How Rajasthan's human milk banks are paving the way for India to save its babies

QUICK PILL

The problem

• India\'s infant mortality rate is very high - a rate of 40 per 1,000 live births

• Rajasthan\'s infant mortality rate is a whopping 47%

• Diarrhoea and pneumonia are the main causes of death

• Lack of breast milk can reduce immunity, thus allowing for these diseases to kill

The service

• Divya Mother\'s Milk Bank, the first of its kind in India, opened its doors in 2013 in Udaipur

• It provides breast milk, called \'liquid gold\' in many parts of the world, for free

• Women from all backgrounds donate milk

• They are pre-screened for various diseases like HIV and hepatitis

• The milk is then pumped, pooled, pasteurised and frozen ready to use for up to six months

The benefits

• The benefits of breastfeeding extend well beyond basic nutrition

• Survival increases at least six-fold if the newborn gets mother\'s milk, particularly in the first hour (the golden hour)

• Brazil\'s 200 plus milk banks have achieved a 73% reduction in child deaths since 1990

"Agar apni maa ka doodh piya hai to saamne aa," Amitabh Bachchan once said in the film Laawaris.

The nutritional benefits of mother's milk are numerous - after all, it is the best source of nutrition for a new baby. It also adds a kind of invincibility, as Bachchan insinuates in the dialogue above.

Yet it can't be taken for granted. What happens if the mother can't generate enough milk? Or if the child is too weak to suckle?

In the heart of Rajasthan's Udaipur city, a solution exists within the walls of the Divya Mother's Milk Bank (DMMB). Here, babies are given the right to free breast milk - which at times saves their lives and allows for them to have a healthier future.

With those kind of advantages, how does it matter if the milk is from the child's own mother or another?

Recently in Udaipur, Kanku Bai gave birth after a complex Caesarian surgery. After all the complications, another one arose - she was unable to generate any breast milk to feed her baby.

Around the same time in Udaipur, another mother, Sunita Soni, also went through a complicated childbirth. Her baby had to undergo intestinal surgery and was admitted in neo-natal intensive care unit (NICU). All this left the baby too weak to suckle. To top it all, Sori's breasts felt like rocks thanks to the surplus milk.

Though both women knew the option to use packaged powder milk exists, the two mothers landed up at DMMB.

The human milk bank

If there is access to properly stored breast milk, the lives of many premature babies who have trouble breastfeeding can be easily saved.

Yog Guru Devendra Agrawal, the 41-year-old founder of DMMB, says 70% of infant deaths in India occur within the first month itself - something he saw first hand himself.

In 2005, Agrawal had founded the Maa Bhagwati Sansthan, which runs an orphanage for unwanted and destitute infants, Mahesh Ashram. "I would get upset when I saw newborns get sick frequently either due to diarrhea or pneumonia," he says.

"Later, wisdom dawned that perhaps since these infants were more vulnerable to infections as they didn't get mother's milk," he says.

To ensure freshness and quality, mothers are encouraged to pump milk at the bank itself

This inspired him to build a 'human milk bank'. By then, the Sansthan already had three other smaller initiatives on Yoga, health and environment.

In April 2013, the DMMB was set up as the first human milk bank in the country. The investment cost around Rs 10 lakh and space was provided at Udaipur's Zenana Hospital free of cost by the Rajasthan government.

The hospital, situated at Panna Dhay Rajkiya Mahila Chikitsalaya within the city's RNT Medical College campus, is easy to locate.

Inside it, the milk bank is attached to the NICU to ensure convenience to new mothers. Around 80% of the donors are mothers who await their babies' recovery at the NICU, while the remaining 20% are voluntary donors.

To ensure freshness and quality, mothers are encouraged to pump milk at the bank itself and not bring pumped milk from home.

From its small, well-equipped clinic within the premises of the state-run hospital, the bank collects excess milk from mothers pre-screened for various diseases like HIV and hepatitis through a pump, which is then pooled, pasteurised and frozen ready to use for up to six months.

Thanks to the generosity of donors, in just two years, from April 2013 to March 2015, DMMB received a total of 10,853 units from 1,729 donors. Of this, 10,131 units of milk have so far benefitted almost 900 neonates.

This service, what health experts have long described as "liquid gold" in many parts of the world, is free of cost. The donor mothers are simply offered coconut water and a token gift - a small packet of "suwa" (a local herb) - that helps generate more milk.

Project officer Bhawna Joshi, who's been associated with the DMMB since its inception, says, "If the test results are OK, the milk is collected with the help of breast pumps from donor mothers, pooled, cultured, pasteurised and properly sealed. It is then frozen at minus 20 degree Celsius," she adds.

Saving lives

According to UNICEF, breastfeeding a child within the first hour of birth (called the 'golden hour' by the WHO), protects the child against infections and reduces infant mortality by up to 22 times in the first month of life.

Shockingly, only one in four babies born in India are breastfed in the first hour, according to data from the third National Family Health Survey (2005-2006). And less than one in two women exclusively breastfeed for the first six months, as is recommended.

India has an infant mortality rate of 40 per 1,000 live births. Compared to this, Rajasthan's infant mortality rate is a whopping 47%.

Diarrhoea and pneumonia are the two diseases that are most responsible for infant mortality in the developing world. They contribute to 55% and 53% of infant deaths respectively within the first year of life, WHO says. These are inextricably linked to poor breastfeeding practices in the first six months of life.

The benefits of breastfeeding extend well beyond basic nutrition. Breast milk gives an infant a steady supply of white blood cells, antibodies, lymphocytes, vitamins and easy-to-digest carbohydrates and fat, all of which help it build resistance from external infection during its most vulnerable initial months.

Agrawal says chances of survival increase at least six-fold if the newborn gets mother's milk, particularly during the golden hour.

Popularising the practice

Although this was the first human milk bank to be open in the country, other states have begun to implement similar measures. In early August, Chief Minister Jayalalitha inaugurated 352 breastfeeding rooms and seven breast milk banks in hospitals across Chennai, bringing much cheer to mothers.

According to this recent Times of India report, India now has 17 breast milk banks across the country.

Vasundhara Raje too announced 10 human milk banks in Rajasthan in this year's budget. One has already started in Jaipur.

This service, what health experts have described as "liquid gold" in many parts of the world, is free of cost

Some countries like Brazil and Norway have made exemplary use of human milk banks. Brazil's 200 plus milk banks have achieved a 73% reduction in child deaths since 1990. Brazil's strategy includes innovative measures like training postmen to provide pregnant women information on breastfeeding and using firefighters to collect surplus milk from lactating women.

Agrawal would like to see India make some headway down the Brazil route. He has big dreams for India. As he told the BBC last year: "Perhaps it won't be possible in my lifetime, but I want human milk powder to be available in grocery stores."

Give and you shall reap

"I could feel the milk oozing every hour but I was not allowed to breastfeed my daughter because she had an intestinal obstruction," recalls Sori. She finally found relief at the DMMB where her milk was stored and used to feed many other babies, not just her own.

Rekha Chhedwal was incredibly moved when she read about the plight of orphan infants and became a donor. "The very first question that came to my mind was whether it would mean having less milk for my baby. But now that I've donated regularly for almost a year, I can happily say mere bacchhe ke liye kabhi doodh kam nahin hua (my own child was never deprived of milk)."

Till now, Chhedwal has been the largest donor at DMBB. Another donor Usha Varsi says, "The joy of donating milk for an infant in need is beyond words. The sense of satisfaction one gets, only a mother can understand."

She is aware of the hesitation the donor experiences. "Nazar lag jaayegi" (inviting bad omens) is the common refrain, she says. "But we must learn to live for the society. We are not losing anything by donating. In fact the more you give, the more you get," Varsi says.

Varsi strongly feels that the doctors have a major role to play in motivating and convincing other donors and recipients so that not a single drop of precious breast milk goes waste. "No formula milk can be as rich as mother's milk," she adds.

Family support is incredibly important for the mothers to become milk donors. Luckily, Varsi's mother-in-law was supportive of her sharing gesture. So was Chhedwal's husband.

The women who donate at the DMMB come from all classes and creeds. The same is true of the recipients. For the milk of human kindness, there is no caste, creed or colour.