Should donors be compensated for breast milk as well as the time it takes to pump and deliver it?
Experts say that while it’s important to recognize the contributions that breast milk donors make, they warn that introducing money into the mix raises ethical and practical health concerns.
“There’s been a bit of research looking at the motivation [of breast milk donors],” Karleen Gribble, PhD, an adjunct associate professor in the School of Nursing and Midwifery at Western Sydney University in Australia, told Healthline.
“The reasons are centered around altruism. They want to help somebody,” she explained. “But if you put money into it, then you’re adding something. You know, you have quite a different motivation.”
In the United States, nonprofit milk banks that are accredited by the Human Milk Banking Association of North American (HMBANA) do not pay donors for breast milk.
However, some for-profit milk banks do compensate donors.
Money is also sometimes exchanged in direct peer-to-peer milk selling.
In some cases, profit motive could potentially put children of breast milk donors at risk if their caregivers feel pressure to sell breast milk that would otherwise be used to feed the infants.
Financial incentives could also push some breast milk sellers to adulterate their milk to increase its volume.
In fact, one study reported in the journal Pediatrics found that about 10 percent of breast milk samples purchased online had been mixed with cow’s milk.
On the other hand, compensation for breast milk may provide a welcome source of income and acknowledgement for producers’ time and energy.
It might also help increase the number of people who donate breast milk, contributing to the supply of milk available to infants.
Breastfeeding can improve health outcomes
According to a report published in The Lancet in 2016, improved breastfeeding practices could prevent up to 823,000 annual deaths worldwide in children under the age of 5.
Breastfeeding is associated with higher IQ in children and adolescents, as well as lower risk of childhood obesity, type 2 diabetes, leukemia, and infectious illness.
Breastfeeding may be particularly important for babies who are born prematurely.
“In premature infants, exclusive [feeding with] breast milk decreases preterm mortality and the incidence of necrotizing enterocolitis, sepsis, BPD [bronchopulmonary dysplasia], and ROP [retinopathy of prematurity], while increasing infant brain volume and neurodevelopment in infancy, childhood, and adolescence,” Dr. Lawrence Noble, FAAP, an associate professor of pediatrics at Mount Sinai School of Medicine in New York, told Healthline.
“Therefore, the AAP [American Academy of Pediatrics] recommends that preterm infants be fed mother’s milk and, when not available, donor milk, rather than formula,” he added.
Nonprofit milk banks
When caregivers are unable to feed premature infants using their mother’s breast milk, they may be able to access donor breast milk from a nonprofit milk bank.
There are currently 24 HMBANA-accredited nonprofit milk banks operating in the United States.
In order to donate breast milk to an HMBANA-accredited bank, donors must first go through an extensive screening process.
“Donors must undergo interviews with the milk bank; fill out a detailed questionnaire, including [questions about] medical illnesses, medications, and drug and alcohol use; submit detailed medical forms from their physicians; and undergo blood tests,” Noble explained.
If they pass this screening process, their donated milk is collected, processed, and stored using methods designed to reduce the risks of contamination and infection.
To help defray the costs of screening donors and managing donated breast milk, nonprofit milk banks typically charge recipients a fee of about $5 per ounce of milk.
“Although the milk is donated, there are expenses, such as milk processing, milk distribution, and buying of pasteurizers, freezers, and bottles,” Noble said
Some recipients of donor breast milk have insurance plans that cover these fees.
Others pay for them out of pocket.
This expense can pose a potential barrier to breast milk recipients, an issue the AAP addressed in a recent policy statement.
“The AAP published a policy statement last December that stated that the use of donor human milk in high-risk infants should never be limited by ability to pay. It called for policies to provide high-risk infants access to donor milk based on medical necessity, not financial status,” Noble said.
While nonprofit milk banks perform a valuable service, many people do not live close enough to a milk bank to feasibly donate or access breast milk there.
Caregivers of healthy babies face additional barriers to accessing banked milk, since it is typically prioritized for use in premature and sick infants in neonatal intensive care units.
“If they’ve got an otherwise well infant and, for some reason, don’t have enough milk — maybe they’ve had a mastectomy or they have to take medication that’s not compatible with breastfeeding — usually those people won’t qualify for banked milk. There are some exceptions to that, but usually, they can’t access it,” Gribble told Healthline.
As a result, a growing number of people are sharing breast milk through informal networks of peer-to-peer exchange.
“We’ve seen a lot of concern that this sort of peer-to-peer milk sharing might be taking milk away from milk banks,” Gribble said.
“But it seems that a lot of people who donate milk directly to another person wouldn’t qualify to donate to a milk bank, or they can’t do it because there’s no milk bank in their area, or it’s actually the relationship they develop with the recipient that enables them to put the work into expressing milk for donation,” she continued.
Although some people do buy milk through informal channels, Gribble has found it’s “pretty unusual” for people to pay for breast milk acquired through peer-to-peer exchange.
While networks of peer-to-peer breast milk exchange seem to be growing, they lack the formal mechanisms for donor screening and quality control implemented at nonprofit milk banks.
As a result, many healthcare providers discourage families from participating in direct peer-to-peer milk sharing or buying milk from online sources.