
The ethics of donating breast milk - tomkwok
http://mosaicscience.com/story/give-and-take-ethics-donating-breast-milk
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austenallred
I actually have a friend who is in the latter stages of importing donated
breast milk from Cambodia. At first, when he told me about it, I was a little
bit disgusted, but the more I think about it the more I realize it could be a
net win for everyone.

He described it as:

1\. Breast milk is, hands down, the best nutrition a baby can have. Babies in
the NICU need it, there's a massive shortage, and we can't match its
nutritional value with formula, period.

2\. A woman will continue producing breast milk as long as she continues
either feeding or pumping, even if her child is too old.

3\. There's a desperate shortage in the US, because people don't want to take
the time to come to the donation facility for the blood tests, and those are
very expensive to do by mail.

Basically, what he's doing is paying women in Cambodia for their breast milk.
A woman in Cambodia will donate her milk for a few dollars a day, and it
completely changes her lifestyle. Women are willing to come to their
facilities to be tested, and are willing to go through background checks that
make sure they're not neglecting their in doing so.

They can then export the breast milk to places that have shortages (like the
US), and make a profit.

Domestically it's regulated by the FDA like a foodstuff (beans or corn), and
it can be homogenized just like cow's milk.

It takes a while to get over the weird factor, but it seems like economically
it's a win-win. I'd be curious to see if anyone else would consider this
exploitative. I've gone back and forth.

~~~
userbinator
_It takes a while to get over the weird factor_

I suppose it's weird for those who have never seen a cow being milked before,
and I wouldn't be surprised if that was true for a large number of the (city-
dwelling) population.

~~~
foldor
I don't think it's so much the fact that people haven't seen a cow being
milked, so much as it's about the fact that drinking human milk is something
we're not used to considering. It's always been a very personal and intimate
thing between mother and child, so this seems unusual in comparison.

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patorjk
My wife had a Caesarean section and was unable to produce milk. She went out
and filled our freezer with some milk a friend donated her. I went along with
it since I knew it was healthier than formula and didn't want my son missing
out on any needed nutrients. However, we definitely got some strange looks
from family and friends, with many people thinking it was gross. Hopefully its
less weird in the future.

~~~
quesera
The American fear of boobs is such a bizarre thing. We will happily
artificially impregnate cows and pump them til they're dry to extract an
inferior product, but cower in fear of the free, natural, superior option.

We've been lied to for decades, and our too-smart-for-that-malarkey
grandmothers are dead.

This is a good addition to the what-will-future-generations-think-we-were-
stupid-about lists.

~~~
niix
I'm not sure when "weird" became the stigma around feeding baby, but its
unfortunate. My wife and I have a 3 month old, and if our baby is hungry - she
breast feeds him. (Mind you she is very conservative about the whole process).
Its amazing the people that give strange looks in a restaurant, after all
everyone else is eating. Why can't our son?

~~~
Lawtonfogle
Because we don't live in a culture that mandates you hide your fork and plate
when they aren't being used to eat with. Imagine a culture where forks are
taboo and often times illegal to be shown in public, except when you eat and
where most people don't use forks. Where giving a child a picture of a fork
(that isn't being used to eat with) is a significant social social breach that
will get you hated and labeled for years and perhaps even a crime. Use of a
fork in public in such a situation would get weird looks.

In fact, even imagining such a society seems absurd, but that is how our
current culture is (at least where I've lived at).

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celticninja
The one issue I have with the article was the mention of concern that it was
the use of formula that led to the death of the child. All things being equal,
and in this instance they were twins, the formula alone was not to blame.

Breastmilk is better than formula but formula beats no food at all or too
little to sustain a child.

This sort of thinking (from the article) actually makes things harder for new
mums who can feel pressure to breastfeed and avoid formula. Breastfeeding is
not easy nor is it always possible. The whole article could have made the same
poi t without blaming formula for contributing to the death of the infant.

~~~
thearn4
New first time father of a 3 month old. It's really taken me by surprise how
much guilt is thrown at women who either have to or choose to supplement
breast milk with some formula. In our case, my wife cannot produce enough to
cover him 100%, so we supplement. And he's growing well and extremely healthy
so far (shrug).

I guess this form of "mommy guilt" is well in line with the trend of every
person you meet having their own opinion about every aspect of child raising.
Where I'm really starting to think that, outside of the advice of your
pediatrician (who should never be ignored), most of it really does not matter
at all.

~~~
russnewcomer
First time father with a seven month old here. I observe there is frequently
more attachment to an idea (don't formula feed!) than there is the ideal (baby
should be as healthy as possible).

But I also observe that part of that is driven (at least, in America, where
you seem to also be located) by the conceptual societal framework that has led
kids to understand you should only be with people who don't criticize you, and
my wife and I heard from several people while she was pregnant that we 'need
to find our tribe,' where we try to exclusively spend our social time in a
sub-group of people that share our philosophies on child-rearing and related
fields. I reject this line of thinking as needlessly polarizing, and I think
that if you only are with your tribe, you're going to be messing up your kid
the same way everyone else in that tribe messes up their kids (and I also
observe that every generation of Americans since the 'Greatest Generation'
complains about how their parents raised them, I don't expect my children's
generation to be any different)

------
russnewcomer
I have a seven month old, and my wife has shared bagged milk that she pumped
before we figured out that he can't eat it because he seems to be MSPI.

The hardest part about infant nutrition is that passing on knowledge about it
isn't a part of modern American culture, and so when we had our son, we felt
we had to do a lot of reading and research to figure out what was the best
thing to do.

And it's tragic, although understandable from a certain perspective, that a
significantly lower portion of [statistically speaking] lower-income African
American women do not plan to breastfeed. Tragic solely in the cost savings
that it could be for them that could help them slowly make their way out of
poverty. (Yes, yes, structural societal issues aside, I mean for them
individually).

It also appears pretty true that almost anything involving infants, birth, and
the fuzziness of medical ethics provokes strong reactions from those involved.
Hopefully, the focus will remain on doing the best thing, and less on doing
the thing that people yell the most about.

~~~
pavel_lishin
> _I have a seven month old, and my wife has shared bagged milk that she
> pumped before we figured out that he can 't eat it because he seems to be
> MSPI._

A very cursory google search tells me that MSPI only appears to be related to
soy and cow's milk. Am I googling wrongly?

~~~
russnewcomer
Not googling wrongly at all. Just missing that the proteins that the mother
ingests make their way into the breast milk. Therefore, when my wife ate
dairy/soy then pumped and bagged the milk, it is no longer usable for our son
since it has the proteins from her consumption in it.

~~~
pavel_lishin
Oh, wow - so if she wants to breastfeed, she basically has to avoid soy and
dairy?

New dumb startup idea: match women like your wife with women who are
lactose/soy intolerant (but whose babies aren't), and do a milk swap!

~~~
russnewcomer
Yeah. It's really kind of torturous to try to plan meals (no cheese, and the
amount of packaged food we can eat goes waaaaay down), or figure out what she
could possibly eat when we go out (especially if we are somewhere longer than
planned and need to eat before getting home, that's terrible.).

There are informal milk swaps, but part of the deal is that the way the
biology works, it's better for the baby to have their own mother's milk ( if
you're giving another mother's milk, it's statistically not much different
than formula [to anyone reading, I know this is a controversial statement
simplifying a complex issue]).

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kchoudhu
My daughter was born via c-section, so there was a short period between her
birth and my wife's milk coming in when my wife was driven to tears by her
inability to provide nutrition to the child. The coin has recently turned,
however, with my wife now having a slight overproduction problem: after
freezing the excess over the course of the month, there was literally no more
room in our freezer for normal food.

We'd love to see the excess used productively (she's literally pumping and
dumping gallons of the stuff every week). Unfortunately, the litigious nature
of US ensures that this is a non starter, as we are unable to find anyone
willing to give us an assurance that we are free of liability if a child
became ill after drinking my wife's milk.

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Mz
In addition to women who can't produce enough: There are preemies who have
difficulty latching on. Suckling at mom's breast is far more work for the baby
than a bottle is -- again, for preemies or babies with health issues, this is
a real problem.

When I had minor issues with breast feeding, I was able to resolve them myself
in spite of nurses being zero help. When someone close to me had trouble
breastfeeding, I did not know the answer but was able to be emotionally
supportive of her and helped her get over any guilt or bullshit social
messages about how this should be easy and natural for both her and baby. She
also was able to find solutions in spite of the stupid things people around
her were saying.

I suspect this is easier for women in cultures where women have more babies on
average and breastfeeding is more the norm. It is a situation where you have
much better odds of being personally acquainted with someone who had the same
issue and can tell you how to fix it. I was appalled by the really crappy
attitudes I was surrounded by and the dearth of practical solutions.

Perhaps importing breast milk makes that problem "worse", but you at least are
able to feed your baby, which is actually the more important issue.

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pvaldes
Beware!. I can see some big problems here that have to be carefully managed.
For some reason the article do not even mention that:

 _" Despite the ban on persistent organochlorines (OCs) in most of the
developed nations, their usage continued until recently in many Asian
developing countries including Vietnam, for agricultural purposes and vector-
borne disease eradication programs."_

 _" This result suggests recent usage of DDTs in both north and south
Vietnam"_ (2004)

 _" Analysis of infant exposure to DDTs via breast milk suggested that the
daily intake rates are close to or above the threshold for adverse effects on
children health"_

Source.
[http://www.sciencedirect.com/science/article/pii/S0269749103...](http://www.sciencedirect.com/science/article/pii/S026974910300472X)

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legulere
I'm wondering wether pasteurized human milk really provides that much
advantage over formula. Isn't it the bacteria that's providing all the
benefits for the immune system?

~~~
beat
It really does, especially in critical formative days and weeks.

Formula is pretty much the equivalent of junk food. You can live on it, but
not optimally.

