Armida Fernandez, founder trustee of Society for Nutrition, Education and Health Action, started the first human milk bank in India in 1989 in Lokmanya Tilak Municipal General Hospital in Mumbai. There are currently seven milk banks in the country, functioning in various hospitals. Four are in Mumbai and one each in Pune, Hyderabad and Baroda. Fernandez spoke to Ratnika Sharma at the World Breastfeeding Conference held in Delhi between December 6 and 9 about the logistics and challenges of setting up a breast milk bank
What is the Human Milk Bank all about? How does it work in the Indian context?
A human milk bank is essentially like a blood bank except that it stores human breast milk and is used for premature or sick babies or whose mothers cannot express milk naturally. In India, it works as a hospital-based collection wherein we collect milk from lactating mothers, then pasteurize it and cold store it. We have a supervised milk collection, which is based on certain criteria like the mother should be HIV negative, Hepatitis B negative and free from veneral diseases.
How much will it roughly cost to set up a milk bank in a hospital? What are the logistics?
Setting up a milk bank is very cost effective and the equipment, like shaker bath, freezer and pumps cost very little. It would cost around Rs 4 to 5 lakh at the most. If there are not enough nurses at the hospital, then one would have to spend on a separate nurse to help the donors and a part-time technician. And you would probably need a 800 sq feet room, that’s all!
How much milk do you get from donors in a day? Does all of it get consumed?
We get around 50 ml of milk from one mother on an average and we get around 75 donors, so around three-and-a-half litres of milk each day. We cater to around 20 to 25 sick and premature babies who need breast milk from the milk bank. A normal baby needs around 80 to 150 ml of milk per kg of his/her weight, sometimes one feed is enough and sometimes several are required. The discard rates are less than 0.1 per cent because the demand is always more than supply. Moreover, the donated milk has a shelf life of up to six months thus, further reducing the chances of wastage.
Do you find it difficult to convince mothers to donate milk because they tend to be possessive about it? Is there any socio-cultural hindrance?
When we started in the late 80’s, there were no formula food or any alternate source of milk so it was an accepted norm that some mothers had to donate milk for needy babies. Once the trend was started, mothers got used to the idea and donated freely. But of course, these days it takes time to convince mothers in hospitals. Since we have hospital-based donation system, we cannot persuade women through advertisements, but once the trend is set, people follow. As far as the cultural barriers are concerned, that was never the problem. The practice of wet nursing has been there since the time of Krishna.
What is the biggest challenge in initiating this project? How many milk banks will we need in order to cater to orphaned babies as well?
The biggest challenge is to convince the hospital administration that we need a milk bank, especially in hospitals that have large ICUs. A baby needs milk not only at one stage but at several stages of his/her growth. And our hospital caters to abandoned babies if they are brought to the hospital. The need of the hour is to get the culture of breastfeeding and donating breast milk going. All big hospitals must have a milk bank to ensure a healthier future.
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