South Africa is tackling the causes of under five mortality with a network of human milk banks. Usually located at hospitals and clinics, the banks collect and pasteurise donated human milk and distribute it to babies, often sick or orphaned, that are in need of breast milk. The system feeds more than 2,800 babies a year across at least 44 banks, serving over 75 hospitals, and is organised through independent institutions overseen by a central organising body.
Results & Impact
More than 2,800 infants were fed by the South African Breastmilk Reserve in 2015, and it has helped more than 8,000 babies since it was created in 2003. At least 44 human milk bank facilities are currently established, supplying over 75 hospitals.
South Africa Breastmilk Reserve, Department of Health Republic of South Africa, Milk Matters, iThemba Lethu, PATH, Unicef
Milk donation and use is overseen by the Human Milk Banking Association of South Africa, which has developed ethics and safety guidelines, but banks are set up and run independently through a range of government and non-governmental partnerships. Hospitals, neonatal clinics and orphanages host the milk banks and coordinate collection and distribution of donated human milk.
South Africa, Brazil, Vietnam
Cost & Value
Operating costs for the South African Milk Bank Reserve is around $20,000 per month.
Running since 2009
The HIV epidemic put an end to informal voluntary milk banks in the 1980s, but new technology that meant milk could be pasteurised to kill pathogens made the process possible again.
Milk Bank programs are running in more than 37 countries, including Norway, Italy and, most successfully, Brazil, where a government-driven effort is seen as the most effective and extensive milk donation program in the world. A partnership between the government and NGOs Path and Alive and Thrive is currently establishing a milk bank in Vietnam.
South Africa has provided milk to thousands of needy infants, potentially saving hundreds of lives, with a nationwide human milk bank.
Overseen by the Human Milk Banking Association of South Africa and run by government agencies, NGOs and even profit making businesses, a network of around 44 milk banks now collects and distributes donor breast milk to babies in need. Banks themselves are responsible for recruiting donors, transportation and storage, and treating the milk by pasteurisation to ensure it’s safe for babies to drink.
The Ministry of Health’s major partner, the non-profit South African Breastmilk Reserve (SABR), has helped more than 10,000 babies since it was created in 2003 and now feeds nearly 3,000 every year, supplying over 75 hospitals with donated human milk.
To ensure its availability for women all over South Africa, SABR also operates a public private partnership in which private hospitals make donations to fund the distribution of milk to public hospitals, ensuring the supply of donated milk is available to all the babies that need it regardless of their ability to pay.
“We supply services under a universal guideline that says that all infants that are under 1.8 kilos and younger than 14 days have a right to access donated breast milk,” Stasha Jordan, Managing Director of SABR, said. “Healthcare should be a service that is delivered first and foremost at no cost to those who cannot afford it but we also need to maintain the right level of service delivery.”
South Africa’s Health Minister has been a key champion of the milk banks, Jordan continued, and has spearheaded the program by encouraging all of South Africa’s provinces to establish and extend their banking efforts. Government cooperation has led to the establishment of banks in hospitals and neonatal units, where donated milk is available for free at the point of need. Babies or mothers requiring donor milk are prescribed the supplement by their doctors.
For the government the establishment of milk banks, especially by independent organisations like SABR, are a huge benefit. “We decrease dramatically the cost of healthcare,” Jordan said. Among the conditions milk banking prevents is necrotising enterocolitis, a condition of the intestine often fatal to infants. “We save the state institution a great deal of budget by decreasing the morbidity of the premature infant and decreasing the length of bed stay, too.”
Mothers who are in contact with medical professionals are also educated on the importance of breastfeeding and the possibility of donating to banks. This doesn’t just contribute to the supply of donated milk: it helps build a culture of breastfeeding in South Africa that will improve the health prospects of babies in the longer term, too. Other models are based on community organisations, such as homes for orphans or abandoned children, which set up their own milk banks, collecting and distributing with donor funding and supported by volunteer networks.
Before the 1980s, informal milk banking was common in South Africa. But HIV, which is transferred through the consumption of breast milk, put an end to that even as it increased the number of infants in need. It was only after the discovery of the Holder method of pasteurisation, which kills the HIV virus, that milk banks could operate safely again. Donors are screened for HIV or hepatitis, and all milk is pasteurised to ensure it doesn’t contain any pathogens that might be damaging to the baby.
Among infants who benefit from donated breast milk are orphans whose mothers have died, are HIV-positive, taking drugs or who are too sick to breastfeed. Infants who are severely malnourished or premature will also benefit from donated milk. It’s rich in all the nutrients that babies need to survive and thrive, and builds the immune system more effectively than formula – so much so that an estimated 820,000 deaths in children under five every year could be prevented by best breastfeeding practice.
Around the world, human milk banks have made a significant impact on child health and mortality. In Brazil, what’s thought to be the world’s most successful government milk banking initiative currently feeds an estimated 155,000 babies annually.
While that programme is government-run, Jordan believes the partnership model is working well for South Africa. “The state really is stretched to the limit,” she said. “As a sector we are very passionate and very ambitious and it works really well. NGOs play an integral role in service delivery and we strengthen state facilities. We can raise issues as civil society and hold government accountable and they are prepared to collaborate closely with us because they are aware of our good intentions.”
(Picture credit: South African Milk Bank Reserve)