If there was a world championship in the production and distribution of the vital resource of breast milk, one country would win hands down, every time. In Brazil, human milk isn't treated as a nice-to-have, as in the quaint phrase "breast is best." It's a vital national asset. Public breastfeeding is encouraged. And policemen and firefighters are even said to make deliveries. And most importantly, Brazil has almost half the world's breast milk banks, which collect and store extra milk from nursing mothers, to be dispersed to sick infants or mothers whose babies are having issues breastfeeding.
The obsession with breast milk seems to be paying off. Brazil's child mortality rate has fallen from 61 deaths per 1,000 babies in 1990 to 16 per 1,000 in 2015—a drop of 73%. Of course, not all of that is attributable to breastfeeding—we don't really know how much. But the government thinks it's a big factor. And there's good evidence that breastfeeding improves Brazilian lives. A major study following 6,000 Brazilian babies over a 30-year period saw steady long-term benefits. Across all economic backgrounds, rich and poor, breastfed individuals tended to have higher IQs, to complete more education, and have higher earnings.
The question is whether other countries can emulate Brazil's model and get something like the same results. If so, the effects could be quite dramatic. Another study found universal breast milk availability—that is, both among woman who can breastfeed, and banked milk for the 15% to 40% of mothers who can't breastfeed at any one time—could avert, per year, 823,000 deaths of children and 20,000 maternal deaths, and produce global economic benefits totaling $300 billion.
We might think of breast milk like an effective drug—like, say, a polio vaccine. It's a source of nutrition, a means to fight infection, a source of immunity, and perhaps a boon to the gut microbiome. Researchers have begun to think of human milk not just as food, in the form of proteins and fat, but also as the basis for a long-term healthy gut, the subject of intense medical interest at the moment.
In fact, human milk contains a substance called human milk oligosaccharides, or HMOs, that babies cannot digest. Asks Ed Yong in the New Yorker:
Why would a mother expend so much energy manufacturing these complicated chemicals if they were apparently useless to her child? Why hasn’t natural selection put its foot down on such a wasteful practice?
Here’s a clue: HMOs pass through the stomach and the small intestine unharmed, landing in the large intestine, where most of our bacteria live. What if they aren’t food for babies at all? What if they are food for microbes?
The idea that human milk is precious isn't new, of course. Wet nurses appear in ancient texts like the Bible and the Koran (the Prophet Muhammad is said to have been wet-nursed). Families have long passed milk between each other. But the science of breast milk has become more extensive of late, says Kiersten Israel-Ballard, an infant nutrition expert at PATH, the global health nonprofit. And that could allow campaigners to lobby more effectively for action, including more supportive environments for breastfeeding and better management of the human milk supply. Already the WHO endorses breast milk wherever possible.
The global milk banking infrastructure is currently limited, especially in poorer countries. East Africa has exactly no banks, for instance. The United States has only 23, according to the Human Milk Banking Association of North America. Israel-Ballard says the HIV epidemic in the 1980s halted momentum on milk banks. But modern treatment and screening methods are helping to bring milk banking back—a few more are currently being built. However "many milk banks don't have enough milk," she says. "They don't sit within larger programs that promote breast feeding. If you have no breastfeeding population, you don't have milk banks."
Israel-Ballard is confident organizations can build milk banks more cheaply and easily in the future. It's not that difficult to do. "It's not rocket science," she says. "You have milk, you treat it, you do some microbial testing. It's not that high tech."
One area that could definitely be improved: heat-treating, so there's no, or less, loss of all the good breast milk materials (immunity, microbiome-initiating, colostrum-goodness). PATH is keen to work with the dairy milk industry, which (obviously) has years of experience in qualities of milk.
Working with the University of Washington's computer science department, PATH is developing a cell-phone attachment that monitors the pasteurization (heat treatment) process. The device is similar to the temperature feedback stick used in drug cold-chains. Pasteurizing machines ("glorified dishwashers") are currently too expensive (they can run up to $100,000 apiece), she says.
"This whole field has been ignored, but it wouldn't take much to advance, and we could really change how many milk banks there could be in the future," Israel-Ballard says.
In truth, we really ought to have pipelines for the stuff (they had something like it in Mad Max: Fury Road, though it's not a happy reference). Or some kind of Uber model. It's time to build the breast milk production and delivery network.
So, any designers and engineers, it's time to think of ways to make this a global priority. And philanthropists—this is a big payoff investment. Let's be a little more Brazilian.
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