Breast Milk for Sale

Is donating milk an act of altruism, like organ donation? Or are donors providing a good that they should be compensated for?

Laura Breiling / Mosaic

Angel works on the fourth floor of an aging brick high-rise, at the end of a dim, narrow hallway. The windows of her office look out onto a leafy courtyard where physicians and support staff bustle in white jackets and scrubs. The noise she makes nearly drowns out all sounds of conversation in the room.

Angel is a squat silver chest about waist-high. She is the $100,000 milk pasteurizer imported from England to Norfolk, Virginia. At North America’s newest milk bank at the Children’s Hospital for the King’s Daughters, Angel sterilizes around 2,000 ounces of milk every week, Monday through Friday.

The manager of the hospital’s Mother’s Milk Bank, Ashlynn Baker, gave Angel her nickname because she kills deadly microbes that can sometimes be found in donor milk, playing a key role in the process that takes milk from donating mothers and gets it to babies in hospital. Donors can bring their milk in person or freeze it and have it shipped overnight in a cooler at no cost.

“We get donors from up and down the east coast,” says Baker. “It really blows my mind.”

North America is currently home to 19 milk banks, with nine more opening their doors soon. The Human Milk Banking Association of North America, which helps to run and accredit these banks, has gone from dispensing around 400,000 ounces of pasteurized donor human milk per year in 2000 to 3.8 million ounces in 2014. John Honaman, its Executive Director, says that the rise is due to both an increase in awareness of the health benefits of breast milk and an increase in the number of preterm infants who need donated milk.

The maelstrom of hormones that help a woman give birth to her baby also tell her body to start producing milk. When the baby then sucks at her nipple, it stimulates the release of the hormone prolactin, which tells her body to produce more. Even so, it can take several days for milk to come in. For mothers of preemies—as well as first-time mothers and those whose babies were delivered by Caesarean section—the milk supply can take even longer to start.

On the other hand, mothers can find themselves producing more milk than their baby needs, especially if they use an electric breast pump. This has given some the option of sharing the milk their child doesn’t need; human-milk banks take the excess and give it to those who do. But as more parents and hospitals seek to use pasteurized donated milk, HMBANA banks have begun experiencing shortages. For-profit milk-banking companies have sprung up, and milk can be bought and sold online, with fewer or no checks on quality or contamination. It’s becoming a lot more complicated than simply sharing.

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In 2015, Sarah Keim, an epidemiologist at Ohio State University, published an analysis of 102 samples of breast milk she’d purchased online. Eleven had significant amounts of cow’s milk. “That is a concern,” she says. “We were surprised to find the extent of that problem.” Once money becomes involved, she adds, it becomes more likely that people will adulterate breast milk to make a quick buck.

Sharing breast milk is not new. Women have done it for millennia, letting friends’ or relatives’ hungry children nurse at their own breasts. Other times, women would hand-express their milk into pots or jars to give to families in need. And wet nurses, often impoverished or enslaved women, were often used to provide milk for wealthy children, even if it came at their ability to nurse their own. In the early 1900s, hospitals and charities began freezing and banking breast milk for sick babies.

But even with a bank as the middleman, donating breast milk is still a transaction between two mothers. The question: Should women who donate milk to these banks be compensated? And more than that, does paying for donated milk change the nature of the relationship between the women involved?

Laura Breiling / Mosaic

In 2011, Afrykayn Moon, then 32 years old, was nearly arrested for breastfeeding on a city bus in Detroit, Michigan. What angered her the most wasn’t the bus driver calling the police but rather the response she got from other mothers: “I was getting emails from people telling me how horrible a mother I am for wanting to breastfeed and doing it in public,” she says. “I had a lot of people who were actually surprised that a black woman was breastfeeding, period. They didn’t know we still do that.”

It is true that fewer black mothers in the US breastfeed than white and Hispanic mothers—59 percent of black mothers versus 75 percent of whites and 80 percent of Hispanics. In Detroit, only 40 percent of mothers ever even plan to breastfeed their children. Determined to change this, Moon founded Breastfeeding Mothers Unite to educate black women in Detroit about the health benefits of breastfeeding in the hopes that more of them would do so.

Then she learned about a new initiative by a company called Medolac.

In late 2014, the Oregon-based company had partnered with the Clinton Global Initiative to reach out specifically to low-income Detroit mothers and pay them a dollar an ounce for their breast milk. While these payments were to compensate donating mothers for their time and effort, the idea behind this particular scheme seemed to be that if cash-strapped women could make money from their milk, then more of them might breastfeed their children, if only to keep producing milk.

Moon immediately cried foul. The idea that the ability to earn money from breast milk would encourage low-income mothers to breastfeed their children was “absurd” to her.

“If I’m breastfeeding but my electric bill needs to be paid or my rent needs to be paid, or my water bill needs to be paid, and I know I can sell my milk to this company and then I can get my bills paid, well guess what I’m going to do,” she says. “I’m going sell my milk to keep my bills up, and not a drop of that milk is going to go to my child.”

With Detroit’s low rate of breastfeeding and one of the country’s highest rates of infant mortality (15 of every 1,000 children in Detroit die before their first birthday), Moon says that the city needs every last drop of breast milk. The Medolac move also brought back a sinister association to Moon. Enslaved black women were often used as wet nurses for white children, leaving them unable to provide milk for their own children.

“This is the face of slavery coming back,” she says.

Georgetown University philosopher and bioethicist Rebecca Kukla says that, while some tactics used by companies might be perceived as exploitative, there’s nothing inherently unethical about a woman selling her breast milk. “There’s a difference between what someone does out of economic necessity and what they do as a private choice to make their life work,” she says.

It’s the choice 33-year-old Detroit area mother Andrea Short made. She breastfed her first child, Jaden, with no difficulties, but when her daughter Johanna was born, she wouldn’t latch on. So Short began to pump in order to feed Johanna breast milk with a bottle. Soon, however, Short had pumped way more than Johanna would ever need and was running out of freezer space to store the milk. That’s when she found out that Medolac was willing to buy.

Over several months, Short sold more than 5,000 ounces of milk that Johanna wasn’t using, providing her young family with needed income. Although both Short and her husband, Jonathan, work full-time (she in a hospital and he as a firefighter), the family relies on benefits from the Women, Infants and Children program to make ends meet. With part of the money from Medolac, Short bought a swing for their large front porch that gives her children a safe place to play.

“I was grateful for the money and the opportunity I had,” she says.

As soon as Moon heard about Medolac’s plan, however, she teamed up with other local non-profits, including the Black Mothers’ Breastfeeding Association, and began sharing as much information as she could online. Women from around the country wrote and signed an open letter to Medolac, asking them how paying mothers for breast milk would ensure that more local children were breastfed.

Medolac, which defines itself as a “public benefit corporation,” was taken aback by the furor. Doug Hawkins, its senior vice president for corporate affairs, says that in all his years of working in the for- and non-profit sectors, he had never seen anything like it. “We partnered with local organizations,” he explains. “Those that weren’t in the circle got their knickers in a twist, so to speak. They completely poisoned the environment,” he adds, calling the response “completely irrational.”

Nine days after the open letter was published, Medolac abruptly cancelled its plans.

Laura Breiling / Mosaic

State Representative Erika Geiss has since drafted a bill for the Michigan legislature that sets up guidelines for companies that want to purchase breast milk. Her bill requires that all collected milk is pasteurized and tested, that the milk goes to the infants most in need first, and that participating women get support and education about breastfeeding. If they have a nursing baby, the infant must get as much of their mother’s own milk as required before any excess milk gets sold.

“I would never want to see a system set up where someone could ‘farm’ a mother out to provide milk,” says Geiss.

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Blood and tissue donation work entirely on altruism; many people think breast milk should be no different. John Honaman says the Human Milk Banking Association of North America sees no place for profiting from breast milk, and thinks the system is at its best when mothers who have received donated milk decide to then donate in turn.

“If we were faithful to the needs of a community, we would always want to be in a position whereby the need is associated with the supply because you have a perfect circle,” he says. “Moms need to give, kids need to receive.”

Morgan Bryan is a schoolteacher in Houston. When her twin boys, Austin and Jonah, were born at 24 weeks, her milk hadn’t yet come in. And with the agonizing stress of watching her tiny, vulnerable infants barely cling to life, she had trouble producing any milk at all. So when Austin and Jonah’s doctor asked the Bryans if they would be okay with their children receiving donor human milk, they didn’t hesitate.

“I didn’t ever think twice. They had multiple blood transfusions and it’s the same thing. And if that is what they needed, that is what we’re going to give them,” says Bryan. “I was so excited that Jonah could take milk, I was in immediately.”

Several days later, Bryan was producing enough milk that she was able to feed her sons with her own, supplemented by a fortifier made from donor human milk. Austin and Jonah quickly grew stronger.

At eight weeks, Austin died of an unrelated infection, but Bryan was so grateful for the donor milk her sons received that she donated her own excess milk to the Texas Children’s Mothers’ Milk Bank.

“There’s just a nice feeling,” she says, “because I know that my kid needed it at one point and I know that when you’re sitting in the NICU and you can see all the other babies, you know that those babies are getting it as well.”

This article appears courtesy of Mosaic.