Editor’s Note: This essay is part of a series of dispatches from the Knight Science Journalism Program’s 2021-22 Project Fellows.
It was when my daughter was a newborn, about two years ago, that I first heard about companies that were selling breast milk products. I was just teaching her to take a bottle so I could go back to work, and she became fussy whenever I offered it to her. Different brands and nipple sizes didn’t solve the problem. After trying and retrying with the same bottle of pumped breast milk for several hours, until it had been out so long it was no longer advisable to use, I found myself having to mournfully dump it down the drain.
As the problem dragged on for weeks, I vented about the situation to a new moms group I was part of on WhatsApp. Someone suggested I look into donating the milk instead of throwing it away. Of course, I couldn’t do that because I couldn’t give anyone else milk that my daughter’s mouth had already contaminated. But it did get me thinking about donation in general. As I went down the research rabbit hole, I learned about a company called Prolacta that paid lactating people for their milk.
Soon enough, I was reading confusing online posts about the company’s legal disputes, particularly with its competitor Medolac. This story started, for me, as an effort to sort out fact from fiction should I ever consider supplying them my milk. I reached out to the multiple players involved, and it took months to convince them to answer my questions. As a Knight Science Journalism Project Fellow this year, I’ve been investigating the legal situation between those players. But during the process, I also learned a lot about the wider context of breast milk’s use in hospitals.
I found out that, at a typical U.S. hospital , around 10 percent of babies in neonatal intensive care receive banked donor breast milk, according to a 2017 study. A prescription is required to receive this milk, and the nonprofit milk banks, which operate independently of the hospitals, try to route it to the most critically ill babies. While donors and recipients don’t exchange any money, hospitals do pay some of the milk banks’ costs. The demand for milk, however, is actually much higher than the nonprofits can meet. When my daughter was in neonatal intensive care, for instance, she received formula.
Parents want breast milk for all kinds of reasons, including inability to breast feed themselves and formula intolerance, but once they leave the hospital they can no longer get this milk through a nonprofit bank, for the most part. To compensate, there are informal milk sharing programs online, through which lactating people can either donate or sell their milk directly to a parent. But many clinicians have warned against using them, for fear the milk could be tampered with. To serve more people, then, milk has to enter a more formal system where it can be tested.
The primary way to boost the supply of banked breast milk in hospitals is to encourage more breast feeding. The more parents breast feed their own children, the more likely they will have extra to donate. One country that’s been particularly effective at using this strategy is Brazil, which has run a very successful breastfeeding campaign that’s also led to a robust milk banking system. Donors have easy access to plenty of milk banks, which are state-sponsored. The banks are affordable to run because they use inexpensive equipment rather than sophisticated lab tools.
The cost per year of pediatric health care and premature death attributable to feeding infants formula in the United States has been estimated to be in the billions of dollars.
On the other hand, many experts are skeptical that more breastfeeding is enough to meet demand. While a higher percentage of Americans have been breastfeeding in the past decade, the numbers are leveling off. The alternative is the commercial route. Paying people to supply milk has brought in more people who otherwise wouldn’t choose to donate, members of the industry say. A reason to worry about this trend is that, in the past, wet nurses — people who take on the responsibility of breastfeeding someone else’s child — often neglected to feed their own babies. The same could happen here if a financial incentive is introduced.
Whatever the model we land on, it’s important to consider the growing for-profit breastmilk industry in terms of the social and political context in which they’re emerging. While the medical community has increasingly promoted breastfeeding, many people have medical, family or work situations that don’t allow them to do it. In the last couple of decades, scholars have tried to quantify the value of the work of breastfeeding, which is typically taken for granted. The cost per year of pediatric health care and premature death attributable to feeding infants formula in the United States has been estimated to be in the billions of dollars.
This type of quantification, however, hasn’t led us to value milk providers anymore as a society, or to offer more social programs to support breastfeeding. Instead, it is used to create value for breast milk as a commodity. I hope, even as readers hear about the disputes between breast milk companies in my recent story for The Washington Post Magazine, they’ll consider this wider context, which I’ve been contemplating myself, as a new mother. I’ve been asking myself: Is it ethical to pay for milk? Is it ethical not to? Could parents actually be lured away from breastfeeding their own children for $1 an ounce? If not, how much would it take? Should the government be providing more support for milk banking? Is the developing breast milk industry exploitative? Should breast milk as a body product be regulated the way we regulate blood or the way we regulate organs?
I’ve wondered about all of this while at the same time reckoning with the demanding nature of the work of breastfeeding and the limited support parents get for it. It’s both a beautiful, altruistic act and a seriously undercompensated form of labor. The industry that’s developing around breast milk, whether we supply milk for it or not, tells us a lot about the way that we value women and the work of birthing and raising children. This is work we’ve been discussing a surprising amount this past week because of the nationwide formula shortage. I couldn’t have imagined when I started working on this project, that it would be published during this important cultural conversation.
Time has felt like it’s moved quickly since I first became interested in this story. My daughter is no longer breastfed. And yet, feeding her has become challenging in new ways. Once a lover of peas and beets and all other vegetables, besides squash, she now demands plain buttered white rice at every meal. I’m sure this is just the latest in a lifetime of culinary battles. In the midst of these mild frustrations, I will have to remind myself to thank her at some point because her fussy eating habits inspired my Knight Science Journalism Fellowship project.
Sushma Subramanian is a health and science journalist and author of “How to Feel: The Science and Meaning of Touch.”