NEW
DELHI - In India, where infant mortality rates are
among the world's worst - 57 deaths per 1,000 live
births - and infant deaths in the newborn's first
month is a disquieting 43 per 1,000, preventive
medical measures can go a long way in saving
lives.
It was towards this aim that Asia's
first human milk bank was set up at the Lokmanya
Tilak Municipal General Hospital (LTMGH) in Mumbai
in 1989. Since then, some 25 human milk banks
across India - most of them sited in the western
states of Maharashtra and Gujarat - have been
performing vital services for premature babies
requiring temporary intervention in cases of
delayed lactation, abandonment or illness. These
banks have also been lifesavers for infants whose
undernourished mothers may be too feeble to breast
feed.
"As incidents of low birth weight
and pre-term babies are very high
in
India, it is imperative for the survival of these
babies that constant and adequate supply of milk
is guaranteed to them. Milk banks can perform a
critical function in such a scenario," says Dr
Priti Vyas, a senior obstetrician at Fortis
Hospital, New Delhi.
Non-lactation,
according to the doctor, can be triggered by
stress during pregnancy or during delivery. It can
also be caused by consumption of alcohol or
smoking, postpartum hemorrhaging or premature
birth.
In such cases, experts believe
giving human milk to a pre-term baby on a
ventilator can not only help save its life but
also hold off life-threatening ailments like
asthma, diabetes, infections and allergies. Such
milk may also be used to treat many conditions in
Neonatal Intensive Care Units like prematurity,
malabsorption, short-gut syndrome, intractable
diarrhea, congenital anomalies, formula
intolerance and immune deficiencies.
Global studies have demonstrated that
breast milk is far superior to mass-produced
formula milk. In fact, there have been specific
studies to illustrate that formula-fed infants
have a significantly lower IQ scores than those
weaned on breast milk. The World Health
Organization and the United Nations Children's
Fund, made a joint statement in 1980 advising that
"Where it's not possible for the biological mother
to breast feed, the first alternative, if
available, should be the use of human milk from
other sources. Human milk banks should be made
available in such situations."
In New
Zealand, research that followed the growth
trajectory of more than 1,000 children from birth
until age 18, demonstrated that children who were
breastfed performed better in school and scored
higher on standardized math and reading tests. The
research's authors - David M Fergusson and L John
Horwood of Christchurch School of Medicine -
underscored that omega 3 fatty acids (or DHA)
which are present in breast milk (but not in
formula milk) promote lasting brain development.
The authors discovered that the longer infants
were breastfed, the higher they scored in
evaluations.
According to Dr Armida
Fernandez, founder of India's first human milk
bank at LTMGH, human milk banks are crucial for
India because even though the practice of women
donating milk on humanitarian grounds is common,
it is erratic and the shelf life of such milk is
not more than 24 hours. What is required in such
circumstances, is a reliable institution like a
milk bank which can "pool, preserve and provide
milk for nearly six months".
Human milk
provides factors not replicated in any other
source of nutrition, according to Fernandez. It is
also the best nutrient for an infant and the
provision of a safe source of donor milk supports
breastfeeding by accentuating that human milk
cannot be replaced. The milk bank is thus an
advanced form of wet nursing practiced in the
countryside.
The milk bank at LTMGH feeds
over 30 sick and premature babies each day. The
milk collected comers from lactating mothers who
come to the hospital and in some cases even from
outsiders. After extraction, the milk is cooled
and poured into autoclave stainless steel
containers measuring 150cc, 250cc or 300cc. It is
then pasteurized at 65 degrees Celsius for 30
minutes and then frozen at minus 20 degrees
Celsius. This way, it can be stored for up to six
months.
Random culture is also conducted
during which 2 cc of the pasteurized milk is sent
for microbiological testing at the lab for HIV,
history of jaundice and syphilis. It is also
subjected to tests to detect "milk culture" or its
biochemical status. Babies weighing less than a
kilogram are fed about two cc of milk every two
hours. The milk extracted at banks may be of
three kinds. The colustrum extracted in the first
four days from a woman is given to babies infected
with diarrhea and malnutrition or those suffering
from burn injuries. The milk collected over the
next five to ten days is "transitional milk" and
the milk collected thereafter is called "mature
milk" which has less protein. The quantity, drawn
with the help of a pump, ranges from 40 to 600 cc
per mother. However, as pediatricians point out,
such milk can only be a stopgap arrangement for
sick, pre-term or undernourished babies.
Despite the vital service milk banks are
providing in India, their number hasn't seen a
steep rise. Nor is the government doing much to
promote setting up of new milk banks in the
future. As a result, it's a rare investor who is
keen to pump money in such ventures.
It's
a quintessential Catch-22 situation: because the
number of human milk banks in India isn't too
large, they have not yet been accorded "industry"
status. This naturally excludes them from benefits
awarded to the organized sector. Small wonder then
that there is no uniform standard for quality
control, a template for starting a breast milk
bank, a protocol for donor screening, collection
techniques, transportation and storage.
According to Dr Sandhya Khadse of Sasoon
General Hospital in Pune, there is an urgent need
to create more awareness about milk banks and
motivate people to support such ventures. Khadse
recently inaugurated a milk bank at Sasoon
Hospital in Pune (a city with about 9,000 births
annually) and feels that there is a need to
promote breastfeeding amongst the masses. At
Sasoon, for instance, the doctor has displayed
charts to inform mothers about the importance of
breast milk and breastfeeding hygiene. She is also
motivating women to save their extra milk for
other needy babies.
Similarly, at LTMGH,
lactation nurses spread awareness about the bank
by informing lactating mothers admitted to the
hospital about the milk bank and also handle their
queries related to milk donation.
Like
India, the global system of human milk banking has
seen slow progress. While it was a popular concept
in the West during the 1960s, things began to sour
with the arrival of infant formula milk. Further,
a fear of transmission of viruses such as HIV in
body fluids led to anxiety about the donation of
body fluids, including breast milk, and inhibited
the momentum of the milk bank movement.
Despite such hurdles, there's no denying
that human milk banks have a vital function to
perform in society. According to the UN, the
Millennium Development Goal For Child Survival by
2015 can't be achieved without a significant
plummet in neo-natal deaths which account for 30%
of the deaths of the world's under-five children.
The neo-natal mortality rate, estimated at 4
million annually, has its largest share in south
Asian countries - especially India, Pakistan,
China and Bangladesh - according to the
International Society of Tropical Pediatrics
(ISTP).
The ISTP, which recently met in
India, called for the adoption of new measures to
strengthen safe motherhood and child survival
services and the imperative need to
institutionalize links at various levels to fill
up gaps in the provision of health care. Effective
and low-cost interventions, according to the ISTP,
are urgently needed in this sector.
In
such a scenario, establishing more human milk
banks can be crucial in saving young children's
lives.
New Delhi-based independent
journalist Neeta Lal has had her
work published in over 70 publications across 20
countries.
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