Breastfeeding is crucial for an infant's survival and health, but in India only 41% of infants are breast-fed within the crucial first hour of being born. The World Health Organization says that vulnerable infants, who cannot be fed their mother's milk, should be fed donor human milk.

Paediatricians and experts stress the need for a network of sustainable human milk banks to fulfil the need for donor human milk as breast milk contains antibodies which help protect infants against many common illnesses. Such banks or Lactation Management Centres in India started as early as the late 1980s. They collect, preserve and provide donated breast milk for infants who require it.

This World Breastfeeding Week, FactChecker spoke to Dr Arun Gupta, Central Coordinator, Breastfeeding Promotion Network of India (BPNI) and Dr Satish Tiwari, Founding Convener of Human Milk Banking Association of India, on the current state of the network of human milk banks in India and policy shifts required to encourage breastfeeding and breast milk donation. Excerpts:

How many milk banks are currently functional in India and are they proportionately distributed across rural and urban areas?

Dr Satish Tiwari: There are about 100-110 milk banks in India currently. Unfortunately, these are not proportionately distributed in urban and rural areas of the country. Most of them are in district headquarters or Metro cities. If the mother is from a rural background and delivers the baby in district hospital or medical college, she can get the milk for her baby if she requires, but only till she or the baby is admitted in the hospital with a milk bank.

Around 7.5 million children born in India have low-birth weight and 3.5 million are born preterm. Can you elaborate on how milk banks can be effective in their care?

ST: The share of prematurely born babies or low birth weight babies in India is around 35%-40% of the total births. These babies often require special care neonatal services for many days. Many healthcare centres or hospitals in our country don't have the infrastructure to keep both the mother and the baby in the hospital and many times this is also because families are unwilling to keep the mother admitted in the hospital. So, to feed the children admitted for special care, such facilities are needed in our country.

The present milk bank caters only to the needs of the babies delivered in their own hospital, but not every child in need of milk will be in a hospital. They are unable to provide milk to the babies delivered in other hospitals or in the community. Also, all hospitals that have a significant number of deliveries (around 1,000 per year) should have comprehensive Lactation Management Centres (CLMC).

Are the milk banks in India regulated to ensure there's no exploitation?

ST: At present, there are no specific regulations from any legal authorities regarding milk banks or CLMCs. There exist certain guidelines by the government and academic organisation's and we hope the centres follow the ethical and legal recommendations. But, in the absence of any regulatory systems or authorities, there is every possibility that the women and mothers may be exploited for commercial gains.

Dr Arun Gupta: There are no regulations. In 2017, when guidelines were being formulated, we, at BPNI, had demanded some regulations. Guidelines only have value if you follow them. If you want to set up a milk bank, the guidelines say that you must hire lactation counsellors who are trained intensively, but most banks don't do that properly. Even at delivery points, such as district hospitals, the duties and budget for Lactation Support Staff is outlined, but often they're not present. They're not investing in adequate human resources. This is the missing piece in the guidelines.

The Lactation Management guidelines state that breast milk cannot be used for commercial purposes. But the profit-making human milk market is on the rise in India too. What are the dangers of this commercialisation both for women and children?

AG: The national guidelines for lactation management say there shall be no commercial sale, but there is no law in the country that says it's not possible. A licence was given to a company in Bangalore to sell breast milk under the ambit of 'dairy products'. After BPNI objected, their licence was cancelled in April this year. But later we found out they had another license to sell it under 'AYUSH proprietary medicine'. They are also exporting it. Legitimacy is given by the government itself. The danger is the exploitation of poor women, and if it is privatised, only the rich will be able to afford it.

Since Lactation Management Centres need women who voluntarily donate milk, what is the criteria that qualifies a donor?

ST: As far as CLMCs are concerned, mothers are screened for major infections or illnesses so that the milk which will cause harm to the babies is not collected. The mothers are screened and milk of those suffering from HIV, Hepatitis B or similar infections is not collected. Also, women who smoke, are drug abusers, or have serious systemic diseases don't qualify.

AG: The strategy should also be to support and counsel donors appropriately during the process. They should be made aware that if they donate their milk, it will not be deficient for their own baby.

For how long do the infants receive donor human milk and how are these infants selected?

ST: If there are some health issues with the mother or the child, the baby may be given milk from the centre till these issues are resolved and the mother can feed her own child. She is encouraged to feed the baby and stop taking milk from the bank. In case a mother is not available usually the babies are given milk till the child weighs about 3 kilograms and other safer feeding options are available.

The selection of infants depends strictly on academic recommendations of a qualified paediatrician, especially when mother's milk is not available.

AG: The broad criteria, according to the National Neonatology Forum, would be babies who are born preterm, or babies with extremely low birth weight and who cannot suck. How long a baby is fed depends, till the time they gain requisite weight or start taking milk directly from the mother.