Context: Maternal milk is increasingly recognised as important for the wellbeing of infants
Let’s be careful on the vocabulary
The researchers, the scientist,s the industry use terms like “human milk, “lactating bodies “avoiding to specify that this milk is exclusively produced by women Therefore we will prefer using maternal milk ou mother’s milk.
The WHO (World Health Organization [WHO], 1991). WHO (2001) recommends that infants should be exclusively breastfed for the first 6 months of life. The rate of exclusive breastfeeding globally for infants under 6 months of age is only 48%.
According to WHO, Mother’s milk is the ideal food for infants. It is safe, clean and contains antibodies which help protect against many common childhood diseases. It provides all the energy and nutrients an infant needs in the first few months of life.[1]
Maternal milk is particularly important for premature babies [2] and babies in neonatal units.
Maternal milk: a developing market
The process consists of recruiting maternal milk donors, collecting the donated milk, and then processing (pasteurizing), screening, storing ( deep-freezing) and distributing the milk to infants in need.
Non-profit milk banks: Milk banks developed early in the early 1900s. Milk is donated, and recipient families pay a fee to cover the processing and distribution processes (mainly to hospitals). In France the fees are set annually by the Ministry of Health set. For 2024, they are set at 80 Euros per litre for fresh or frozen milk and 133 euros per 100 grams for freeze-dried milk. These costs are fully covered by the French social security system.
Maternal milk industry. Since 2000, maternal milk has become an industry. Factories develop, advertise and sell mother’s milk products as nutritional supplements, fortifiers for infants with special nutritional needs. “A 2017 survey found that 44% of advanced neonatal care hospitals in the United States were using a maternal milk-based fortifier developed by the world’s largest maternalmilk company, Prolacta BioScience”. Women are paid, and the products are sold at a set market price.
Online market. The supply and demand for maternal milk is developing online, sometimes with strange request for specific diets: gluten-free, dairy-free, organic[3] , non drinkers…and also with demands that have nothing to do with the needs of infants.
Market growth
Demand for maternal milk has increased significantly in high income countries. This milk is presented as being much more efficient than formula for infant, specially premature babies. Technology, such as breast pumps, makes it easier to express milk, pasteurisation allows transportation and long storage of the product.
The industry has two objectives:
- Find new customers
“Unlike milk banks that only dispense breast milk by prescription; we want to make breast milk accessible to anyone who wants it” says Rachel Ellen, founder of Mammalia Breast Milk Company[4].“Researchers believe that their inventions will not only benefit premature and full-term babies but also may benefit children and adults in other applications.”[5] Maternal milk is promoted as a sort of miracle product for all sort of uses.[6] - Develop new products from maternal milk”.
Some authors have also pointed to bio-piracy practices as the industry has filed patents on molecules, extracted from breastmilk. Among the six products mentioned in their paper, there is the patented “lactobacillus reuteri”, used to improve digestion and restore normal flora, which is derived from samples obtained from Peruvian mother’s milk [7].
Consequences : a new form of global exploitation
As a result of this significant market growth, the industry has sought new resources in low-income countries and among marginalised and vulnerable social groups in high income countries. According to Sara Steel, this situation could lead in the draining of human milk from poorer countries into richer ones, the exploitation of women and girls in developing settings and even potentially the recruitment and harbouring of women for the purpose of milk “farming” like has been seen around surrogacy and “baby farming”. [8]“ She also found out that “ pharmaceutical companies admitted up front in their internal documents that the volume of the milk that they purchased came from disadvantaged communities and also from communities that have historically experienced racial or ethnic marginalisation”.
On an individual level, this situation will have the following consequences:
- Infants of women involved in pumping and selling their milk may not be optimally breastfed.
- The incentive offered by the industry may drive donors out of the not-for-profit milk bank system.
- Women with no, or poorly paid maternity leave, with no access to health care during pregnancy and post-partum may see selling their milk as a way to support themselves and their children.
Remember, there is a long history of women in the 19th century, called wetnurses, being exploited for breastfeeding for the wealthiest babies, high and middle class, to the detriment of their own abandoned babies. The same thing happened in Northern America, where women slaves were used for the same purpose.
In India
To stop India from being targeted as a source of women milk, the Food Safety and Standards Authority of India (FSSAI) has issued an advisory statement on the “unauthorised commercialization of human milk and its products[9] “
In Cambodia.
The Utah-based company Ambrosia Labs paid women in Cambodia to pump their milk twice a day, and then ship the pasteurised milk to most US states from 2015. Cambodia banned the practice in March 2017 (The Guardian 2017[10]). Unicef welcomed the ban, saying the trade was exploitative and that excess breast milk should stay in Cambodia, where many babies lack proper nutrition. In Cambodia, exclusive breastfeeding of newborns for the first six months fell from 75% in 2010 to 65% in 2014.
In wealthy countries.
Oregan-based Medolac Laboratories was targeting African-American and low-income women as suppliers for their products “until feminists in the Detroit area opposed the sourcing of milk from a population with generally low breastfeeding rates, lack of partnerships with local breastfeeding organisations and as a response, as well, to the history of black women”.
[1] https://www.who.int/health-topics/breastfeeding#tab=tab_1
[2] “In babies born premature, the coordination of sucking, swallowing and breathing needed for effective feeding is usually not fully established until about 32 to 34 weeks’ gestation” before tube feeding is applied https://www.bliss.org.uk/parents/about-your-baby/feeding/tube-feeding
These vulnerable infants—mainly preterm neonates with low birthweight—are at greater risk of morbidity and mortality from severe digestive complications, infections, and https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30402-4/fulltext
These vulnerable infants—mainly preterm neonates with low birthweight—are at greater risk of morbidity and mortality from severe digestive complications, infections, and delayed growth or development than full-term or healthy infants. For these infants, WHO recommends safe use of donor human milk through human milk banks as a key risk reduction strategy.
[3] https://www.longwoods.com/content/25400/healthcare-policy/medicine-body-fluid-and-food-the-regulation-of-human-donor-milk-in-canada
[4] https://www.milkgenomics.org/?splash=the-breast-milk-products-of-the-future
[5] https://wphna.org/worldnutritionjournal/index.php/wn/article/view/173/130
[6] https://www.parents.com/breast-milk-uses-and-home-remedies-8671810
[7] Ibid. “Biopiracy happens when researchers or research organizations take biological resources without official sanction, largely from less affluent countries or marginalized people.”(Rose, 2018
[8] “A very lucrative liquid: the emerging trade in human milk as a form of reproductive exploitation and violence against women. https://www.emerald.com/insight/content/doi/10.1108/IJHRH-07-2019-0058/full/html
[9] https://economictimes.indiatimes.com/news/india/fssai-says-no-permission-given-for-sale-of-mothers-milk-warns-of-action-against-violators/articleshow/110470255.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst
[10] https://www.theguardian.com/world/2017/mar/28/cambodia-breast-milk-us-export-ambrosia-labs