News Family

Breast May Be Best, But Buying Breast Milk on the Internet Is Risky, Says Study

Martha Kempner

Some women who are unable to breastfeed turn to the Internet to buy breast milk from others who produce more than they need. While this may seem like a good use of modern technology to share a scarce and important resource, new research suggests it could be dangerous.

Some women who are unable to breastfeed their infants because of adoption, lack of production, medical issues, or other reasons turn to the Internet to buy breast milk from others who produce more than they need. While this may seem like a good use of modern technology to share a scarce and important resource, new research suggests it could be dangerous. A study published this week in the Journal of Pediatrics found that much of the breast milk purchased or exchanged online contained potentially harmful bacteria.

Researchers from Nationwide Children’s Hospital in Columbus, Ohio, found over 13,000 websites offering to sell or exchange breast milk when they began their study in 2011. They bought samples from 100 of these sites and compared them to samples from a nonprofit breast milk bank, USA Today reported. There are 12 of these banks in the United States, and they follow strict guidelines set by the Human Milk Banking Association of North America. Not only do these banks carefully screen donors, they pasteurize the milk before shipping it out to infants, which kills harmful bacteria. Milk purchased or exchanged on the Internet is not pasteurized. (For the purposes of the study, however, the milk from the milk bank was provided to the researchers without being pasteurized so that it could be more fairly compared to the unpasteurized milk purchased via the Internet.)

The study found big differences in the two sets of milk. Specifically, it found that 72 percent of the milk purchased online had detectable levels of gram-negative bacteria (which are associated with bloodstream infections, wound infections, meningitis, and fecal contamination), compared to 35 percent of milk bank samples; 63 percent of the Internet samples tested positive for staph infections, compared to 25 percent of milk bank samples; 36 percent of the Internet samples tested positive for strep infections, compared to 20 percent of the milk bank samples; and 3 percent of the Internet samples were contaminated with salmonella, compared to none of the milk bank samples. Though HIV can be transmitted through breast milk, that virus was not found in any of the samples.

Dr. Sarah Keim, the study’s lead author, told the New York Times, “Most staph and strep are harmless at normal levels. But some of the levels we found were very high.” She added that salmonella “doesn’t belong in milk at all.” Keim believes that the high level of bacteria is most likely caused by poor hygiene in the collection process (women who don’t wash their hands and/or don’t adequately wash the breast pump) as well as improper shipping techniques. For example, 19 percent of Internet sellers did not include dry ice or another cooling mechanism when they shipped the milk.

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Keim and her team also questioned the authenticity of some of the samples they got. She told the New York Times, “Buyers have no way of knowing even what they’re getting—it could be cow’s milk or formula.”

Though milk banks are safer, pasteurization can also destroy some of the substances that make breast milk beneficial to babies. Moreover, milk banks tend to reserve their supply for premature infants with medical issues and will only provide it with a prescription. If there is extra supply, they may give it to a healthy infant with a prescription, but there is rarely such a surplus, and the milk is expensive at about $6 per ounce. (Remember that a one-month-old drinks about 25 ounces per day.)

Kim Updegrove, president of the milk bank association, says she understands why some women turn to the Internet given these prohibitions. She told the New York Times, “I hate to say this to an informal sharer, because they are trying to do good. But they are playing a game of Russian roulette.” Her comments to the Philadelphia Inquirer were even stronger. “Human milk is a body fluid, so it contains all the bacteria and viruses that are in the mom’s body at the time the milk is expressed,” she said. “It’s no different than blood. Would you go to your neighbor and ask for a pint of blood?”

Some people, however, believe that the practice of sharing breast milk through informal networks of neighbors and friends or even online is an important way to spread the benefits of breastfeeding to more infants. They say that the study focused on most risky method of sharing breast milk—having it shipped from anonymous people who are selling it online. Shell Walker, a midwife in Phoenix, started a site called Eats on Feets, through which women share milk in person. (Her site does not allow women to sell the milk, because that opens up ethical and safety questions.) She called the study “sensational and flawed.”

Still, most experts agree that sharing breast milk is too risky. The Food and Drug Administration discourages both online and person-to-person sharing, and the American Academy of Pediatrics discourages feeding preterm infants breast milk from unscreened donors.

Updegrove believes that women are better off turning to the supermarket shelf than the Internet: “My advice would be to use formula. These children are just too precious.”

News Family

Buying Breast Milk Online Remains a Risky Proposition

Martha Kempner

Efforts to promote breastfeeding as the best option for infants may have led some parents to believe formula is not a good option and to turn to the Internet to find someone else’s milk, a practice the FDA says is unsafe.

Some women who are unable to breastfeed have turned to the Internet to buy breast milk, trusting that this is a better alternative to infant formula.

Some of the breast milk available online, however, is contaminated with bacteria, such as strep or staph. The latest study, published this month in Pediatrics Online, also found that one in ten samples bought online contained cow’s milk, which is not safe for infants.

Women who couldn’t breastfeed used to rely on wet nurses, but formula has meant that parents have another safe option. Efforts to promote breastfeeding as the best option for infants may have led some parents to believe that formula is not a good option and to turn to the Internet to find someone else’s milk, according to women’s health specialists.

Sites like Only the Breast allow people to buy, sell, or donate breast milk over the web. PennyHoarder.com suggests lactating women use their milk as a money-making project. Other sites, such as Eats on Feets and Human Milk 4 Babies, frown on making money off of breast milk; instead, they consider themselves breast-milk sharing communities and encourage free exchange after careful screening of donors.

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However it is done, the FDA warns against feeding your baby another person’s breast milk.

“FDA recommends against feeding your baby breast milk acquired directly from individuals or through the Internet,” the agency said in a 2010 statement. “When human milk is obtained directly from individuals or through the Internet, the donor is unlikely to have been adequately screened for infectious disease or contamination risk. In addition, it is not likely that the human milk has been collected, processed, tested or stored in a way that reduces possible safety risks to the baby.”

Research confirms that the FDA’s warnings are sound. A 2009 study of more than 1,000 women who wanted to donate to breast-milk banks found that 36 tested positive for syphilis, hepatitis B and C, and/or HIV.

A 2013 study found that 72 percent of 100 breast milk samples bought off on the Internet contained gram-negative bacteria (which are associated with bloodstream infections, wound infections, meningitis, and fecal contamination), 63 percent tested positive for staph infections, 36 percent tested positive for strep infections, and 3 percent were contaminated with salmonella, as Rewire reported.

Though HIV can be transmitted through breast milk, that virus was not found in any of the samples.

The new study provides follow-up analysis on the same samples and found that many of them included either cow’s milk or infant formula.

Sarah Keim, the lead author on both of these studies, told CNN that the amount of these other ingredients found in the samples shows that sellers deliberately “topped off” their breast milk presumably to sell more.

“If a baby with cow’s milk allergy were to drink this milk it could be very harmful,” Keim said.

Milk banks are a safer alternative because they screen the blood of the donors and the milk itself. These banks then pasteurize the milk, which kills off contaminates. But the milk is expensive and the supply is small. Most of it goes to premature infants in neonatal intensive care units across the country.

For those who can’t produce breast milk or get it from a milk bank, formula is the best choice.

“There is a lot of unwarranted guilt surrounding not breast-feeding babies,” pediatrician Jennifer Shu told CNN. “Even though breast milk is best, in some situations, formula is the better and safer choice.”

News Family

Study: Other Factors May Be Responsible for the Health Benefits Ascribed to Breastfeeding

Martha Kempner

A new study suggests that other characteristics of the women and families who breastfeed may be responsible for improving their infants’ health—not just the act of nursing or breast milk itself.

Recently, Rewire has been reporting on initiatives around the world designed to increase the number of women who breastfeed and the length of time for which they do it. A pilot program in a low-income part of Britain, for example, is offering to pay mothers in the form of gift cards if they exclusively breastfeed their infants for six months. The United Arab Emirates took the drastic measure of legally mandating two years of breastfeeding. And here in the United States, the American Pediatric Association has a policy that pediatricians should not provide materials that promote formula feeding, such as gift bags, industry-written pamphlets, or coupons.

All of these programs and policies were implemented based on the underlying belief that breastfeeding provides numerous benefits to the health and well-being of babies that cannot be achieved through other means. These beliefs did not develop out of thin air—they are based on years of research. But a new study suggests that it may be other characteristics of the women and families who breastfeed that improve their infants’ health, rather than the act of nursing or the breast milk itself.

Researchers from Ohio State University analyzed data on more than 8,000 young people, many of whom were siblings and 25 percent of whom were from sets of siblings in which at least one was breastfed and at least one was bottle-fed. This inclusion of siblings with “discordant” feeding patterns is what the authors say is innovative about this study, because it attempts to account for those characteristics of mothers and families, other than breastfeeding, that are known to affect health outcomes. Lead author Cynthia Colen said in a press release, “Many previous studies suffer from selection bias. They either do not or cannot statistically control for factors such as race, age, family income, mother’s employment—things we know that can affect both breast-feeding and health outcomes.” Women with higher income and better employment are more likely to nurse, and children of women with higher income and better employment are more likely to have positive health outcomes.

Colen and her team looked at 11 indicators of better health that have, in previous studies, been credited to breastfeeding, including body mass index (BMI), obesity, asthma, hyperactivity, parental attachment, and behavior compliance as well as scores predicting academic achievement in vocabulary, reading, math, intelligence, and scholastic competence. As expected, the analyses of the samples when compared across families suggested that breastfeeding resulted in better outcomes than bottle-feeding in most of these measures.

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Interestingly, though, when the sample was restricted to siblings who lived in the same families but were fed differently as infants, the positive effect of breastfeeding all but disappeared on ten out of the 11 indicators. The only one that continued to have significant differences was asthma, though not in the direction one would expect. Children who were breastfed as babies seem to be at increased risk for this breathing disorder. The authors, however, suggest that some of this difference may be a result of the data on asthma, which was based on self-report rather than an actual diagnosis.

Though this is just one study, it does cast some doubts on the recent emphasis on breastfeeding as the best or only acceptable way to care for an infant. Moreover, it suggests that programs and policies designed to promote breastfeeding by mandating it, offering coupons, or making formula harder to obtain may be missing the mark. Colen believes that we need to “understand that breast-feeding might be very difficult, even untenable, for certain groups of women. Rather than placing the blame at their feet, let’s be more realistic about what breastfeeding does and doesn’t do.”

She adds, “I’m not saying breast-feeding is not beneficial, especially for boosting nutrition and immunity in newborns. But if we really want to improve maternal and child health in this country, let’s also focus on things that can really do that in the long term—like subsidized day care, better maternity leave policies and more employment opportunities for low-income mothers that pay a living wage, for example.”