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24 April 2017: The South African Department of Health is currently developing regulations on milk banking. While some of the existing milk banks follow standards and guidelines set by the Human Milk Banking Association of South Africa, for processing and pasteurizing, others follow the SABR guidelines modelled on the NICE guidelines for human milk banking. They operate independently using different funding mechanisms to meet community needs. Three human milk bank models, all of which are not-for-profit, are found in South Africa
According to Stasha Jordan, Executive Director of the South African Breastmilk Reserve, breast milk banks can play a vital role in supporting breastmilk feeding in South Africa. “However, it is important to carefully consider the regulations around milk banking in South Africa.”
“The current regulatory framework for human milk banking gives us the opportunity to reflect on the importance of treating donated breastmilk in accordance with the ethical standards that inform the human tissue and organ donor sector. Stakeholders in human milk banking in South Africa have differing views on whether access to this tissue should be a right or a privilege,” says Jordan.
Jordan says that the ethical distribution and capacity management of (DBM) for the NICU in hospitals have become key focus areas in the breastfeeding and healthcare sectors. “Ten years into active human milk banking at the hospital level, we are witnessing a growing desire of prescribing doctors to exceed the current DBM user guidelines.”
“An equitable allocation system for donated breastmilk that takes into consideration utility, justice and respect for person, should drive the ethical considerations that pertain to universal access and distribution of donated breastmilk,” she shares.
“In the face of increasing need for human breast milk, it is important that we work to overcome the ‘negative’ attitude and misperception South African women have towards breast feeding. Improving access to breast milk banking is one step in the right direction. However, we need to carefully consider the ethical considerations of breast milk banking to prevent hurting the same infants we are looking to protect,” says Jordan.
Professor Morgan Chetty, CEO of the KwaZulu Natal Managed Care Coalition Ltd and Chairman of the IPA Foundation of SA, says that there are three ethical issues that also need to guide the use of human milk that is banked; decision making, informed consent, and conflict of interest. “In the first instance, decision making is currently guided by a combination of the best available scientific evidence, clinical experience and consideration of the needs of individual patients. If donor milk is available and the evidence of human milk’s advantage over commercial formula feeding is universally accepted, the clinician’s decision should be to support the choice of mother’s milk.”
Chetty adds that clinicians must also provide information about current state of knowledge of mother’s milk as part of informed consent process for infant feeds. “There is also the issue of market incentives to use commercial formula. Healthcare providers should disclose any relationship with entities that could influence their recommendations or discussions with the parents.
According to the World Health Organisation (WHO), exclusive breastfeeding for the first six months of an infant’s life is the cornerstone of good health and survival. Breastmilk helps to reduce infections by strengthening these babies’ immune systems. “This is even more important for babies born prematurely and of very low birth weight.”
A study published in the Lancet in 2016 indicated that optimal breast feeding of infants under two years of age has the potential to prevent over 823,000 deaths per year, but only 37% of infants younger than 6 months are exclusively breastfed in low to middle income countries worldwide.
The research also concluded that exclusive breastfeeding gave protection against child infections and malocclusion, increases in intelligence, and probable reductions in weight and diabetes. It also found that for nursing women, breastfeeding gave protection against breast cancer and it improved birth spacing, and it might also protect against ovarian cancer and type 2 diabetes.
According to a study by South African medical researchers, formally employed HIV negative mothers were twice as likely to stop breast feeding by 12 weeks. In this study, most of the women had little or no maternity leave provision. Soon after giving birth, many poor mothers need to get working again. What little income they earned went towards purchasing formula milk instead.
Jordan says that the study also indicated the early introduction of formula milk and a steady increase in breast feeding cessation amongst HIV negative women could not be prevented, despite postnatal home visits from peer breast feeding counsellors. “The researchers remarked that this scenario is unique to South Africa. The use of formula milk within the first six months of an infant’s life is uncommon in other parts of continent.”
Jordan and Chetty will both be speaking at the Ethics, Human Rights & Medical Law conference, which will form part of the 7th annual Africa Health Exhibition & Congress 2017 taking place from 7-9 June 2017 at the Gallagher Convention Centre in Johannesburg, South Africa. More than 9,300 regional and international healthcare professionals and medical experts are expected to attend the event.
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