What is the best measure to bring down infant mortality? Experts across the globe say that the answer is to encourage breast feeding. But what happens to babies whose mothers for some reasons cannot provide them with adequate milk? The solution to this issue is human milk banks. The concept was brought to India by Dr Armida Fernandez who helped in establishing India’s, in fact Asia’s, first human milk bank at Lokmanya Tilak Hospital, Sion, Mumbai in 1989. This initiative has today become the need of the hour. Raelene Kambli meets the visionary to understand the importance of a human milk bank and ways to promote this concept in India
What are the benefits of breast milk, especially for premature babies?
Breast milk is superior infant food. There are many benefits to breast milk. It has many essential components such as proteins, carbohydrates, fats, vitamins, minerals and many anti-infection properties that provides different kinds of defence against diseases among new born babies. Especially, among premature babies, it help them from contracting infections which is the biggest cause of mortality among such babies.
Do you see a trend where Indian mothers these days are lactating less?
Human beings are mammals so it is a natural process for mothers to lactate for their new born babies. It is only when the hormones are hampered that a mother may have less or no milk to provide her baby. There could be several reasons for the same. One could be emotional stress where the mother is worried about how much she can feed her baby. Lack of confidence could be another reason and thirdly it could lack of emotional support from the family. All of these emotions can make a mother feel that she does not have enough milk to provide her baby. This is mostly with city mothers, and especially with working mothers.
How important is the concept of human milk bank? How was the concept accepted globally?
Human milk bank plays a very important role in providing breast milk to new babies of mothers who cannot provide their babies with adequate breast milk. It is a tool by which we can reduce infant mortality in India and is the need of the hour.
Globally, in the late 80s there were milk banks in America, Australia and many other European countries. However, the spread of HIV/ AIDS suddenly led to the shut down of many milk banks across the globe. Nevertheless, the concept has picked up momentum again. Currently, Brazil has the largest network of human milk banks in the world, followed by South America, Spain, Portugal etc.
How did you start this breast milk bank at Sion hospital?
In 1977, I took over the department of neonatology at Sion Hospital. We looked after babies right from their birth up to four weeks of life. At that time, nearly six to eight thousand babies where born at the hospital. Amongst them, I saw that the hospital also registered many high risk pregnancies, where mothers had complications such as high blood pressure, heart diseases or lung diseases. In around 30 per cent of these, the mother or the child would have been at risk. Also, there were mothers who had the risk of delivering premature babies. When these babies were born, they were either sick or their mothers were sick and so these babies were separated from their mothers and were admitted in our neonatal intensive care. In such circumstances, mothers were not in a position to breast feed their babies. These babies were then given formula milk which actually kept them at a higher risk of contracting infections. We also knew that these babies needed breast milk to survive. So, we gave these babies breast milk of another mother who would be willing to donate her milk. We continued this practice for sometime.
In 1987, I visited Oxford on a fellowship and I saw breast milk banks in Birmingham and Oxford for the first time. Here the breast milk was scientifically collected, pasturised and stored. This is a safe way to provide breast milk to babies. The idea immediately appealed to me and I decided to introduce a breast milk bank at the Sion Hospital.
How did you manage to get funds to start a milk bank?
Well, initially I found it very difficult to convince people of this concept. Especially to the officials from the BMC. The idea of storing human milk and providing babies with milk of another mother did not bode well with these municipal officials. I had to cite them examples from the Mahabharata wherein Krishna was fed and looked after by Yashoda who was not his biological mother. That’s how I got the permission to start the milk bank at the Sion Hospital. However, they did not give me the funds for the same. So, it took me two years to get a sponsor. Then, Taj Group of hotels donated funds to start this milk bank.
What is the process of storing breast milk?
Unlike milk banks abroad, at Sion Hospital we had only in-house donors or mothers who came back in outpatients. Mostly, these mothers come from the slum areas and so we need to take care of hygiene. Our rule at Sion Hospital was that donors will have to come to the hospital to donate milk where our nurses would hygienically help mothers to collect milk. After the milk is collected, some portion of it is sent for testing and remaining is pooled as we have donors who donate milk in 20cc or 30cc. Thereafter, the milk is pasturised at 62.5o for 30 minutes then we cool it at -23o Celsius. This milk is stored in stainless steel containers. We label the container with the date of collection. Each of these milk containers can last for upto six months. We store these milk containers in the freezer and use the milk containers in the first-in first-out basis. Whenever we require milk for babies we defrost the milk containers and not boil the milk as boiling can destroy all the nutrients present in the milk.
Why stainless steel? Does stainless steel have any kind of specific properties?
Abroad they use Pyrex or polythene glass containers which are very expensive. And there is huge risk that the glass containers can break. Stainless steel containers are easily available in Indian homes. It is easy to procure, easy to sterilise and clean. And its the most safe way to store.
How many human milk banks are operational in Mumbai?
Right now we have these milk banks at Sion Hospital, Cama Hospital, JJ Hospital, KEM and Navi Mumbai. The good news is that the government is also thinking of starting human milk banks across the country. In fact, recently the government of Rajasthan started a human milk bank. So, slowly the government is also realising the benefits of having milk banks.
Who else is involved in promoting milk banks in India?
PATH, an organisation who has been working in this field for a long time, is constantly negotiating with the government to take its concept forward.
What are the challenges in starting and running a human milk bank?
When you start a new thing, there will always be some challenges associated with it. Everything new is not accepted easily and so was the concept of human milk banks. It was a tall task to convince people to accept this concept, especially the municipal corporation officials. I had to tell people that when it was easy for us to provide milk of another animals to our children why not the milk of another mother. The other challenge is the hygienic collection of milk, safe pasturisation process and post that, the microbiology test. Since we have maximum mothers coming from the slum areas, screening them for infections becomes a must, so we need trained nurses who would maintain hygienic standards.
Are there appropriate guidelines to run human milk banks?
There are no guidelines and regulations from the government side. Nevertheless, in the last one year, paediatrics and neonatologists have got together and formed a group where we are setting guidelines for milk banks.
Are there any gaps in maintaining our milk banks as compared to the global standards?
The standards abroad is slightly different then ours. There, mothers are very vocal about disclosing their habits such as smoking , drinking etc whereas in India, mothers are not vocal about their habits. The other difference is that the way of collecting milk is different for ours. There, mothers collect the milk at home and drop it at collection centres established everywhere. Also, milk banks abroad do not pool milk, so each mother’s milk is stored separately in a separate container. Additionally, the equipment used to pasturise the milk and store it is more expensive and of high quality. Ours is a more low-cost model which is similar to Brazil. They also has a low-cost model and have milk bank across the country. But their quality and methodology to store milk is touted about. Our team has recently visited Brazil and has learnt some lessons which we can certain duplicate in our practice.