Distributing Reproduction Under Racial Capitalism: Crises and Conjunctures of Human Milk Banking in South Africa

Call to action for equitable access to human milk for vulnerable infants

The use of donor human milk is rising. Maternal awareness of donor human milk use, milk donation, and milk banks has not been well described in the United States. To explore maternal experience, knowledge, and attitudes regarding donor human milk use and milk donation. We also assessed counseling by medical providers about donor human milk use and donation. A cross-sectional prospective survey design was used in this study. We anonymously surveyed mothers (N = 73) attending the 1 to 2-week well newborn appointment. Analyses were completed using one-way ANOVA and logistic regression. Participants' infants primarily received their own mother's milk (87%, n = 61). No infants received donor human milk, but 4% (n = 3) of participants donated milk. The majority of participants had positive responses to attitudinal statements about donor milk. When presented with a hypothetical scenario, participants chose formula (89%, n = 59) over donor human milk (11%, n = 7) for their infant. Moreover, if donor human milk was the only option available, they chose donor human milk from a relative or friend (60%, n = 40) over a milk bank (40%, n = 26). Medical providers had discussed donor human milk use or donation with 4% (n = 3) of participants. The majority of participants previously had minimal experience using donor human milk and limited knowledge regarding donor human milk and milk banks. According to participants, medical providers did not routinely discuss milk donation and the role of donor human milk with families.

The Human Milk Banking Association of North America(HMBANA) is a professional association for supporters of non-profit donor human milk banking.HMBANA develops guidelines for donor human milk banking practices.The construction of China's human milk bank has just begun in few areas in 2013.To further promote the development and implementation of donor human milk banking in our country, this review introduce the guideline for establishment and operation of a donor human milk bank which drafted by HMBANA in 2013.The guideline can provide the basis for the development of human milk bank in our country. Key words: Donor human milk banking; Standard; Guideline

Vital Human Milk: Implementing a Donor Milk Program

BackgroundProvision of donor human milk is handled by established human milk banks that implement all required measures to ensure its safety and quality. Detailed human milk banking guidelines on a European level are currently lacking, while the information available on the actual practices followed by the European human milk banks, remains limited. The aim of this study was to collect detailed data on the actual milk banking practices across Europe with particular emphasis on the practices affecting the safety and quality of donor human milk.Materials and methodsA web-based questionnaire was developed by the European Milk Bank Association (EMBA) Survey Group, for distribution to the European human milk banks. The questionnaire included 35 questions covering every step from donor recruitment to provision of donor human milk to each recipient. To assess the variation in practices, all responses were then analyzed for each country individually and for all human milk banks together.ResultsA total of 123 human milk banks completed the questionnaire, representing 85% of the European countries that have a milk bank. Both inter- and intra-country variation was documented for most milk banking practices. The highest variability was observed in pasteurization practices, storage and milk screening, both pre- and post-pasteurization.ConclusionWe show that there is a wide variability in milk banking practices across Europe, including practices that could further improve the efficacy of donor human milk banking. The findings of this study could serve as a tool for a global discussion on the efficacy and development of additional evidence-based guidelines that could further improve those practices.

Background: Donor human milk (DHM) bank practices, such as pasteurization and pooling according to postpartum age of milk donations and number of donors included in a pool may impact the resulting concentration of bioactive components of DHM.Aims: We determined the impact of Holder pasteurization, postpartum milk age, and pool donor number (number of donors included in a pool) on resulting concentrations of total immunoglobulin A (IgA; which provides immune protection to the recipient infant) and insulin (an important hormone for gut maturation).We also documented inter-relationships between these bioactive components and macronutrients in DHM pools.Methods: Pre and post-pasteurization aliquots of 128 DHM samples were obtained from the Rocky Mountain Children's Foundation Mother's Milk Bank (a member of the Human Milk Banking Association of North America, HMBANA). Macronutrients were measured via mid-infrared spectroscopy. Total IgA was measured via customized immunoassay in skim milk and insulin was measured via chemiluminescent immunoassay.Results: Mean post-pasteurization total IgA concentration was 0.23 ± 0.10 (range: 0.04–0.65) mg/mL a 17.9% decrease due to pasteurization (n = 126). Mean post-pasteurization DHM insulin concentration was 7.0 ± 4.6 (range: 3–40) μU/mL, a decrease of 13.6% due to pasteurization (n = 128). The average DHM pool postpartum milk age was not associated with total IgA or insulin concentrations, but pool donor number was associated with bioactive components. Pools with only one donor had lower total IgA and lower insulin concentrations than pools with at least 2 donors (p < 0.05). Increasing the number of donors in a pool decreased the variability in total IgA and insulin concentrations (p < 0.04).Conclusion: Increasing the number of donors included in DHM pools may help optimize bioactive components in DHM received by premature infants. These results help inform milk banking practices to decrease compositional variability in produced DHM pools.

This intervention considers uneven development and social reproduction within racial capitalism. Social reproduction refers to the range of practices that form the conditions of possibility for the life of capital, as well as life and death within racial capitalism. This spans a range of institutions and networks within households, communities, states and across national borders as well as the labour practices, relations and organization that reproduce racial capitalism. Here, we examine the extraction of time, taking up theorizations across carceral geographies, postcolonial theory and Caribbean studies to demonstrate how coercive relations of social reproduction contribute to uneven development. In particular, we look at the role of the state in racial capital’s capture of reproductive activities across our work on electric utilities in Atlanta, Georgia and extralegal land tenure on Jamaica’s north coast. In bringing these distinct sites into conversation, we re-affirm the need to study uneven development by understanding how the circulation and accumulation of capital is imbricated with the production of hierarchies of all kinds of difference. We show how a conjunctural countertopography can reveal how state practices advance accumulation under conditions of widespread surplus lives, as capital wagers on captive life and premature death.

Background: The use of human milk provides substantial short- and long-term benefits. With the establishment of the first donor human milk bank in Singapore, high-risk preterm and critically ill infants whose mothers have an inadequate milk supply can have access to pasteurized donor human milk. Materials and Methods: A self-administered anonymous questionnaire was conducted among doctors and nurses working in the special care unit and neonatal intensive care unit of KK Women's and Children's Hospital. The questionnaire was divided into three main sections, namely, demographics, knowledge assessment, and opinion. The aims of the survey were to assess the knowledge, attitudes, and perceptions of health-care workers on breast milk donation and milk bank, and to identify any differing perceptions among different racial and ethnic groups. Results: A total of 38 doctors and 140 nurses from various racial and religious backgrounds participated in this survey. More than 50% of respondents know the benefits of breast milk over formula milk; however, knowledge of the milk donation process and the effect of pasteurization on donated breast milk can be improved on. In the opinion section, 78.7% of survey respondents were supportive of the human milk bank. Sixty-eight (38.2%) respondents felt that recipients should receive milk from donors of the same race and ethnicity, whereas 56 (31.5%) disagreed and 53 (30%) were neutral. Conclusion: Donor human milk banking is well received and supported by health-care workers. Knowledge of milk donation, screening, pasteurization, and storage can be improved on. Further evaluation is required to determine the underlying concerns that different ethnic groups may have.

Best practice guidelines for the operation of a donor human milk bank in an Australian NICU

We present ongoing development of a low-cost system to improve the flash-heat pasteurization process for human breast milk currently utilized in resource-constrained developing regions. Flash-heat was designed for low-resource environments, is simple to use and requires minimal infrastructure. It is currently used at a small-scale to provide safe breast milk to vulnerable infants with special needs. Safety concerns have limited the adoption of this method for use in human milk banks. The system presented in this paper improves the safety and procedural compliance of the flash-heat process by continuously monitoring the temperature of milk as it is being pasteurized, providing feedback to the user performing the procedure and bringing-in remotely-located quality assurance personnel into the process-approval loop. In partnership with PATH, a Seattle-based NGO, the system will be piloted at a human milk bank in South Africa later this year. The longer-term vision of the project is that the improved monitoring, feedback and reporting capabilities will help scale-up the adoption of cost-effective flash-heat pasteurization for establishing human milk banks in developing countries.

Background: Breast milk provides the optimal nutrition for growing infants. This is because it contains all the nutrients a baby needs in exactly the right proportions. It also contains biologically active live cells which promote health and helps to develop a passive acquired immunity by transferring antibodies developed by the mother. But, there are a large group of infants such as; pre-term, low birth weight and ill infants who are unable to breastfeed. On such condition, WHO recommends pasteurized donor human milk as the next best feeding option? However, its use is limited to industrialized countries and few developing countries. Thus, this study was designed to generate preliminary information on the knowledge and acceptability of pasteurized donor human milk banking. Methods: An institutional based descriptive cross sectional study was conducted to analyze the knowledge and attitude of mothers and health professional towards pasteurized donor human milk banking. In addition, the microbial safety of raw and pasteurized breast milk stored at -20 0C for 60 days was studied. Moreover, the flavor change of raw and pasteurized breast milk over 60 days of storage time was assessed. Result: Small number of mothers (5%) ever heard about donor human milk banking. About 53.7% of health professionals did not know donor human milk banking. All health professionals use infant formula as alternative to breast milk when mother unable to breastfeed. Only 20% of study mothers could accept feeding their baby donor human milk by physician prescription. Safety or fear of transfer of disease (85.1%) was the main factor for mothers not interested to feed their baby donor human milk. On the contrary, about two-third of study mothers were willing to donate their breast milk if human milk banking will be established. Three-fourth of health professionals believed that it is feasible to establish pasteurized donor human milk banking. Lack of knowledge about its safety by mothers and health professionals is the major challenge in establishing pasteurized donor human milk banking. In pasteurized breast milk sample stored at -20 0C (deep freezer) for 60 days no bacterial growth was detected. However, in raw breast milk samples a mean of 4.66 log10 CFU/ml of total aerobic plate count, 3.22 log10 CFU/ml of Enterobacteriaceae, 3.49 log10 CFU/ml of Staphylococcus aureus were detected. Within 60 days of storage time, pasteurized milk samples did not devolve off flavor. However raw breast milk samples developed off flavor. Conclusion: the present study showed that majority (95%) of mothers never heard about pasteurized donor human milk banking and substantial number (80%) of mothers did not went to feed their baby even after short description due to fear to transfer of disease. Additionally, more than half of health professionals never heard about pasteurized donor human milk banking. Similarly, fear of disease transfer and safety during processing of pasteurized donor human milk banking is the major concern mentioned by most health professionals on its acceptability. In our microbiological analysis Within 60 days of storage time pasteurized donor human milk was bacteriological safe and has acceptable sensory quality.

Background: Breast milk provides the optimal nutrition for growing infants. This is because it contains all the nutrients a baby needs in exactly the right proportions. It also contains biologically active live cells which promote health and helps to develop a passive acquired immunity by transferring antibodies developed by the mother. But, there are a large group of infants such as; pre-term, low birth weight and ill infants who are unable to breastfeed. On such condition, WHO recommends pasteurized donor human milk as the next best feeding option? However, its use is limited to industrialized countries and few developing countries. Thus, this study was designed to generate preliminary information on the knowledge and acceptability of pasteurized donor human milk banking. Methods: An institutional based descriptive cross sectional study was conducted to analyze the knowledge and attitude of mothers and health professional towards pasteurized donor human milk banking. In addition, the microbial safety of raw and pasteurized breast milk stored at -20 0C for 60 days was studied. Moreover, the flavor change of raw and pasteurized breast milk over 60 days of storage time was assessed. Result: Small number of mothers (5%) ever heard about donor human milk banking. About 53.7% of health professionals did not know donor human milk banking. All health professionals use infant formula as alternative to breast milk when mother unable to breastfeed. Only 20% of study mothers could accept feeding their baby donor human milk by physician prescription. Safety or fear of transfer of disease (85.1%) was the main factor for mothers not interested to feed their baby donor human milk. On the contrary, about two-third of study mothers were willing to donate their breast milk if human milk banking will be established. Three-fourth of health professionals believed that it is feasible to establish pasteurized donor human milk banking. Lack of knowledge about its safety by mothers and health professionals is the major challenge in establishing pasteurized donor human milk banking. In pasteurized breast milk sample stored at -20 0C (deep freezer) for 60 days no bacterial growth was detected. However, in raw breast milk samples a mean of 4.66 log10 CFU/ml of total aerobic plate count, 3.22 log10 CFU/ml of Enterobacteriaceae, 3.49 log10 CFU/ml of Staphylococcus aureus were detected. Within 60 days of storage time, pasteurized milk samples did not devolve off flavor. However raw breast milk samples developed off flavor. Conclusion: the present study showed that majority (95%) of mothers never heard about pasteurized donor human milk banking and substantial number (80%) of mothers did not went to feed their baby even after short description due to fear to transfer of disease. Additionally, more than half of health professionals never heard about pasteurized donor human milk banking. Similarly, fear of disease transfer and safety during processing of pasteurized donor human milk banking is the major concern mentioned by most health professionals on its acceptability. In our microbiological analysis Within 60 days of storage time pasteurized donor human milk was bacteriological safe and has acceptable sensory quality

Donor human milk banking has been practiced for over 100 years and is used where a mother’s own milk is unavailable for her infant. With this historical practice has come evidence for the clinical use of pasteurised donor human milk (PDHM) primarily to reduce the risk of necrotising enterocolitis (NEC) in the preterm very low birth weight infant. However, clinicians are not universal in their support for the use of donor human milk in these at risk patients. Some remain unconvinced at the evidence for benefit and some may remain concerned regarding the safety of the product. These safety concerns can only be addressed through the proper management of donor human milk banking. This chapter reviews the current evidence for the use of pasteurised donor human milk and examines how recent developments in management practice in human milk banking are addressing these concerns. When a mother’s own milk is unavailable, PDHM remains a viable feeding option where an infant is at risk of NEC. With an ongoing focus on safety in practice and demonstration of benefits through research, donor human milk banking may remain relevant for another 100 years.

Modern donor milk banking was conceived in the US in the early 1900s as a medicalized version of wet nursing. Over the course of the century the fortunes of donor milk banking have varied considerably. In the last 20 years donor milk banking has been negatively affected by the development of specialty formulas, safety issues related to viral transmission, and lack of clinical research. To survive, US milk banks have been receptive to clinical uses considered as "alternative medicine," and have cooperated with governmental agencies to develop standards for safety. A qualitative analysis of collected case histories of US donor milk recipients demonstrates that donor human milk banking can be critical to survival and the well-being of at-risk infants, children, and the occasional adult. By analyzing national data collected by survey method and examining the literature, the researcher compared German and US milk banks and distribution data. German milk banks use donor milk exclusively for premature infants and have less stringent operating standards, yet dispense volumes of milk greatly in excess of the US milk banks. While statistics are lacking for the total recipient population in the US, a projected analysis (based on German consumption) of the potential volume that could be dispensed in the US is presented, indicating that the population in need of this crucial public health service is currently under-served in the US.

Mother's breast milk supplemented with donor milk reduces hospital and health service usage costs in low-birthweight infants