Child Safety

India is planning a network of human breast-milk banks but first needs to put safeguards in place

Breast-milk collected from donors on a large scale need to be checked for adulteration and contamination.

Union Health Secretary CK Mishra inaugurated a human milk bank at Lady Hardinge Medical College earlier this month. The Ministry of Health Family Welfare has been planning a network of human milk banks for 661 newborn care units across the country to feed newborn babies who cannot be nursed by their mothers.

This is a welcome step that can discourage the use of infant formula, which is not as nutritious as human breast-milk. But regulation of human milk banks to ensure safety and quality of milk need to be discussed before the government goes further with the much needed programme.

Human milk used in neonatal intensive care units helps reduce necrotising enterocolitis or NEC in which portions of the bowel undergo tissue death. Use of breast-milk also helps cut down severe infections and colonisation by bacteria in newborns. Human milk banks work by collecting, screening and distributing human milk donated by women. Human milk banking is growing in many countries. According to the World Health Organisation, receiving milk from a human milk bank should be the first alternative for a baby whose mother is not able to breastfeed.

Human milk banking started informally almost a hundred years ago, however the first human milk bank was set up in the United States in mid 1980s. India’s first human milk bank was set up in Mumbai in 1989. Human milk banking has taken off in a big way in Brazil, which has more than 200 such centres. In 2011, Brazil’s milk collection was 1,65,000 litre from 1,66,000 mothers and provided service to 1,70,000 babies. Supported by Brazil, the human milk bank network is growing in Latin and South America. North America, Europe, South Africa, and Australia have also made significant progress. India is just beginning.

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Dr Ajay Khera, deputy commissioner for child health, has said that human milk banks will be called as lactation management centres and that human milk banking will be a part of an overall breastfeeding strategy. This is important since donated milk could be harmful for the recipient if adulterated or contaminated. Human milk may be contaminated with bacteria or even viruses like HIV. In the US, human milk is now being sold online but the Food and Drug Administration is urging women not to feed their babies with the milk that has not been screened at a milk bank.

Moreover, when human milk becomes a tradable commodity, there are also risks of adulteration with cow’s milk to enhance profit. Researchers in United States found that 10% of its human milk samples were adulterated with cow’s milk. In Bengaluru, there was a huge outcry when a private company wanted to set up a commercial human milk bank with doctors and public health advocates calling the proposal “exploitation of poor mothers”.

These risks warrant safeguards. The government should lead the process for developing and regulating operations of human milk banking to ensure safety. Human milk banking guidelines should be vetted by a technical committee comprising of scientists, medical, technical and legal experts. The committee should be free of conflicts of interest. The guidelines should be endorsed by professional associations. The Indian Academy of Pediatrics’ has also developed guidelines on human milk banking which calls for ethical standards and need to establish milk banks in large neonatal intensive care units.

Any national guidelines developed for human milk banking must include the following salient features:

  • Collection, storage and supply of human milk should be accomplished in a given time frame without adulteration and should be strictly monitored and documented.
  • Human milk should not be shared casually.
  • Guidelines should indicate who can donate and who can receive human milk.
  • A certificate of health should be obtained from healthcare providers of the donor and recipient.
  • Well-trained staff should be appointed at a human milk bank, who can screen milk and monitor supply with utmost honesty. They should also be equipped with social skills to interact with donors and recipients.  
  • Donors should be tested for HIV 1 and 2, Human T-cell lymphotropic virus or HTLV 1 and 2, syphilis, and hepatitis B and C.
  • Donors should sign up voluntarily and their consent should be obtained.
  • Operations for storage,pasteurisation, checking contamination, and monitoring the milk donations must be clearly defined. Human milk needs to be stored at -20°C. It is then thawed and a bacterial culture is taken from it. The milk is pasteurised and re-cultured before it is dispensed.
  • Milk should be monitored during storage to check for bacterial growth.  
  • All this information should be shared with health workers and with donor and recipient families for their consent.
  • There should be national level oversight to coordinate the whole process of human milk banking, as well as regulatory mechanisms.

The guidelines should also lay down clearly the order in which infants may receive milk from human milk banks to ensure that newborns who are critically ill or preterm babies are on top of the list. Here too, the critically ill and preterm babies should be allotted on a first-come-first-serve basis to avoid misuse.

Possible conflicts

Human milk bank should not be a profit-making industry. Commercial milk banking is open to potential risks since companies can make profits from adulterating donor milk.

Baby food companies should not be allowed to set up or operate human milk banks or even being part of decision making since they have clear conflicts of interests.

An example is the International Breast-milk Bank project, which works as a non-governmental organisation. According to a report, 75% of the milk donations it receives goes to Prolacta Bioscience that makes and sells “human milk fortifiers”. This means they compete to provide human milk to premature or very sick babies who are unable to get their mothers’ milk.

Two full bottles of pumped human breast milk. (Photo: Parenting Patch/Wikimedia Commons)
Two full bottles of pumped human breast milk. (Photo: Parenting Patch/Wikimedia Commons)

Human milk banks should also avoid ties with breast-milk pump companies as this could create conflicts of interest. Human milk banks should be operated like blood banks or any other human tissue bank. Donors should be told about the nature of the transaction they are involved in.

New mothers should be given every encouragement and support for lactation and breastfeeding. Human milk banks should be an option for women who cannot breastfeed even after they have received such support and counseling. If more women receive good lactation support it will also lead to more human milk donations as lactating mothers can donate any extra milk instead of throwing it away.

Brazil’s human milk banking within a breastfeeding strategy has helped reducethe country’s infant mortality by 73% since 1990. India has good examples of human milk banking at Sion Hospital in Mumbai that was set up in 1989 and the Rajasthan state government’s initiative to provide milk from Tonk’s district hospital to neonates deprived of mother’s milk. But, in scaling up human milk banking across India, the government needs to ensure the right safeguards are in place.

The writer is a paediatrician and founder of the Breastfeeding Promotion Network of India.

Corrections and clarifications

Prolacta Bioscience writes: Mothers who chose to donate their excess breast milk to Prolacta Bioscience could choose to direct their donation for the benefit of several different charitable organisations, among which International Breast-milk Bank Project was one. Those who chose to direct their breast milk donation to the project did so knowing that 25% of their donation would go directly to help orphans with HIV in Africa, and that the Project would receive $1 per ounce for the balance (75%) of their donation, which would be used by Prolacta to make life-saving neonatal nutritional products for premature infants in neonatal intensive care units. Prolacta is the only company in the world to offer 100% human milk-based fortifiers for extremely premature infants. Prolacta’s neonatal nutritional products are intended for hospital use only and are available by prescription only in neonatal intensive care units.

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Swara Bhasker: Sharp objects has to be on the radar of every woman who is tired of being “nice”

The actress weighs in on what she loves about the show.

This article has been written by award-winning actor Swara Bhasker.

All women growing up in India, South Asia, or anywhere in the world frankly; will remember in some form or the other that gentle girlhood admonishing, “Nice girls don’t do that.” I kept recalling that gently reasoned reproach as I watched Sharp Objects (you can catch it on Hotstar Premium). Adapted from the author of Gone Girl, Gillian Flynn’s debut novel Sharp Objects has been directed by Jean-Marc Vallée, who has my heart since he gave us Big Little Lies. It stars the multiple-Oscar nominee Amy Adams, who delivers a searing performance as Camille Preaker; and Patricia Clarkson, who is magnetic as the dominating and dark Adora Crellin. As an actress myself, it felt great to watch a show driven by its female performers.

The series is woven around a troubled, alcohol-dependent, self-harming, female journalist Camille (single and in her thirties incidentally) who returns to the small town of her birth and childhood, Wind Gap, Missouri, to report on two similarly gruesome murders of teenage girls. While the series is a murder mystery, it equally delves into the psychology, not just of the principal characters, but also of the town, and thus a culture as a whole.

There is a lot that impresses in Sharp Objects — the manner in which the storytelling gently unwraps a plot that is dark, disturbing and shocking, the stellar and crafty control that Jean-Marc Vallée exercises on his narrative, the cinematography that is fluid and still manages to suggest that something sinister lurks within Wind Gap, the editing which keeps this narrative languid yet sharp and consistently evokes a haunting sensation.

Sharp Objects is also liberating (apart from its positive performance on Bechdel parameters) as content — for female actors and for audiences in giving us female centric and female driven shows that do not bear the burden of providing either role-models or even uplifting messages. 

Instead, it presents a world where women are dangerous and dysfunctional but very real — a world where women are neither pure victims, nor pure aggressors. A world where they occupy the grey areas, complex and contradictory as agents in a power play, in which they control some reigns too.

But to me personally, and perhaps to many young women viewers across the world, what makes Sharp Objects particularly impactful, perhaps almost poignant, is the manner in which it unravels the whole idea, the culture, the entire psychology of that childhood admonishment “Nice girls don’t do that.” Sharp Objects explores the sinister and dark possibilities of what the corollary of that thinking could be.

“Nice girls don’t do that.”

“Who does?”

“Bad girls.”

“So I’m a bad girl.”

“You shouldn’t be a bad girl.”

“Why not?”

“Bad girls get in trouble.”

“What trouble? What happens to bad girls?”

“Bad things.”

“What bad things?”

“Very bad things.”

“How bad?”

“Terrible!!!”

“Like what?”

“Like….”

A point the show makes early on is that both the victims of the introductory brutal murders were not your typically nice girly-girls. Camille, the traumatised protagonist carrying a burden from her past was herself not a nice girl. Amma, her deceptive half-sister manipulates the nice girl act to defy her controlling mother. But perhaps the most incisive critique on the whole ‘Be a nice girl’ culture, in fact the whole ‘nice’ culture — nice folks, nice manners, nice homes, nice towns — comes in the form of Adora’s character and the manner in which beneath the whole veneer of nice, a whole town is complicit in damning secrets and not-so-nice acts. At one point early on in the show, Adora tells her firstborn Camille, with whom she has a strained relationship (to put it mildly), “I just want things to be nice with us but maybe I don’t know how..” Interestingly it is this very notion of ‘nice’ that becomes the most oppressive and deceptive experience of young Camille, and later Amma’s growing years.

This ‘Culture of Nice’ is in fact the pervasive ‘Culture of Silence’ that women all over the world, particularly in India, are all too familiar with. 

It takes different forms, but always towards the same goal — to silence the not-so-nice details of what the experiences; sometimes intimate experiences of women might be. This Culture of Silence is propagated from the child’s earliest experience of being parented by society in general. Amongst the values that girls receive in our early years — apart from those of being obedient, dutiful, respectful, homely — we also receive the twin headed Chimera in the form of shame and guilt.

“Have some shame!”

“Oh for shame!”

“Shameless!”

“Shameful!”

“Ashamed.”

“Do not bring shame upon…”

Different phrases in different languages, but always with the same implication. Shameful things happen to girls who are not nice and that brings ‘shame’ on the family or everyone associated with the girl. And nice folks do not talk about these things. Nice folks go on as if nothing has happened.

It is this culture of silence that women across the world today, are calling out in many different ways. Whether it is the #MeToo movement or a show like Sharp Objects; or on a lighter and happier note, even a film like Veere Di Wedding punctures this culture of silence, quite simply by refusing to be silenced and saying the not-nice things, or depicting the so called ‘unspeakable’ things that could happen to girls. By talking about the unspeakable, you rob it of the power to shame you; you disallow the ‘Culture of Nice’ to erase your experience. You stand up for yourself and you build your own identity.

And this to me is the most liberating aspect of being an actor, and even just a girl at a time when shows like Sharp Objects and Big Little Lies (another great show on Hotstar Premium), and films like Veere Di Wedding and Anaarkali Of Aarah are being made.

The next time I hear someone say, “Nice girls don’t do that!”, I know what I’m going to say — I don’t give a shit about nice. I’m just a girl! And that’s okay!

Swara is a an award winning actor of the Hindi film industry. Her last few films, including Veere Di Wedding, Anaarkali of Aaraah and Nil Battey Sannata have earned her both critical and commercial success. Swara is an occasional writer of articles and opinion pieces. The occasions are frequent :).

Watch the trailer of Sharp Objects here:

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This article was published by the Scroll marketing team with Swara Bhasker on behalf of Hotstar Premium and not by the Scroll editorial team.