For the good of the babies, we need more milk banks

World Breastfeeding Week, celebrated globally in the first week of August, highlights the profound impact of breastfeeding on public health. Despite the known benefits, breastfeeding isn’t always straightforward; in fact, fewer than one in 10 Kiwi babies are exclusively breastfed for the recommended six months. Which is why I’d argue that we need more investment in lactation support and milk banks, to give all infants an equal chance of long-term health.

Of course, some parents may choose or need to use infant formula, the most common go-to alternative to breast milk, but the unique benefits of breast milk cannot be overlooked. Babies who miss out on breast milk are more susceptible to allergies, infections, and excessive weight gain.

Breast milk is rich in antibodies, hormones, enzymes, pre and probiotics that nourish the gut microbiome, providing personalised nutrition, especially in the early postnatal period. Even a little breast milk has positive health effects, and the benefits increase with longer breastfeeding duration. As awareness grows, some parents turn to milk donation from women who produce more milk than needed by their babies, a historic practice known as milk sharing.

Formal milk donation is facilitated by breast milk banks, which screen donors and ensure the safety of the donated milk for hospitalised vulnerable babies while mothers build their own milk supply. Globally, there are over 750 milk banks, with Brazil having a national network of more than 200, which also provide lactation support to all parents. Across the ditch, the Australians cleverly embedded a milk bank within Red Cross Lifeblood services, leveraging existing resources for efficient collection, processing, and nationwide distribution of blood-derived products to hospitals.

If only we were more like Australia, at least in this regard. New Zealand has only four hospital-based milk banks in Christchurch, Wellington, Palmerston North, and Whangarei, all established through significant efforts by motivated individuals, raising questions of why a small country like ours cannot come up with a similar national approach to milk banking.

Most of these individual efforts receive limited funding, sometimes putting extra pressure on already under-resourced lactation consultants. Notably, Auckland, the largest city with the two busiest neonatal intensive care units in the country, lacks a milk bank, creating disparities in healthcare access. Is this yet another example of the post-code lottery in healthcare?

Informal milk sharing, where mothers with excess milk donate to families in need, exemplifies a sense of community and generosity. This practice can be facilitated by healthcare professionals or occur via social media. Provided appropriate health screening of donor and hygiene practices are followed, informal milk donation is considered safe.

Concerns about informal milk sharing include potential contamination, dietary restrictions imposed by parents on donors, and of home processing methods that might inadvertently compromise quality and nutritional safety of donated milk. For example, donors might, with the best intentions, pasteurise the milk or freeze-dry it, processes that can compromise the quality of milk if done incorrectly. Overheating milk can denature some proteins or inadvertently destroy immune properties of breast milk, while inappropriate freeze-drying can increase pathogenic microorganisms that could be harmful for babies. ‘Reconstructing’ it by adding water might influence nutritional composition of milk, posing a significant health risk for babies’ nutrition. In hospitals, informal milk sharing can divert resources from essential lactation support.

There seems to be one underlying issue: insufficient investment in timely and appropriate lactation support so families can start off breastfeeding in the best way possible. The past 10 years of data on breastfeeding duration and exclusivity clearly demonstrate this. We urgently need to increase publicly funded access to lactation consultants, both in hospitals and the community. It’s unrealistic to assume that under-resourced and overworked staff providing postnatal care can address this issue – and bear in mind that many families leave the hospital so quickly after birth that they don’t have a chance to start breastfeeding properly given milk production often begins about three days after giving birth.

Research has shown that that integrating milk banks into maternity care increases breastfeeding rates and reduces infections and hospital readmissions, resulting in significant healthcare cost savings. Establishing a national network of well-resourced and properly funded breast milk banks in New Zealand would enhance early life nutrition and provide safe, equitable access to donor milk. This can only be good for newborns, their families and society as a whole.