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From ‘breast is best’ to ‘fed is best’

Heartbreaking appeals for breast milk for infants with mothers lost to covid-19 have been doing the rounds. Given the dangers of contamination and lack of screening during a pandemic, is there an alternative?

A file photo of the breast milk bank at Fortis La Femme hospital in Delhi
A file photo of the breast milk bank at Fortis La Femme hospital in Delhi (Getty Images)

Among all the appeals for help that have dominated our social media timelines over the past few weeks, one category has been especially heartbreaking: appeals by caregivers for donated breast milk for newborns whose mothers have died of covid-19.

On 13 May, actor Tisca Chopra tweeted: “A friend passed away with Covid& the little baby girl needs to be breastfed, she is #PREMATURE Baby is at the NICU, Holy Family Hospital & daily requirement is 100ml...”, asking a hospital with a breast-milk bank or “a mother who can help” to connect with her. A few days later, actor Bhumi Pednekar tweeted a similar appeal, asking lactating mothers near Bankura, West Bengal, to come forward and donate breast milk for a two-month-old baby, suggesting that they “freeze the milk themselves”. Mothers who have offered to breastfeed babies who have lost their mothers have even made headlines: Assam’s Ronita Krishna Sharma, mother of a two-month-old who offered to personally breastfeed children in Guwahati, was the subject of news stories in The Times Of India and on NDTV, among others.

Without diminishing the genuine desire to help such unfortunate babies, we must ask if the intended outcome of these appeals—lactating mothers donating breast milk on their own, which would probably be the case since breast-milk banks are few and far between in India—is at all safe. Even if a breast-milk bank or a regular hospital with the required breastmilk-handling protocols is involved in the process, the time, effort and risk of infection associated with getting a lactating mother to either visit such a bank or have her preserve the milk under sterile and refrigerated conditions till it can be consumed, are huge. Is it worth it?

It is a fraught question. Breastfeeding is such an emotive subject—more importantly, so surrounded by medical dogma and orthodoxy—that it is difficult to even question whether breastfeeding is indeed the best option for a child under such unprecedented circumstances, with so much time and effort required to procure the milk, with all the labour of sourcing it and ensuring it is safe to consume being done by caregivers who have a thousand other things to worry about. One hesitates to put forward a solution—can the babies simply not be fed formula?

Many doctors agree that it is the safest option under the circumstances. “If they (caregivers) can get properly screened and tested breast milk, then that’s good, but there’s no need to panic if they can’t. Infant formula has developed significantly to include many nutrients and mimic human breast milk as closely as possible and this can be safely given to these babies, especially under these circumstances where one cannot be sure that the donated breast milk has been properly tested and sterilised,” says R. Kishore Kumar, senior neonatologist and chairman of Cloud Nine Hospitals, a leading chain of maternity and childcare hospitals headquartered in Bengaluru.

Dr Kumar goes so far as to say that “formula has become somewhat demonised in the past few decades”, referring specifically to the aggressive campaigns by formula companies in the 1970s claiming their product was superior to human breast milk, which led to a justified backlash within a few years. Global agencies like Unicef and the World Health Organization led awareness campaigns about the benefits of breastfeeding, doctors and nurses started championing it, and campaign slogans like “Breast is Best” and “Liquid Gold” entered common parlance.

Has this preference for the most natural, evolutionary solution—one that also offers the correct nutrients and maternal antibodies to the child (though maternal antibodies pass on to the child even during gestation)—gone too far? “At a time when it may not be possible to strictly follow the milk collection and processing protocols, formula is not at all a bad alternative. A bad alternative would be cow or buffalo milk,” says Roli Munshi, consultant paediatrician at Yatharth Hospitals in Noida. “In the NICU, we get screened breast milk from authorised breast-milk banks. It is beneficial for pre-term babies but it is rarely sold directly to consumers,” says Dr Munshi.

Taking note of the social media appeals for donated milk, these banks are also starting to come forward to be a part of the process—a good thing, since it will ensure proper handling. “We are starting a campaign next week to encourage lactating mothers to come forward to donate their milk for babies who have lost their mothers or whose mothers are unable to breastfeed because of covid-19. We will be guiding them about the process, and our staff can also go to their homes to collect the donated milk following the proper protocols,” says Nitisha Sharma, secretary of the Jaipur-based Inaya Foundation and founder member of the Amrit Milk Bank at Mahatma Gandhi Hospital, one of the first human breast-milk banks in India.

During a pandemic, however, would energies be better conserved by falling back on an artificial alternative that has served generations without any major side effects? It is not as if babies who do not receive breast milk at all do not thrive, or that they suffer life-changing developmental disadvantages. Studies have shown that the link between breastfeeding and better outcomes for infants, such as higher IQ, lower rates of infections and lower rates of obesity, can be influenced by other factors as well, such as better socioeconomic status and higher maternal education and IQ.

Studies such as the Promotion Of Breastfeeding Intervention Trial (PROBIT), a landmark randomised trial in the Republic of Belarus conducted in the late 1990s and published in 2001, show that breastfed babies had fewer instances of diarrhoea and eczema—that’s about it. The study itself stated, in conclusion, that “the effect of breastfeeding in protecting against infection is more striking, and thus easier to demonstrate, in settings where poverty, malnutrition and poor hygiene are prevalent”. One of the reasons breastfeeding has been encouraged in developing countries is precisely this—in places where the availability of sterilised water and feeding equipment is doubtful, breast is of course best. But its benefits across socioeconomic categories may have been overblown.

Another landmark study, Is Breast Truly Best? Estimating The Effects Of Breastfeeding On Long-term Child Health And Wellbeing In The United States Using Sibling Comparisons by Cynthia G.Colen of the University of Ohio and David M. Ramey from the Pennsylvania State University, examined the impact of breastfeeding by comparing outcomes between pairs of siblings who had been fed differently, one with breast milk and the other, formula. “Our results suggest that typical estimates of the impact of breastfeeding on child well-being may be overstated,” concluded the study cautiously.

While no one is arguing that breastfeeding is not a good practice, one that is beneficial to both mother and baby, it is good to question whether, with the best of intentions, the insistence on breastfeeding has gone too far. This also plays out in the lives of many new mothers who struggle with breastfeeding; looking for alternatives like formula, they encounter only shaming and a more aggressive push towards breastfeeding.

“After struggling to feed my daughter for weeks—we had latching issues and my milk flow was not great—and several rounds of lactation consultations, incessant pumping, eating things that would supposedly increase milk production and generally losing my mind over it, my daughter’s paediatrician finally told me ‘you know what, just give her formula.’ My daughter thrived and I did much better too. I often think back to those days, wondering why they felt they had to make me go through all that and I find myself shaking with anger,” says PN, a Bengaluru-based mother to a five-year-old.

As a new campaign that seeks to empower mothers to make an informed choice between breastfeeding and formula-feeding says, “Fed is Best”.

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