Equitable access to human milk: A vital solution that lacks global standards

Access to safe blood and blood products has long been considered an essential part of effective health care systems. Identified as a crucial part of life-saving treatments and therapies, a global regulatory framework and supportive programs exist to ensure high standards for collection, safety, storage, and appropriate and ethical use of blood within health systems.

Contrast that with another incredibly powerful health intervention for which such standards are all but absent—the collection, banking, and delivery of safe donated human milk to newborns who do not have access to their own mother’s milk and need milk to survive their first days or weeks of life.

In low-resource settings, more than 32 million newborns are considered vulnerable due to illnesses, prematurity, or low-birthweight. And a non-breastfed child’s risk of death is six times higher than that of a breastfed child. Human milk consumption—through breastfeeding and other practices—is one of the most efficacious and cost-effective interventions we have at our disposal to support child nutrition. Considered the optimal first food and an essential medicine, the power of human milk can save countless lives.

How can we ensure all babies have equitable access to human milk?

One of the best ways to ensure a newborn consumes breast milk is to support their mother’s lactation. When this is not enough and these vulnerable babies cannot access their own mother’s supply – due to maternal death, illness, delayed initiation of lactation, or abandonment – the preferred alternative to formula is to provide donor human milk through human milk banking. By collecting, pasteurizing, testing, and storing safe, donated milk from screened lactating mothers and providing it to infants in need, human milk banks ensure that even if babies cannot receive their own mother’s breast milk, they can still receive human milk early in life.

For nearly a decade, PATH has worked at the forefront of strengthening health systems’ ability to integrate human milk banking into newborn care, including projects in South Africa, India, Vietnam, and Kenya. While we have made progress, we—along with the partners and Ministries of Health we work with—have repeatedly encountered a frustrating gap: a dearth of global standards as well as insufficient guidelines to support regions and countries seeking to establish or scale up locally appropriate human milk banking systems.

Although more than 600 human milk banks exist around the world, each region has had to independently develop systems for implementation, with no mechanism for systematic coordination of global best practices.

Now, through intensive collaboration with global policy and technical leaders in newborn health, nutrition, and human milk banking, PATH has developed Strengthening Human Milk Banking: A Resource Toolkit for Establishing & Integrating Human Milk Banks. This toolkit is comprised of 11 separate core documents and accompanying materials—including templates, standards, and tools—to guide critical steps for establishing human milk banking as an integrated component within breastfeeding support and neonatal care, with in-depth focus on readiness, quality assurance, operations, auditing, training, monitoring and evaluation, and communications. These tools are intended to be utilized as a cohesive package, with embedded links throughout to orient and guide users to relevant resources. This toolkit, in its entirety, is freely available and globally accessible. The content was developed to be adaptable to local context requirements to maximize effectiveness and reach. In the absence of global guidance on safety, quality, and ethics on human milk, we hope that this toolkit will serve as a powerful resource for achieving critical standards around the world.

“We know that breast milk saves lives; appropriate and safe provision of donor human milk is a powerful intervention to ensure that every baby has equitable access—even those without their own mother’s milk,” said Kiersten Israel-Ballard, PATH’s Associate Director of Maternal, Newborn, and Child Health & Nutrition. “This new toolkit provides a robust and comprehensive set of resources for health systems to draw upon for strengthening the entire continuum of newborn nutrition – by protecting, promoting and supporting breastfeeding with integrated quality-controlled and locally adapted human milk banking systems.”

If implemented as a component within a comprehensive and integrated system, human milk banks can also serve a broader purpose for protecting, promoting, and supporting breastfeeding, embedded within both nutrition and newborn care programs.

By advocating for, expanding access to, and promoting proven newborn and nutrition interventions, we have the opportunity to build a movement that transforms the entire newborn nutrition field. And if we do, the most vulnerable citizens of our planet—newborn babies in low-resource settings—will have the opportunity to not only survive the earliest days of childhood, but to thrive for years into brighter futures.

The PATH Newborn Nutrition Team

Contact: Kiersten Israel-Ballard, Associate Director, Maternal, Newborn Child Health and Nutrition kisrael-ballard@path.org

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