An open letter from Prof Emeritus Anna Coutsoudis and Dr Penny Reimers.
Human Milk Banks (HMBs) in low resource settings are facing pressure to conform to standards and practices of HMBs in well-resourced settings.
The latest of these is the creation of digital tracking systems tracking the delivery and dispensing of donor human milk (DHM).
The chief reason HMBs exist is to provide lactation support to mothers so that mothers will be enabled to exclusively breastfeed and provide their infants with their own milk with its documented benefits to mother and child both short and long-term.
The question is: Does a HMB need tracking technology in order to fulfill the chief reason for its existence? Is this tracking technology vital for all HMBs, even those operating in low-income countries?
The reality is that the majority of the most vulnerable infants are in low-income countries and these are the very countries most in need of access to donor human milk and HMBs. For these countries, the cost of implementing certain measures can be a barrier to the mere existence of services meant to support and promote the health and well-being of the communities that need them.
It is important that HMBs in low-income settings are not stifled by standards which are costly, inappropriate for the services they offer and which do not contribute meaningfully to the HMB and the vulnerable little ones they serve.
It is possible to set up and run HMBs simply and sustainably at very low cost, without costly digital tracking systems and all the “bells and whistles” that have become the norm in high-income countries.
A recent example of this has come from Mbale, Uganda where neonatologist, Dr Kathy Burgoine, and her team have recently demonstrated that it is possible to set up an effective low cost HMB where the majority of money is not spent on technology, but instead on human resources and having lactation supporters available.
HMBs in low-income countries should be encouraged to continue to spend the majority of their finances not on the latest technology (which is likely not appropriate for their context) but instead on the foundational reason for HMBs: providing lactation support to mothers so that mothers will be enabled to exclusively breastfeed and provide their infants with their own milk.
The focus should always be to see these infants discharged exclusively breastfeeding.
We need to be reminded that while Donor Human Milk is vastly superior to dairy based formula milk, Mother’s own unprocessed raw human milk – which is vital, especially in low-income countries – is superior to DHM which does not contain the same nutritional, immunologic, and microbial components.
With sufficient lactation support, the majority of mothers are able to build up their own supply to provide their own tailor-made breastmilk for their infant and only in exceptional cases may need a few days of DHM to tide them over until their own supply is well established.
It is essential that every effort be made to ensure that these very vulnerable infants have access to their own mothers’ milk by providing the cost-effective, necessary and sustainable services that make this possible.
With each new advance in DHMB we should ask ourselves: Is this contributing to the goal of promoting, protecting and supporting breastfeeding? And additionally: Is this advance serving the most vulnerable in the most effective way? After all, it is for the most vulnerable that HMBs exist.
