program. The program contains three elements: 1) promotion, protection and support of breastfeeding at the BMB, 2) processing and quality control of expressed human milk, 3) BMB management.

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An educational exhibit during the 2014 International Breastfeeding Week in Rio de Janeiro, Brazil.

Donor education and milk donation promotion are two important components of BMB. Selection and education of donors begins prenatally. Milk donation, advantages of breastfeeding, breast anatomy, physiology of lactation, techniques for hand expression, milk conservation, among other topics, are discussed during prenatal classes taught at the milk bank. Recently delivered mothers in the hospital receive a milk bank orientation and written materials describing hand massage and expression techniques, milk conservation, and donation. Moreover, mothers receive information on post-natal care and potential breastfeeding problems. Finally, all services and organizations involving newborn care are discussed—from ambulatory care, to public health centers, to the Program for Family Health. The above information is also broadcast on the radio, television, in newspapers, in schools and at many events.

For more information

Contact liquidgoldconcept@gmail.com to get in touch with Anna Sadovnikova to learn more about human donor milk banking internationally and in the United States.

You can also listen to the Reply All podcast that came out on March 9, 2016, to learn more about Anna’s experience in Brazil.

[1] HMBANA Guidelines for the Establishment and Operation of a Donor Human Milk Bank. 2013. Human Milk Banking Association of North America, Inc. Fort Worth, TX.

 

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