20 May Breast milk banks won’t solve the formula crisis, but they’re a lifeline
The Washington Post (May 19, 2022) – As the formula shortage continues to roil the United States, many parents are desperate for other sources of nutrition for their infants.
Milk banks, where humans donate their own breast milk to be pasteurized and stored for someone else’s use, primarily serve micropreemies, whose mothers aren’t able to provide enough milk for them to survive, and other medically fragile babies. The banks are now scrambling for more donations amid the formula crisis, as requests for milk are on the rise.
“Generally speaking, the babies we serve are in the NICU,” said Lindsay Groff, executive director of the Human Milk Banking Association of North America (HMBANA), which includes 28 nonprofit member banks across the United States and three in Canada. “We have to serve babies in life-threatening situations, then we can talk about healthy, full-term infants. But we can only do that if someone steps up and donates.”
These banks follow stringent guidelines to screen donors, who ship or drop off frozen breast milk to the closest bank in specialized packaging. The milk is pasteurized before being delivered to babies in need. Donors include women who have excess supply or parents with milk in their home freezer that their baby no longer needs.
There has been a trending rise in demand for donated human milk for years now, Groff said, with a 22 percent increase from 2020 to 2021. The banks distributed 9.2 million ounces of milk last year. “Now, we’re in a totally different situation. … People are panicked and worried about what to do for their babies. Some are turning to donor milk if that’s an option for them,” Groff said. Member banks are reporting a 20 percent increase in demand as of last week. “I suspect as the desperation continues, that the number could increase,” she said.
Groff was a donor a dozen years ago, shipping her milk from Philadelphia to Columbus, Ohio. Her daughter had a birth defect that required surgeries that resulted in her not being able to breastfeed. “I pumped and pumped and a nurse in the NICU told me I could donate it. I had no idea,” she said.
If a parent needs milk from a nonprofit milk bank, they must have a prescription from their child’s doctor. Insurance sometimes covers the milk, but otherwise, families pay about $4.50 per ounce, just enough to cover processing fees, said Denise O’Connor, a lactation consultant and the founder and executive director of the Mid-Atlantic Mothers’ Milk Bank. Babies can have the milk shipped to them in secure containers packed with dry ice to keep the milk frozen. (There are also a small number of for-profit milk banks that pay donors for their milk and sell it for profit.)
Families with healthy full-term babies who would not qualify for a prescription can request a small amount of milk from banks, the equivalent of a few bottles, or up to 40 ounces. “If someone is out there and desperate, down to the last can [of formula], reach out to the local milk bank,” Groff said. “If you can’t get help for a number of reasons, you can check the next closest one.”
O’Connor said the bank went from donating 57,000 ounces when it first opened in 2016 to donating 30,000 ounces every month now. “This formula shortage has really increased our demand quite markedly,” she said. “Hospitals are relying more heavily on us.”
“I cannot overemphasize the profound impact that donor milk has,” O’Connor said. “Every single drop is going for good.”
Over the past decade, the value of human milk for premature babies has been studied and found to be incredibly beneficial, said Lisa Stellwagen, professor of pediatrics at UC San Diego School of Medicine and the executive director of the University of California Health Milk Bank. So if the parent of a preemie or micropreemie is not able to feed their baby with their own milk, that supply is supplanted as often as possible with donated milk from nonprofit banks.
Heather Trudeau’s daughter, Reya, is benefiting from donated milk since being born with a complex and critical congenital heart defect. While Reya was at the Children’s Hospital of Philadelphia for six months, Trudeau pumped her own milk. But Reya struggled to digest it. Trudeau donated her milk to a bank after it was believed Reya was allergic. “Months later, breast milk was the only thing she could tolerate,” she said. But Trudeau wasn’t pumping anymore and didn’t have a supply. “I was frantic.”
Reya started receiving donated milk from a milk bank when she was about 7 months old. She’s now nearly 11 months old and thriving, and consumes 20 ounces of breast milk each day.
O’Connor said there is a constant need for milk donors and there “always has been, even outside of this formula shortage.”
The milk at the banks in the United States is not enough to make up for the lack of formula in stores, Stellwagen said. “We’re not going to be able to solve this formula shortage,” she said, pointing out that Italy has 36 milk banks and a much smaller population. “We’re far behind in this country.”
For now, Stellwagen said, parents need to be aware of how to handle this formula shortage. If a baby is younger than 6 months old, they should either be fed breast milk or infant formula. If their formula isn’t available, try to switch to a brand that is considered interchangeable. Do not, she said, substitute toddler formula or whole milk until they are at least 6 months old. And absolutely do not dilute the formula to try to make it last longer, which causes overhydration and could lead to seizures and brain damage. Diluted formula is also insufficiently nutritious.
If a baby is older than 6 months, they can be fed some table food because their immune system is a little more robust, she said. They also can be fed with toddler formula or whole cow’s milk for a short time. “Though we would encourage them to get back to infant formula” when the supply is back, she said. “You don’t want to mess around with improper nutrition.”
The American Academy of Pediatrics does not recommend informal milk-sharing from Facebook groups, neighbors or strangers, said Stellwagen, who is the AAP’s policy chair for breastfeeding. Milk bank donors are fully screened, as recommended by the Food and Drug Administration, for viruses that can be prevalent in human milk that could make babies sick, such as HIV, hepatitis and other bloodborne pathogens. Milk banks also screen for “questions that you might not feel comfortable asking” an unknown donor, such as about possible substance use.
Stellwagen said her milk bank has received five times as much interest in donating milk since the formula shortage began, and she hopes that translates into real donations. “I think it’s one of the good things that might come out of this is that we’ll have more of a donor milk supply in milk banks.”