By Bri Ziganti
The word is out on breastmilk– and that word says, breast is best for baby. But for the mothers of premature children, providing a reliable supply of breastmilk is often a cruelly unreachable goal. The recent acceptance of donated breastmilk is an encouraging victory for those who cannot breastfeed.
Unfortunately, only about 5% of American infants who need donor milk actually get it. In some areas, breastmilk shortages are so severe that an entire homegrown industry of “black market” milk trades has developed to handle the need. As of 2015, it’s estimated at least 13,000 posts or advertisements for unregulated breastmilk sharing and sales are made online each year. Combine easier access with the explosion of research recommending breastmilk beyond any other source of nutrition, and it’s easy to see why women who can’t produce their own milk would eagerly take a donation or buy the milk outright. Just one bottle of expressed breastmilk contains antibodies, vitamins A, B1, B2, B6, B12, D, and iodine, as well as the proteins, fats, and lactose macronutrients their babies need to grow tissue. Failing to breastfeed at all can lead to more frequent ear infections, lower respiratory tract infections, and a higher risk of NEC, according to the U.S. Preventive Services Task Force.
Where Does the Breastmilk Black Market Thrive?
Internet sales make up a large percentage of the unregulated breastmilk sharing trend. On average, breastmilk is sold online for $2.50 an ounce; however, on many sites the cost is anywhere between $3.00 per ounce (onlythebreast) to $20.00 per ounce (craigslist). Needy moms can browse listings from all over the country– and in some cases, farther– to purchase milk. The breastmilk is usually frozen so it will keep during delivery, but can be purchased fresh as well. Most sites keep the sellers’ identities anonymous.
Understandably, this anonymity can be too much for a lot of mothers; as such, many families prefer to keep the unregulated breastmilk sharing trade firmly within the community. Local social media groups like Port City Milk Fairy in North Carolina, or the more global group Eats on Feets use Facebook to match needy moms with milk donors in particular counties, states, and even countries. Best of all, the groups do it for free, making donor milk a financial possibility for many families for the first time.
Most participants claim the programs are safe and the benefits well-outweigh any risk factors, but it’s still important to note that there is no testing done to ensure that the donor mother is free of disease or not taking medications that could harm the baby being fed. There is also no guarantee that the milk was stored in clean bottles or bags at the proper temperature. Unsurprisingly, every milk share group posts a firm disclaimer notice on their sites, maintaining that donors aren’t screened, milk isn’t tested, and anyone who feeds their breastmilk to their babies are accepting the liability of using unpasteurized human milk.
While many women consider this uncertainty a small price to pay, doctors aren’t nearly as accepting of unregulated breastmilk sharing’s countless possible health hazards.
“In my mind, it’s a risky business,” explained Dr. Joan Younger Meek, chair of the AAP section for breast-feeding and chair-elect for the United States Breastfeeding Committee. “Even the informal sharing between mom’s sister and the mother’s best friend – there are still risks to that because you don’t know the full health history or if the milk was stored in clean containers.”
The Dangers of Unregulated Breastmilk Sharing
Why so skeptical? While breastmilk can be stored in a deep-freeze for over six months, it usually isn’t transported that way when it’s delivered by a donating mother. Typically, women who share their breastmilk through unofficial channels will pack it in a small cooler and pray it stays cold for the entire trip. If the cooler can remain below 40° F, the milk is considered safe for up to 24 hours. If the cooler should fail, these limits increase dramatically, as breastmilk can only be kept at room temperature for a period of 8 hours or less. After that time, it isn’t safe to use.
Although these guidelines are available on the internet, there’s no guarantee that the donor is aware of how short the time limits really are, or that the milk was stored properly. Conversely, the breastmilk processed by milk banks is typically collected at a depot, sometimes even expressed in a sterile environment, and will either be kept within a safe temperature range or disposed of.
Shady Practices and Unwanted Additives
Dr. Sarah Keim, chief investigator at the Research Institute at Nationwide Children’s Hospital in Columbus, Ohio, identified another, more sinister reason why moms might want to avoid an informal milk share. In her 2015 publication titled “Cow’s Milk Contamination of Human Milk Purchased via the Internet,” Keim describes how her team anonymously bought 102 bottles of milk advertised as human breastmilk online, and tested their composition. Eleven bottles had some level of cow DNA mixed with human DNA. Fully ten of these samples had so much cow’s DNA in them, it was clear that a significant amount of cow’s milk had been added, ruling out “accidental” contamination. While cow’s milk isn’t deadly to most people, it can pose a problem if the baby in question is allergic to dairy. Not to mention, human breastmilk commands a much higher price than cow’s milk, because people obviously expect it to come from a human. Selling one product while shipping another is just dirty practices.
“Someone could add infant formula or cow’s milk to the breast milk,” Keim said, explaining their concern. “But there could be other contaminants in it, such as water or soy formula. Even a small amount can be a problem for a baby with an allergy.”
Safer Alternatives to Unregulated Breastmilk Sharing
Okay, so buying the product or accepting an anonymous donation is out…..but surely, there’d be no such foul play when receiving milk from a family member or a friend? Unfortunately, according to Keim, even that strategy isn’t a guaranteed safe bet. After all, as Keim points out, “someone you think you know well may not be interested in disclosing information about whether or not they’re taking medications or using illicit drugs.”
So, the million-dollar question, then. If it’s not really safe to purchase breastmilk from strangers, or use informally donated milk…..how can moms get a steady supply?
FDA-approved milk banks remain the gold standard.
Unlike individuals, milk banks are required to meet certain safety guidelines. Medolac, arguably one of the most advanced milk banks on the market, boasts the only commercially-sterile donor milk available. Every applicant is tested for disease and harmful medications before they are allowed to donate. Medolac’s pasteurization process sterilizes the milk without impacting its nutrition, allowing it to be shipped and stored at room temperature. This method not only prevents spoilage, but costs far less than shipping frozen breastmilk, making the milk more accessible to cash-strapped families. Finally, Medolac uses SafeBaby’s donor milk tracking software to keep tabs on the milk as it is collected, pasteurized, and delivered to NICUs, so that if contamination or donor illness is detected, the specific lot of milk can be identified, flagged, and quarantined from the rest before it is fed to a baby.
Innovative methods of breastmilk tracking and validation will continue to change the landscape of donor milk. In time, unregulated breastmilk sharing will probably give way to official supply chains, providing mothers and NICUs with safer, cost-effective donor milk without having to turn to the breastmilk black market.