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Liquid Gold

Dubbed “liquid gold,” human breast milk is packed with nutrients and immune factors that provide a variety of health benefits to newborns. In recognition of the vast benefits of breastfeeding, countries across the globe have set up modern milk banks that receive and store healthy, screened breast milk from donors and provide it to babies in need. Over a decade ago, the Human Milk Banking Association of North America and the United Kingdom Association of Milk Banks worked together to set up the International Milk Banking Initiative, which operates in 33 nations to promote safe, ethical and accountable milk banking around the globe.

In recent years, another form of breast milk sharing has spiked in popularity: breast milk markets. These markets differ from milk banks in that they’re economic exchanges through which women are compensated for providing their breast milk. They range from formal companies such as Prolacta Bioscience, which adds nutritional elements to the milk before providing it to neonatal intensive care units, to informal Craigslist-esque websites such as Only the Breast. The rise of these markets, in conjunction with the continued expansion of existing donor banks, carries a multitude of positive social impacts. But as breast milk becomes increasingly commodified, clear regulations on its exchange must be enacted to protect mothers and infants alike.

Breast milk endows many positive health outcomes upon babies who consume it. It promotes sensory and cognitive development and has been shown to protect infants from sudden infant death syndrome and jaundice, among many other ailments. The demand for breast milk is especially high for premature babies due to the protection it provides them from sepsis and other possibly fatal diseases: Neonatal intensive care units in the US demand about 63 million ounces of breast milk per year. The impact of breast milk sharing is astonishing: Brazil, for instance, has witnessed a 73 percent decrease in infant mortality rate since the inception of its first breast milk bank in the 1980s.

Currently, hospitals and new mothers make up a large portion of breast milk seekers, since not all babies are able to consume their own mother’s milk. There are many reasons for this: Some people who give birth suffer from medical conditions or treatments that prevent their breasts from producing milk. For example, undergoing a C-section or simply having insufficient glandular tissue can prevent lactation. Giving birth prematurely can also prevent the development of enough glandular tissue to lactate. In addition to these new mothers, male couples and single fathers also seek breast milk for their children.

Luckily, this demand is met with a reliable supply. There are many reasons why women may seek to donate or sell their breast milk. Often, those who breastfeed naturally over-lactate, producing more milk than necessary for their child’s consumption. Breast milk markets create new economic opportunities for mothers; by selling milk that may otherwise be wasted, new parents now have a unique option to alleviate the financial burden of a newborn child.

Though breast milk sharing holds great promise, it can only reach its full potential if policymakers address the ethical and health considerations associated with this practice. Unlike the heavily regulated donation of blood or organs, the donation and sale of breast milk is relatively unregulated in the US. In fact, there are currently no laws regarding the sale of human breast milk. Economic incentive may give rise to shady markets in which unscreened, potentially spoiled breast milk is sold through backhand sources; such unscreened milk could even contain diseases such as HIV or hepatitis, putting vulnerable infants at risk.

Furthermore, low-income women may be exploited in this exchange. There’s been much controversy surrounding the sale of Cambodian mothers’ breast milk to US company Ambrosia Labs: While some argue that the practice was a precious economic opportunity for Cambodian women—with a relatively generous pay of $0.50 per ounce—others, including the UNICEF, chided the exchange as “exploiting vulnerable and poor women for profit and commercial purposes.” In 2017, the Cambodian government instituted a ban on exporting breast milk.

Yet, there are similar concerns within domestic contexts, with powerful corporations and wealthy individuals exploiting low-income mothers who have few other options. Particularly in the US, the idea of sharing breast milk is understandably questionable because of its complicated history rooted in inequality and oppression. During the 18th century, African women were brought across the Atlantic to work as wet nurses for white families. This commodification of black female bodies to benefit white families presents historically racist, sexist, and classist associations with breast milk sharing systems. After the end of slavery, in the 19th and 20th centuries, upper class families often hired wet nurses, usually women of a lower socioeconomic background, to breastfeed their newborns. This left wet nurses with no choice but to feed their own babies formula. A similar narrative of commodification may taint breast milk sharing today if policymakers don’t set clearer rules and crack down on underground breast milk markets, both in the US and around the world.

Without a doubt, advances toward breast milk markets and banks have been met with controversy. In particular, opposition from corporate interests stands in the way of ensuring the safe and ethical trade of breast milk. A staunch opponent to the movement is the lucrative instant formula business, which has strong conservative political support. Siding with the industry, President Trump’s administration derailed the passage of a World Health Organization resolution supporting the promotion of breastfeeding. Increased breast milk sharing means fewer formula purchases and lower profits for corporations: this is a chain of events companies will do anything to prevent. Nestlé, for instance, tried to convince mothers in developing countries that formula is indispensable, despite research showing that formula is less healthy and more expensive than breast milk. These challenges are all the more reason for lawmakers to protect mothers’ and infants’ well-being.

Still, steps can be taken to tackle the potential problems with breast milk markets down the line. Different countries have vastly different regulations surrounding breast milk, but in the US and elsewhere, there is a dire need for more stringent rules controlling its exchange. Lawmakers should look to the organ and blood donation system for guidance: These donation pipelines are lengthy and complex processes with many layers of regulations and screenings—even blood donations, which are commonplace and informal, involve stringent qualifications and regulations. Furthermore, human breast milk should be pasteurized, an efficient and inexpensive process applied to cow and goat milk that kills many pathogens. With stricter regulations, governments can limit the consumption of potentially unsafe breast milk and work to prevent the exploitation of women through this grey market.

Though there is much to be done, there’s no doubt that breast milk banks and markets are pushing the boundaries of what can be shared, and, in their course, challenging traditional concepts of motherhood. Breast milk sharing has the potential to bring in a flood of positive social and public health impacts; it just needs a clearer set of guidelines to keep it on the right track.

Photo: “Bottle-Feeding

About the Author

Madeline Noh '22 is a Staff Writer for the Culture Section of the Brown Political Review. Madeline can be reached at madeline_noh@brown.edu

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