Need for donor human milk in India

Dr Anitha Haribalakrishna, Associate Professor and Head (Incharge), Department of Neonatology, Seth GS Medical College and KEM Hospital, Mumbai throws light on the current status of human milk banks in India and also highlights that currently the need of the hour is greater awareness about benefits of donor milk, stimulating innovation in human milk nutrition and improved budgetary allocation for research in medical colleges

Statistics show that India has around 3.5 million premature births (born < 37 weeks). That’s an astonishing 13 per cent of the total babies born each year. Accessibility and availability of screened and pasteurised donor milk for these infants can be lifesaving, but in order to meet the nutritional needs of these infants, India would need close to 1,300 fully functional milk banks.

Overall rate of breastfeeding is extremely low in India,

• Where only 41.6 per cent of new-born infants are receiving human milk feeding within 1 hour of birth.¹
• Only 54.9 per cent of infants receive exclusively human milk diet till 6 months of age.¹

Current status of human milk banks in India

Currently nearly 90 milk banks are operational in India. A 2019 survey² points out almost 2/3^rd of milk banks in India reported gaps between demand and availability of donor human milk. Estimates³ suggest that in India, 30 per cent to 50 per cent of neonates admitted to the NICU and 10 per cent to 20 per cent of full-term infants are in need of donor human milk to meet the short- or long-term lack of mother’s milk.

The typical milk bank in India processes about 65-100 Litres/month⁶ and if we calculate that for 90 milk banks that currently exist, they are able to supply 70,000-1,08,000 Litres annually. This leaves a significant gap in the demand vs the supply from milk banks.

Steps to ensure regulation and a mechanism to sustain the supply of DHM

At present, the existing human milk banks are able to provide donor human milk only for needy babies at the individual hospital housing the milk bank but are unable to provide to any other hospitals. Moreover, not all hospitals have the required infrastructure and resources to setup and maintain human milk banks. Optimising nutrition for the vulnerable population of premature and sick newborn infants has always been our clinical priority. Even with a human milk bank in place, many situations emerge when we need to fortify feeds with cows’ milk products which defeats the entire purpose of an exclusive human milk diet. Currently the need of the hour is greater awareness about benefits of donor milk, stimulating innovation in human milk nutrition and improved budgetary allocation for research in medical colleges.

In such a scenario, few private organisations have been able to pitch in to bridge the gap and provide donor human milk for the needy preterm babies, who otherwise would not have had access to human milk. This arrangement has benefited countless babies by providing the optimal feeding choices through an exclusive human milk diet (in absence of breastfeeding) and thereby helped reduce hospital complications and stay.

Benefits of using a human milk-derived fortifier in preterm infants

Till few years back, the only available fortifiers were bovine milk-derived, the use of which increases the risk of complications like NEC, sepsis and feed intolerance in premature infants primarily due to an inherently immature gut. Recent introduction and availability of human milk-derived fortifiers have been a boon for premature babies, enabling clinicians to maintain exclusive human milk diet which helps minimize the risk of complications in the NICU.

Developed nations like US, Germany, Japan, and EU recognise the importance of donor milk which is reflected in categorisation of such products within their respective statutory frameworks. Given that India is the highest contributor to preterm birth and mortality, the priority for relevant authorities is to enact appropriate legislation for classification of donor human milk and human milk derived nutritional products. Organisations currently involved in providing donor human milk and human milk products need to be supported and scaled up as a sector, towards bridging this crucial medical need which has wider implications for the health of the society and nation at large.

References:

1. Ministry of Health and Family Welfare, Government of India. National Family Health Survey India IV. http://rchiips.org/nfhs/pdf/nfhs4/india.pdf.
2. A Landscape Analysis of Human Milk Banks in India, Indian Pediatrics 2019
3. Human Milk Banking: An Indian Experience, NeoReviews 2018
4. Data on file
5. Availability of donor milk, Breastfeeding Medicine 2013