World Breastfeeding Week: How new moms, milk banks are helping save lives
Mothers who once benefited are returning as donors, mobile van units are gathering breast milk at their doors.health Updated: Aug 08, 2017 14:11 IST
Rekha Chhaidwal was at Udaipur’s Rabindranath Tagore Medical College to get her daughter vaccinated in 2013 when she saw a signboard for the Divya Mother Milk Bank.
Curious, the 27-year-old walked in, and manager Bhawna Joshi told her about how some mothers donate breast milk so that babies whose moms weren’t lactating could benefit. Chhaidwal decided immediately to become a donor.
After the initial tests, she found herself holding a pump and expressing excess milk into a bottle. She donated 100 ml and left knowing that her milk could save the life of a newborn in the hospital’s neonatal intensive care unit (NICU).
That thought excited her so much that she returned to the milk bank 299 times over the next two-and-a-half years and donated a total of 30 litres of breast milk. Chhaidwal is now planning a third child, and will once again continue donating as long as she lactates.
Women like Chhaidwal are good news for non-lactating mothers, malnourished new moms and those with premature babies.
Early initiation of breastfeeding and exclusive breastfeeding can prevent deaths due to diarrhoea and pneumonia. Five countries – China, India, Indonesia, Mexico, Nigeria – alone account for over 236,000 child death every year because of inadequate breast feeding.
In India, the breastfeeding rate is improving and the latest National Family Health Survey (NFHS) 4 findings showed that 41.6% of children under 3 were breastfed within an hour of birth in 2015-16 as compared to 23.4% in 2005-06.
Close to 55% of country’s children are exclusively breastfed, a number that stood at 46% till about a decade ago.
Milk banks are helping bridge the gap. The Divya bank was set up in 2013 by Devendra Agarwal, who ran a neonatal care centre in Udaipur and wanted to ensure that as many newborns were breastfed as possible.
The 74-year-old did some research and discovered that Mewar had a history of dhais or nursemaids, chosen from the pastoral Gujjar community to breastfeed the king’s babies for additional nutrition. Panna Dhai, one such nursemaid from the 16th century, is famous for feeding Maharana Udai Singh II, who founded Udaipur as the new capital of the Mewar kingdom after Mughal emperor Akbar conquered Chittorgarh Fort.
This gave Agarwal the idea of setting up a bank of donated milk. “Even back then, there was a strict selection process for nursemaids,” he says. “The royals did a kind of background health check before she was allowed to feed the prince.”
At the Divya bank, donors must undergo blood tests before they donate, to rule out any transmittable diseases or infections. The donated milk is pasteurised and kept at -20 degrees Celsius.
“Treated correctly, mother’s milk can be stored for six months,” says Dr BL Meghwal, the bank’s nodal officer. “At room temperature, mother’s milk can be used for six hours.”
Agarwal, meanwhile, has gone on to set up 10 other human milk banks, and is now adviser to the Rajasthan government on its mother milk bank project. Seven more are in the process of being set up.
RETURNING THE FAVOUR
There are now milk banks across the country, from Udaipur to Delhi, Mumbai and Pune. Among the grateful beneficiaries are Singapore-based management consultant Rakhi Saini, 36.
“My second child was born premature, at 29 weeks. For about two weeks, I had no milk. I was so worried,” Saini says. “Then my doctor at Fortis La Femme told me about human milk banking and that eased my mind.” Fortis La Femme opened its milk bank last year and is already collecting enough milk to help sick babies in other hospitals.
“Ours is a public milk bank as we not only feed our own babies but also send milk to other hospitals. It’s easy to open a bank but difficult to sustain donations,” says Dr Raghuram Mallaiah, head of neonatology and founder of the Amaara milk bank. “There is a shortage. The milk can stay viable for six months but our stock is exhausted within three or four days.”
Among the regular donors right now is Saini, who returned to the hospital as a donor after her child stabilised and she started lactating. “I thought of my premature baby and how some woman helped her, and I wanted to do the same for someone else’s child,” she says.
“It’s easy to open a bank but difficult to sustain donations,” says Dr Raghuram Mallaiah, head of neonatology at the Fortis La Femme hospital in New Delhi, and founder of its Amaara milk bank.
With preterm birth complications being the leading cause of death among children under 5 — 1 million premature babies die globally every year — donated breast milk becomes a vital lifeline.
Of India’s 26 million births, 3.5 million are preterm, of which 300,000 die of associated complications. Breast milk can save an estimated 156,000 of these children each year.
“Breast milk is 88% water and the rest is protein, vitamins, minerals, hormones, living cells [stem cells], bacteria etc. that helps in developing a child’s immunity, brain, gut health and also maintains hydration for the baby,” says Dr Bernd Stahl, R&D director of human milk research at Nutricia Research in Utrecht, The Netherlands.
The first human milk bank in Asia opened in Mumbai, in 1989, the brainchild of neonatologist Dr Armida Fernandez. The bank operates out of the city’s government-run Sion hospital and is now one of six government-recognised human milk banks across Mumbai and Thane.
“At the Sion hospital, we explain to lactating mothers that they can help other babies if they donate excess milk, and most readily agree to do so,” says current head of neonatology Dr Jayshree Mondkar, who now runs the milk bank.
“There are also mothers whose babies are in the neonatal intensive care unit and need to express milk frequently to ensure the output doesn’t drop by the time their babies are ready for it. All this goes into our bank, for free access by premature babies or newborns whose mothers are malnourished or not lactating.”
With donations falling short across milk banks, Dr Sandhya Khadse, dean of the Rajiv Gandhi Medical College in Thane, suggests bringing the concept of human milk vans to Mumbai, might help ease low supply to banks.
She had helped BJ Medical College start one of Pune’s first human milk vans, which began door-to-door collection of milk from lactating mothers in August last year.
“These vans are fully furnished with electro pumps and sterilised milk storage devices and usually have a resident doctor, nurse and social worker on board. They go to the houses of women who have been recently discharged from neonatal care and have had the necessary screening tests,” she says.
Within months, the van had helped double the amount of milk donated to the bank. Collections within the hospital are just not enough, she says.
At Rajiv Gandhi Medical College, anyone can be a donor, as long as you are willing to get a screening test done.
“There is also the concept of informal milk sharing among mothers, but we do not recommend it at all,” says Dr Fernandez. “The mother has to get screening tests done which include an antigen test for Hepatitis B, an HIV test, a test for sexually transmitted and other communicable diseases. The risk of contamination when expressing the milk has to be eliminated. The milk has to be pasteurised and cultured and stored in sterilised stainless steel or glass bottles at -20 degrees Celsius. Unless all these conditions are adequately met, the milk is just not safe for a vulnerable newborn.”