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India: Banking on Mother's Milk

By Womens Feature Service

* Sheila Pawar delivered her baby after a difficult Caesarian. Her family panicked: how would she breastfeed the newborn, considering the time it was taking Sheila to regain consciousness.

* One-day-old Baby S was found abandoned by the roadside. The pitiable cries were heart rendering as the tiny infant screamed with hunger.

* In a tiny hut in the Dharavi slum, two-month-old Munna suffered severe burns when boiling hot 'dal' (lentil) fell on him accidentally. Admitted to the local municipal hospital, injured Munna didn't have the strength to suckle at his mother's breast.

"There are at least 10,000 babies born every year in our hospital. For at least 35 to 45 per cent of these cases (around 3,000 babies) direct breastfeeding is impossible due to several medical or physical reasons," explains Dr Jayashree Mondkar, Head of the Department (HOD), Neonatology, at Lokmanya Tilak Municipal General Hospital, Mumbai, popularly known as Sion Hospital.

In such situations babies require milk from other sources but not "from other species such as cows, buffaloes and goats. We all know that there is no substitute for a mother's milk for a newborn baby and infant," explains Dr Bela Verma, acting HOD, Pediatrics, J.J. Hospital, Mumbai.

This medical predicament resulted in the setting up of a white bank or a human milk bank to help hapless newborns in the city. In countries such as the UK, Sweden, Norway, and USA, the services of human milk banks have been routinely available for many decades now. Indian hospitals only understood the importance of such banks in 1987, when Dr Armida Fernandez, then Dean of Sion Hospital, founded the first human milk bank of the country and, in fact, Asia.

At a human milk bank, a lactating woman's breastmilk is collected, pasteurised, tested for any microbes of diseases and then stored in a freezer at -20 degrees centigrade. A strict procedure is adhered to in the collection and dissemination of the milk. The donor mother has to be healthy and off any medication except for health supplements such as iron and calcium tablets. A donor must express milk by using mechanical or electrical pumps that cost about Rs 1,200 and Rs 50,000 (US$1=Rs 48.7) per set, respectively.

The expressed milk is pasteurised at 62.5 degree centigrade for 30 minutes. It is never boiled. Once pasteurised, the milk is rapidly cooled and poured into an autoclave stainless steel container measuring 150cc, 250cc and 300cc and then preserved at minus 20 degree centigrade.

From each of the three containers, a sample measuring two cubic centimetres is sent for culture and microbiological testing for HIV, history of jaundice, venereal disease for research lab to test, and so on. Based on the sample results, disease-free stock is stored and used when required within the subsequent six months.

"Annually, we collect anywhere between 700 litres to 900 litres of mother's milk - about three litres a day. The in-house new mothers are the donors of the bank. Depending on the birth weight, a baby needs 40 cc to 120 cc of milk a day. We can cater to 25 to 30 babies in NICU (Neo-Natal Intensive Care Unit) every day," explains Dr Mondkar.

"The nurses and doctors attached to our departments inform each and every lactating mother admitted to the hospital about the milk bank. They help dispel doubts and misgivings about the process. Our nurses always manage to convince mothers to donate milk during their stay in the hospital," comments Dr Sujit Jagtap, paediatrician, attached to Cama and Albless Hospital and J.J. Hospital.

Despite Dr Jagtap and others stating that milk banks are neither difficult nor expensive to run, the initiative has found few takers amongst the medical fraternity. India currently has around seven such banks, four of which are located in Mumbai at Cama and Albless Hospital, King Edward Memorial Hospital and, of course, Sion and J.J. hospitals.

Dr Fernandez, now retired, observes, "There are several reasons as to why no one had thought of such banks in India. Firstly, in the 1960's, 1970's and 1980's women in the Western countries had discovered bottle feeding. The advertisers of these milk products had touched a chord and suddenly breastfeeding went out of fashion. Our own educated and working women who love to copy the West followed suit. Even mothers who could breastfeed preferred to feed babies with top milk (powdered milk or fresh milk)."

She elaborates, "The nuclear family system also put a strain on the quantity of milk produced by the mother. The stress of looking after a newborn and working, forced her to feed the baby with top milk."

Until the importance of breastfeeding was understood and gained universal popularity, the need for the human milk bank was not felt. Every time a newborn or infant was in distress, the easily available 'dabba' (powdered milk or cow's milk) milk was resorted to. Even today there are many hospitals, doctors, nurses and working mothers who prefer the easy way out and opt for bottle feeding their babies.

In the villages, among the economically lower strata or in large joint families, a new mother rarely lacks a donor, as wet nursing is quite a common practice among such groups. At any given time, there are always three to four new deliveries, which means that if a woman is unable to breast feed, the other lactating mothers won't hesitate to nurse the child. The milk bank is an advanced form of wet nursing, adds Dr Fernandez.

The bank assumes importance in the light of breast milk being the best nutrient for an infant. The other most popular food supplement - cow's milk - doesn't suit a newborn baby and Dr Mondkar explains why: "One has to just see the size of a calf [to understand]. Cow's milk has that much extra proteins, carbohydrates, hormones and so on to suit the size of its calf. The size of a human baby is at least ten times smaller."

"The good thing about Indian mothers is that they can't bear to see a hungry child. So once they are convinced that their own child won't suffer, or their own milk flow won't reduce, they quite willingly donate their milk," says Dr Verma.

This belief has been reinforced by research conducted by the nurses at Sion hospital under the supervision of Dr Fernandez, titled: "Willingness to Donate, Willingness to Accept Milk', in 1992. It showed that out of 400 mothers, 399 mothers willingly donated milk - a purely honorary service for both donor and recipient.

Sometimes depending on the demand, three different types of breast milk are collected from a newly lactating mother, during the course of her post-partum stay in the hospital. During the first few days of delivery, colustrum is expressed and stored separately through the specified procedure. This is given to babies suffering from diarrhoea, malnutrition and burn injuries. Breast milk expressed over the next five to ten days, referred to as 'transitional milk', is also stored separately. The milk expressed, and stored, thereafter, is called 'mature milk', and contains a comparatively lower protein content.

Most of the time, the supply barely manages to meet the demand within the hospital. Yet, Sion Hospital has responded to an external demand. Dr Mondkar recollects that the hospital bank had supplied stock to an adult patient suffering from a brain injury, and medically prescribed mother's milk. "According to his doctors, there was a remarkable improvement in the condition of the patient but I don't know the medical explanation to it," she says.

As long as there are good, willing Samaritans - donor mothers - doctors and hospitals, even the private concerns, should make an effort to ensure that no newborn is deprived of mother's milk.

Womens Feature Service covers developmental, political, social and economic issues in India and around the globe. To get these articles for your publication, contact WFS at the www.wfsnews.org website.