Savitha was still recovering from a stressful premature delivery, when her doctors informed her that she wasn’t producing enough milk for her baby. “After the birth, I still had instances of heavy bleeding and clotting disorders for which I needed constant treatment. My body was exhausted. My baby, who was in the neonatal intensive care unit (NICU) needed more milk than whatever little I was producing. I had no idea of what more I could do.”

But Savitha’s doctors at Fortis La Femme did. Their solution? A breast milk bank.

Breast milk banks aren’t a new phenomenon in India, but they are scarce. Even though Asia’s first milk bank was set up in Mumbai in 1989, there were only 40 odd banks in India as of 2017.

Brazil, another developing country, has over 217 banks ever since their inception in 1985. Their availability, along with better health care, has helped reduce Brazil’s infant mortality rate by 73%.

But in recent years, there has been an effort to increase the number of banks in India. In September 2016, the state government of Rajasthan set up breast milk banks in 10 of their district hospitals, making it the leading state with a total of 13 banks, with Maharashtra (12) and Tamil Nadu (10) coming close behind.

Bengaluru gets first human milk bank

Meanwhile, Bengaluru’s first human milk bank, Amaara, opened last October. “We had heard of Amaara’s operations in Delhi,” says Shwetha Kamath, a mother of premature triplet babies who had been unable to produce enough milk for all three of my babies. “My doctor had talked to me about Amaara’s services and had also told me that I had the option of feeding them formula milk. Since breast milk is a much healthier choice than formula, I decided to go ahead with Amaara’s milk.”

Situated in Fortis La Femme on Richmond Road, this bank has collected 39,000 ml of breast milk in February 2018 alone and has provided nutrition to 89 premature babies. It has been supplying to 23 hospitals across the city, and all of this from a small room packed with large refrigerators, a steriliser and an almost constantly running pasteuriser.

“There are many reasons why Bengaluru hasn’t had a human milk bank before,” says Dr. Sreenath Manikanti, chief neonatologist of Fortis La Femme Hospital, and Head of Amaara, Bengaluru. “You need funding, personnel etc. And since we are hosted by Fortis La Femme free of cost, we are able to keep Amaara entirely not-for-profit.”

Dr Sreenath with his fellow doctors at Amaara. Pic: Amaara Human Milk Bank

He added that the equipment Amaara uses, including the latest models of breast milk analysers and sterilisers, are provided to them by the non-profit organisation called the Breast Milk Foundation, based in Delhi,  a non-profit organization which strives to improve health outcomes for preemies and ill infants and foster better health for children in general.

Amaara was first conceptualised and established by Dr. Ankit Srivastava of the Breast Milk Foundation along with Dr. Raghuram Mallaiah of Fortis La Femme, in Delhi.

“Both had noticed that many mothers would throw away any excess breast milk they had [when they produced more than what their baby needs in a day],” says Ohika Chakraborty, deputy head of public relations at the BMF. “They knew how valuable breast milk is, especially for premature babies and decided to set up Amaara as a part of Fortis La Femme’s CSR activities.”

Even with the monetary support from the BMF and Fortis La Femme, Amaara is forced to charge a nominal amount for the breast milk they provide to private hospitals.

“We have day to day running costs- to maintain the equipment, for transportation of the breast milk (to and from the donor/hospitals) and to analyse the donor mother’s blood samples etc,” Dr Sreenath says. “For this we need to put a price on the milk we receive; we sell it for less than Rs 2 per ml and at Rs 1500 for 650 ml. Additionally, we provide the milk free of cost to government hospitals, to families below the poverty line. We don’t receive any profit from the sales.”

Why is breast milk considered to be ‘liquid gold’?

Research has often proven that promotion of breastfeeding, especially in the early stages of a baby’s life, has the potential to make a major contribution to the reduction of infant mortality rates; the World Health Organisation (WHO) even encourages exclusive breastfeeding – where the infant only receives breastmilk for the six months of her life, without any additional food or drink, not even water.

“Each mother’s milk is specially crafted by the body for her baby,” says Chethana Kulkarni, a lactation consultant. “ The production of milk will increase and decrease as per the baby’s needs. Breast milk is also suited for the immature digestive system of newborn babies, since it isn’t too rich, like cow’s milk is, which is a common formula ingredient.”

This is especially important for preterm babies, who aren’t designed to drink milk, because of their early exit from the womb. “A preterm baby’s mother’s milk contains more protein and other nutrients compared to the milk from a term baby’s mother,” says Kulkarni.

“Any other type of milk will be too proteinaceous for a preemie baby’s immature stomach,” says Dr. Prathap, Pediatrician and Neonatologist of Motherhood, Indiranagar, a hospital that has used Amaara’s services. “ There is a high risk of the baby contracting severe gut infections like necrotising enterocolitis and other complications. This is why a mother’s milk is best suited for her baby. ”

But in certain cases, mothers of premature babies are unable to produce breast milk immediately after birth. “Reasons of preterm labour could be severe jaundice, high blood pressure etc. which is taxing on the mother’s body, making her unable to produce milk immediately,” says Dr. Shaibya Saldanha, Gynaecologist at Acura Speciality Hospital. “Not to mention the emotional stress they undergo. Usually there is a gap of a few days, before she is able to lactate, during which the baby is given a supplement, which is usually formula. Now, with the alternative of donor milk being present, why would you use cow’s milk?”

Sometimes, the lack of support and understanding starts at home. “My baby wouldn’t stop crying even after being breastfed,” says Dr Soumya Medarametla, who had been donating to Amaara for two months now. “My mother and mother-in-law thought that it was because he was not being fed enough and cajoled me into feeding him formula for his first two days. It was the nurses who told me to revert to breastfeeding.”

Sterilisation, pasteurisation and analysation define milk bank

Wet nurses have always been a part of Indian history and mythology; a popular example would be that of Krishna who was delivered by Devaki but breast-fed by Yashoda. In a country where aunts offer to breastfeed their nephews while their mothers take a break, why is a milk bank unique?

Kulkarni speaks of Facebook groups such as ‘Breast Feed Support for Indian Mothers’ and ‘Human Milk 4 Human Babies’ where mothers encourage a direct exchange of breast milk and promote sharing of breast milk between local families/communities.

“The very first time I donated milk, it was for a colleague of mine,” says Ujwal Hegde, who has been donating to Amaara for four months. “She had a premature baby and she was unable to produce enough milk; since we were in the same hospital I was able to connect to her. It was her relief at having found a donor, and the doctors who told me that I had saved a life, that encouraged me to continue donating my excess milk.”

The methodical sterilisation, pasteurisation and analysation of breast milk in a milk bank sets it apart from a direct exchange of milk through platforms such as Facebook, says Dr. Sreenath. “We screen mothers for Hepatitis B and C and HIV, we label the bottles of a mother’s milk according to whatever levels of nutrients it contains so that we know which milk would help which baby the most. All of these guarantee a faster recovery time for the baby and allows us to supply on a need-come basis.”

Shwetha Kamath speaks about how her primary concern about donor’s milk was about whether or not it had been pasteurised. “I was also concerned about whether the donor’s milk was tested for bacterial diseases and I only went ahead with Amaara because of the tests that they conduct,” she says.

Voluntary donation, no price attached

Mothers, who come forward to donate their milk, do so voluntarily. “They do it as a gesture of goodwill, because they want to help other babies,” Dr Sreenath says. “And our donors, who are mostly upper-middle class women, are anonymous to those who use the service and vice versa so there is no issue of caste or creed etc.”

Donors are made aware of Amaara’s services through word of mouth; whether it is from the hospital where they delivered in or from other mothers. “I learned about Amaara from one of the doctors in Columbia Asia, which is where I delivered,” Hegde says. “He gave us Dr Sreenath’s number when he took me through the process and in a matter of days I had started donating.”

Dr Sreenath speaks about the milk bank at conventions or conferences at hospitals and during personal meetings with other doctors; he also encourages doctors to tell parents who have used the service to spread the word and encourage mothers to donate. “As of now we have more demand than supply,” he says. “We have to change that.”

“In a way it’s hard to reach out to mothers regarding this,” says Dr. Soumya. “It’s not like one can organise a breast milk donation drive [as one would for the collection of blood]. Even though my mother was okay with me donating my milk, she has problems with me showing my bottled breast milk in public; she says that it should be wrapped in a cloth and that if anyone saw it my breasts would not produce milk. It just shows how much of a taboo breast milk/feeding still is.”

Any lactating mother can donate their milk. “Besides the strict screening process for diseases that we go through, there aren’t any other restrictions for donating breast milk. ”

Next breast milk bank to come up at Vani Vilas hospital

In September 2016, Neolacta Lifesciences Pvt. Ltd. had submitted a proposal to set up a milk bank in Vani Vilas Women and Children’s Hospital, attached to Bangalore Medical College, with the intention to provide free milk to sick and preterm babies within the hospital and sell it at a cost of Rs 300 for 15 ml and Rs 1600 for 100 ml across the State. Vani Vilas hospital aims to have a milk bank adjacent to its Neonatal Intensive Care Unit by February 2019.

However, this proposal had raised a lot of concerns at the time that it was first floated: if there is now a market for breast milk, would a poor mother sell her milk and starve her baby as a result? Must there be a price to something as vital as breast milk, must it be commercialised?

Milk bank will serve only premature babies

“People can argue about whether one should or should not put a price on breast milk,” says Dr. Sreenath. “But at the end of the day, a milk bank cannot run without any funding, we need sustenance. Would you rather have a milk bank which charges a reasonable amount for the human milk or have no bank at all? If the state was willing to fund these human milk banks, the situation would have been different entirely, but that is not the case and therefore there needs to be a price.”

“Besides,” he continues. “we only provide milk for premature and critically ill babies, the ones who need it the most. We’ve had many older parents with surrogate babies who have asked us for milk, but we refuse. Breast milk is like liquid gold, extremely precious—especially because of the limited supply we have—and only given to the most needy – premature babies.”