© Laura Breiling / Mosaic
Demand for human breast milk is increasing “exponentially”. What are the ethics of creating a market for it?
North America is currently home to 19 milk banks, with nine more opening their doors soon. The Human Milk Banking Association of North America, which helps to run and accredit these banks, has gone from dispensing around 400,000 ounces of pasteurised donor human milk per year in 2000 to 3.8 million ounces in 2014. John Honaman, its Executive Director, says that the rise is due to both an increase in awareness of the health benefits of breast milk and an increase in the number of preterm infants who desperately need donated milk.
The American Academy for Pediatrics has stated: “all preterm infants should receive human milk. Mother’s own milk, fresh or frozen, should be the primary diet, and it should be fortified appropriately for the infant born weighing less than 1.5 kg. If mother’s own milk is unavailable despite significant lactation support, pasteurized donor milk should be used.”
Sharing breast milk is not new. Women have done it for millennia, letting friends’ or relatives’ hungry children nurse at their own breasts. Other times, women would hand-express their milk into pots or jars to give to families in need. And wet nurses, often impoverished or enslaved women, were often used to provide milk for wealthy children, even if it was at the expense of their ability to nurse their own. In the early 1900s, hospitals and charities began freezing and banking breast milk for sick babies.
Some parents are squeamish about giving their children milk from a stranger, but more and more neonatologists are framing it much more simply. “We tell them that this milk is medicine,” says Amy Hair, a neonatologist at Texas Children’s Hospital in Houston.
It all seems very simple. Some babies need breast milk that their mother can’t produce; other mothers are producing more than their babies need; human milk banks take the excess and give it to those in need. But as more parents and hospitals seek to use pasteurised donated milk, HMBANA banks have begun experiencing shortages. For-profit milk banking companies have sprung up, and milk can be bought and sold online, with fewer or no checks on quality or contamination. It’s becoming a lot more complicated than simply sharing.
In 2015, Sarah Keim, an epidemiologist at Ohio State University, published an analysis of 102 samples of breast milk she’d purchased online. Eleven had significant amounts of cow’s milk. “That is a concern,” she says. “We were surprised to find the extent of that problem.” Once money becomes involved, she adds, it becomes more likely that people will adulterate breast milk to make a quick buck.
But more than that, does paying for donated milk change the nature of the relationship between the women involved?
The Oregon-based company Medolac is an example of the passions that commercial milk banks can generate.
In late 2014, the Oregon-based company had partnered with the Clinton Global Initiative to reach out specifically to low-income Detroit mothers and pay them a dollar an ounce for their breast milk. While these payments were to compensate donating mothers for their time and effort, the idea behind this particular scheme seemed to be that if cash-strapped women could make money from their milk, then more of them might breastfeed their children, if only to keep producing milk.
But Detroit breast-feeding activist Afrykayn Moon immediately cried foul. The idea that the ability to earn money from breast milk would encourage low-income mothers to breastfeed their children was “absurd” to her.
“If I’m breastfeeding but my electric bill needs to be paid or my rent needs to be paid, or my water bill needs to be paid, and I know I can sell my milk to this company and then I can get my bills paid, well guess what I’m going to do,” she says. “I’m going sell my milk to keep my bills up, and not a drop of that milk is going to go to my child.”
With Detroit’s low rate of breastfeeding and one of the country’s highest rates of infant mortality (15 of every 1,000 children in Detroit die before their first birthday), Moon says that the city needs every last drop of breast milk. The Medolac move also brought back a sinister association to Moon. Enslaved black women were often used as wet nurses for white children, leaving them unable to provide milk for their own children.
“This is the face of slavery coming back,” she says.
Georgetown University philosopher and bioethicist Rebecca Kukla says that, while some tactics used by companies might be perceived as exploitative, there’s nothing inherently unethical about a woman selling her breast milk. “There’s a difference between what someone does out of economic necessity and what they do as a private choice to make their life work,” she says.
Blood and tissue donation work entirely on altruism; many people think breast milk should be no different. John Honaman says the Human Milk Banking Association of North America sees no place for profiting from breast milk, and thinks the system is at its best when mothers who have received donated milk decide to then donate in turn.
“If we were faithful to the needs of a community, we would always want to be in a position whereby the need is associated with the supply because you have a perfect circle,” he says. “Moms need to give, kids need to receive.”
Carrie Arnold is a freelance science writer. This article is based on her feature in Mosaic and has been published under a Creative Commons licence.
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