Nonprofit/For-profit Breast Milk Wars Contain Disturbing Issues

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July 7, 2015; NBC Philadelphia

Apparently, nonprofit and for-profit breast milk purveyors are fighting for market share in much the same way blood banks did a decade ago. Peter Frumkin and Carol Chetkovich published a paper in 2002 entitled “Balancing Margin and Mission: Nonprofit Competition in Charitable versus Fee-Based Programs” about how the Red Cross handled competition in its blood bank activities, discussing the choices they made to compete based on product differentiation or cost.

The same issues are playing out in the arena of breast milk banks. Breast milk is a precious commodity with a value 150 times what cow’s milk costs. There are two basic differences between the nonprofits and for-profits in or entering the field; one has to do with the issue of payment to mothers, and the other with issues of product safety and how the milk should be processed. The first issue is very sensitive and has already led to charges of attempted exploitation and the potential of unfair distribution. These issues were laid out in a recent article in the New York Times which related the story of an offer made by the for-profit Medolac to buy the milk of women in financially distressed Detroit. Medolac, which claimed to be working with the Clinton Foundation to encourage breastfeeding by making it financially attractive, withdrew its offer when the Black Mothers’ Breastfeeding Association wrote an open letter to the firm, stating, “We are deeply concerned that women will be coerced into diverting milk that they would otherwise feed their own babies.” Such practices are distressingly referred to as “farming.” In a city with the highest infant mortality rate in the nation, said Kiddada Green, executive director of the Black Mothers Breastfeeding Association, “it reeks of exploitation.”

Kim Updegrove, executive director of the nonprofit Mother’s Milk Bank in Austin, points out that there is also a problem in terms of making choices about who gets the milk. “The nonprofit milk banks have a long history of providing milk to the sickest babies, and provide it based on medical need and not on insurance reimbursement or financial resources,” she said.

For-profit companies in the space are offering payment for breast milk and then selling it at a markup to hospitals. This practice worries nonprofits, which are concerned about their own stores of milk, believing it to be superior in quality to that of for-profit banks. In general, though, demand outpaces the supply by far. The nonprofit Human Milk Banking Association of North America runs 15 breast milk banks across the country, and it estimates those serve 4,000 mothers in need. It would take 60,000 banks to fill the current need in U.S. hospitals now, and the market for it appears to be growing, with some suggesting that breast milk or a product derived from it could also be used to treat sick adults. (And for-profits have that market targeted, too.)

Some states are beginning to regulate the “industry” in an attempt to establish standards, but we would love to hear from readers. What can you add to this discussion?—Ruth McCambridge

  • From the Human Milk Banking Association of
    North America (HMBANA)

    Every mother who provides surplus breast milk to another party deserves complete
    information about how her milk will be used and who will benefit, medically and
    financially, so that she can make a well-informed decision.

    Nonprofit milk banks that are affiliated with the Human Milk Banking Association of North
    America (HMBANA) exist for the sole charitable purpose of saving the lives of
    fragile premature infants. They abide by strict HMBANA guidelines and are
    monitored to assure that members adhere to the highest safety and ethical
    standards.

    Our standards are based on the volunteerism of young women in Canada and the U.S.
    Paying mothers for their human tissue requires ethical review and stricter
    standards of screening and processing of their body tissue.

    We are grateful to the mothers who altruistically donate their milk to nonprofit milk
    banks in order to give critically ill infants a chance to grow and thrive.

    Pauline Sakamoto, MS, RN, PHN
    President, HMBANA
    Mothers’ Milk Bank
    San José, California
    Pauline.sakamoto@hhs.sccgov.org

    Naomi Bar-Yam Ph.D.
    President-Elect, HMBANA
    Mothers’ Milk Bank Northeast
    Newton Lower Falls, Massachusetts
    Naomi@milkbankne.org

  • Rbent

    A key consideration to keep in mind is that the demand for human milk exceeds the supply. There is a role for both models. Interestingly no defaming claims or aspersions have been cast by the for-profit upon the not for profits. One might argue that expecting mothers to spend their time and effort donating with NO compensation of any form is exploitation, playing upon the traditional role of women in all cultures as uncompensated service workers. The model is actually similar to blood or plasma donation. But it is better in that NO physical harm is caused the donor.
    For profit does not equate to more expensive. Hospitals pay for both products, at a similar rate. It is ironic that the principles of capitalism and the efficiencies it brings to bear through competition are not being acknowledged for this industry.

    • Kristen Hallman

      YES!

  • Deidre Orriola

    So glad this is being discussed! This article brings up so many other issues, too. It’s the fact that a baby who needs donated breastmilk can’t get it in a safe way because: many insurance companies don’t
    pay, docs don’t know they can prescribe, not enough moms know how to donate safely or that they can donate at all or where to donate to, not to mention competition created by formula companies that literally compete with breastmilk… And on and on… As public health professionals we need more
    dialogue about all of this and policies that encourage safe and fair donation, bring the cost down for those who need milk while assuring safety at the same time.