International Perspectives

Human Milk Banking: An Indian Experience

Sushma Nangia, MD, DM (Neonatology),* Ruchika Chugh Sachdeva, MS (Nutrition),† Vandana Sabharwal, MS, PhD
(Nutrition)‡
*Department of Neonatology, Lady Hardinge Medical College & Kalawati Saran Children’s Hospital, New Delhi, India
†
Maternal, Newborn, Child Health and Nutrition, PATH India, New Delhi, India
‡
Institute of Home Economics, Delhi University, New Delhi, India

Education Gaps
1. There is a scarcity of systematic data on human milk banking practices in
India.
2. The role of policy and technical leaders in promoting human milk banking
as part of an integrated approach in optimizing neonatal health needs to
be understood.

Abstract
As part of integrated newborn care, human milk banks can reduce death and
illness as well as lower health-care costs for infants born prematurely,
especially with birthweights less than 1,500 g, and for infants born in
resource-limited settings without access to their mother’s milk. Promotion of
human milk banks is of special significance in India which has the highest
burden of such infants. About 50 milk banks are insufficient to meet the
needs of vulnerable infants. The government of India has acknowledged the
role that human milk banking can play in reducing neonatal mortality and
morbidity, and launched the “National Guidelines on Lactation Management
Centers in Public Health Facilities” in 2017 with a vision to make breast milk
universally available for all infants. The government is now working on an
implementation strategy to scale up the lactation management center model
AUTHOR DISCLOSURE Drs Nangia and
(promotion of breastfeeding, kangaroo mother care, and donor human milk)
Sabharwal and Ms Sachdeva have disclosed
no financial relationships relevant to this for all newborn care units and delivery centers in the country. However, for
article. This commentary does not contain a effective expansion, it will be important to ensure improved government
discussion of an unapproved/investigative
use of a commercial product/device. ownership, mandate availability of standard operating procedures at all
facilities, stringent systems of quality control, standardized accreditation, and
ABBREVIATIONS
a robust monitoring system. Local evidence on the effectiveness of the
CLMC Comprehensive Lactation
Management Center
comprehensive lactation management center (CLMC) model and knowledge,
LMU lactation management unit practices, and perceptions of human milk banking are limited. There is a need
LSU lactation support unit for rigorous implementation, process research, and technology innovation,
MAA mother’s absolute affection
along with a robust regulatory framework to prevent commercialization. In
MOM mother’s own milk
MBFIþ Mother Baby Friendly Initiative Plus addition, attitude changes of mothers, maternal influencers, and health-care
NMR neonatal mortality rate providers are all essential to successfully expand the CLMC model.

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 Objectives After completing this article, readers should be able to:

1. Describe how prioritizing an integrated approach in human milk banking

can save lives in India.
2. Recognize the salient features of the national guidelines on human milk
banking along with the human milk banking environment in India.
3. Outline key initiatives to be addressed for effective scaling up of human
milk banking in India.

THE POWER OF HUMAN MILK
Breastfeeding is the most natural, inexpensive, environment-
friendly, and easily accessible method to provide all children,
rich or poor, with the healthiest start to life and ensures that all
children survive and thrive. Breast milk offers the ideal source
of nutrition for the first 6 months after birth, and may remain
a part of an infant’s diet for the first 2 years of age and beyond.
(1) There is evidence that demonstrates the value of breast-
feeding for both a mother and her child. Sushruta, an ancient
Indian surgeon, has beautifully described mother’s milk in
his Samhita, “One just cannot compare even water of seven
seas with mother’s milk, which is nothing but water ensur-
ing optimum growth, nutrition, and healthy life of hundred
years.” (2)
However, many infants lack access to their mother’s own
milk (MOM) because of issues related to the mother’s illness
or death, abandonment, infant’s illness, inability to latch, or
delay in milk production. This lack of access to breast milk
leaves infants more vulnerable to disease, poor health, or
death, especially when they are born preterm, have low
birthweight, or are severely malnourished. (3)(4)(5) In such
a scenario, the World Health Organization, (6) American
Academy of Pediatrics, (7) the Committee on Nutrition
of the European Society for Pediatric Gastroenterology,
Hepatology, and Nutrition, (8) and other policy groups
recommend donor human milk, made available through
human milk banks, as the next best feeding option when
MOM is unavailable. A human milk bank screens and
recruits breast milk donors; collects, processes, and screens
donated milk; and distributes the milk to infants in need.
As part of integrated newborn care, human milk banks
reduce death and illness as well as lower health-care costs.
Data exist, which support the health benefits of donor
human milk, especially for infants born prematurely, with
birthweight less than 1,500 g, (9) and for infants born in
resource-limited settings where a non-breastfed child’s risk
of death is 6 times that of a breastfed child. (10) A myriad
studies demonstrate the positive effect of donor human
milk on vulnerable infants as compared with formula, such
as reduced risk of sepsis and necrotizing enterocolitis, greater
feeding tolerance, reduced length of stay in NICUs, and sub-
stantial cost savings for resource-strapped public health sys-
tems (Table 1). (8)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)
(23)(24)(25)(26)
A recent study found that if all premature infants born in
the United Kingdom in 2013 were provided with mother’s
milk in the NICU, the total lifetime cost savings to the
National Health System would be an estimated $46.7 million
(£30.1 million in the first year) as a result of improved health
outcomes. The total lifetime quality-adjusted life-year gain
was calculated to be 10,594 years. There would be 238 fewer
deaths caused by neonatal infections and sudden infant death
syndrome, leading to a savings of approximately £153.4
million in lifetime productivity. (27)
Providing donor human milk to vulnerable neonates
without access to MOM not only saves lives but also enhances
awareness about breastfeeding and improves breastfeeding
rates. This increase in breastfeeding rates is important
because it has the potential to prevent 820,000 “under-5”
deaths (ie, death before age 5 years), of which 87% are
infants younger than 6 months of age. (28) Improving
breastfeeding rates worldwide is a fundamental driver to
achieve Sustainable Development Goals by 2030.
HUMAN MILK BANKING: A CENTURY-OLD PRACTICE
Saving infants with the use of donor human milk through
human milk banks is a century-old practice. Countries in
North America and Europe established human milk banks
in the early 20th century. The United Kingdom established
its first human milk bank in the 1930s, and Brazil in the
1940s. Today, more than 600 milk banks have been estab-
lished in more than 50 countries. Human milk banks have
been extremely successful in Brazil, its network being the
largest in the world with 213 milk banks and 199 collection

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TABLE 1. Studies Demonstrating the Impact of Donor Human Milk on
Vulnerable Infants
Sepsis • Donor human milk reduced the risk of late-onset sepsis in vulnerable, low-birthweight infants by
19% in the first 28 days. (11)
• Donor human milk has a greater protective effect compared with formula. (12)

Necrotizing enterocolitis
Retinopathy of prematurity
Feeding tolerance
Reduced length of stay in NICU
• Human milk feeding, whether mother’s own milk or donor human milk reduces necrotizing
enterocolitis by as much as 79% when formula is avoided. (13)
• Four systematic reviews across study designs and countries found that donor human milk protects
preterm infants against necrotizing enterocolitis more than formula. (8)(14)(15)(16)
• Human milk feeding in the NICU is associated with lower rates of severe retinopathy of prematurity.
(17,18)
• Preterm infants fed unfortified donor human milk had greater feeding tolerance, fewer vomits, less
gastric stasis, and reduced diarrhea compared with formula-fed infants. (16)
• Cost of providing donor human milk to preterm infants is mitigated by a reduced risk of
complications and shorter length of stay in NICU. (11)(19)
• Fewer hospital readmissions for illness in the year after NICU discharge have been noted. (20)

Cost saving • The percentage of infants who are exclusively breastfed at discharge is about 13% higher in NICUs
with a human milk bank. (21)
• A study reported saving wUS $8,167 per infant using donor human milk through shortened length of
stay and reduced cases of necrotizing enterocolitis and sepsis. (19)
• Estimated savings to NICU or health care plan for every dollar spent on donor human milk: wUS $11. (22)
• In Brazil, the national human milk banking network saves $540 million in health care costs annually. (23)

Neurodevelopmental outcomes and • Later in childhood and adulthood, preterm infants fed human milk have been shown to have lower
long-term benefits rates of metabolic syndrome, (24)(25) increased white matter and brain volume, and significantly
greater scores for mental, motor, and behavior ratings. (19)(26)

centers. The Brazilian Network of Human Milk Banking has
successfully demonstrated the effectiveness of a government-
supported, nationalized, integrated human milk bank pro-
gram that includes breastfeeding promotion, lactation
support, and provision of donor milk, all of which have
contributed to achieving a single-digit neonatal and infant
mortality rate. Brazil’s integrated human milk banking pro-
gram saves the country an estimated $540 million annually
through improved neonatal health outcomes. (29)
PRIORITIZING AN INTEGRATED APPROACH FOR
HUMAN MILK BANKING IN INDIA
India faces its own unique challenges. The country is the
highest contributor to the global birth cohort, neonatal
mortality rate, and birth of vulnerable infants, that is, infants
born prematurely and with low birthweight. Of the 27
million infants born in India annually, 30% are born with
low birthweight (ie, weighing <2,500 g), and 40% of all low-
birthweight infants (estimated at 3.5 million infants), are
born preterm (Fig 1). (30) Of the 0.76 million infants who
die in the neonatal period, prematurity is the major cause,
accounting for 35% of all deaths, followed by infection,
accounting for another 33%. (30)
India has made considerable progress over the last 2 decades
in the area of maternal and child health through innovative and
comprehensive health packages that cover the spectrum of
life cycle stages. However, newborns have missed out on the
attention. Even though the under-5 mortality rate decreased by
42%, from 74 (in 2005–06) to 43 (in 2015) per 1,000 live births,
in the same period, neonatal mortality rate (NMR) decreased
from 37 to 25 per 1,000 live births, accounting for a decrease of
only 32%. (31)(32) This decline in NMR is laudable but it has to
increase to effectively achieve sustainable development goals,
which aim to eliminate preventable deaths of children less than
5 years of age, with all countries aiming to decrease the NMR to
as low as 12 per 1,000 live births. (33)
About 75% of premature infants can be saved with
feasible and cost-effective interventions. These include kan-
garoo mother care; adequate neonatal resuscitation; pre-
vention, detection, and treatment of neonatal infections; and
breastfeeding. (34) Of these, breastfeeding has been iden-
tified as the single most powerful intervention, with the
potential to prevent 0.16 million under-5 deaths in India.
(28) Yet, breastfeeding rates remain low, with only 41.6% of
infants being initiated into breastfeeding within 1 hour of
birth and 54.9% of infants exclusively breastfed until 6
months of age. (35)

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 Breastfeeding has a pertinent and important role to play
in improving the status of neonatal health in India. This
emphasizes the need to universalize access to human milk
as an integral component in the country’s health-care sys-
tem, especially in all newborn units that provide care to sick
infants. Providing human milk through human milk
banks can work only if it is a part of the larger objective
of promoting breastfeeding. There is a need to link human
milk banking systems with breastfeeding and kangaroo
mother care by establishing high-quality systems, sharing
global best practices, and facilitating capacity building. An
integrated intervention will not only assist in feeding human
milk to preterm and low-birthweight infants, but will also
increase breastfeeding rates in the country. Previous experi-
ence shows that human milk banks thrive in countries where
they are protected, promoted, and endorsed as a critical com-
ponent of breastfeeding and newborn care policies. (29)
Based on its existing toolkit on the establishment of
human milk banks, “Strengthening Human Milk Banking:
A Global Implementation Framework,”(36) PATH has
proposed the “Mother Baby Friendly Initiative Plus”
(MBFIþ) model in which human milk banks collect, pro-
cess, and store donor human milk while serving as centers
that provide lactation and kangaroo mother care support.
(29) Because successful breastfeeding often requires
support from the family and community, the model also
positions human milk banks to work with and engage
local communities. These banks promote the significance
of breastfeeding and milk donation, build awareness about
the value of human milk, and collaborate with employers
and other leaders to create an enabling and supportive
environment for breastfeeding and milk donation. (36)
The MBFIþ model is deliberately intended to be altered by
each country to fit its unique needs. Similarly, the model has
been adapted to suit India’s public health structure (Fig 2).
HUMAN MILK BANKING LANDSCAPE IN INDIA
In India, voluntary donation of human milk in the form of
wet nursing has been an integral part of its tradition.
Mythological anecdotes tell tales of Yashoda, who was a wet
nurse (human milk donor) to Lord Krishna. In the 18th
century, wet nursing was widely practiced for offspring of
mothers born into nobility who refused to breastfeed their
infants to preserve their beauty and figure. Later, the practice
declined because of a fear of transfer of infections and
diseases such as syphilis. Much later, the concept of human
milk banks was introduced.
In Asia, the first human milk bank was established
in 1989 by Dr Armida Fernandez in Lokmanya Tilak
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Municipal Medical College and General Hospital, Mumbai,
India. The milk bank was started after realizing the acute
need to save sick infants in hospitals. It soon became
sustainable as mothers who had delivered at the hospital
and donated milk to the milk bank returned for follow-up
care. (37) Despite the successful establishment of this bank,
other hospitals were not encouraged to take up this venture
and this remained the only human milk bank in the country
until the year 2005. From 2005 to 2015, only 22 human milk
banks were established, but in the past 2 years, this number
has more than doubled. There are currently about 50 milk
banks in India, which are still inadequate to meet the massive
demand for donor human milk (Fig 3). To put this in per-
spective, the United Kingdom has 770,000 births each year
and 16 operational milk banks, whereas India has 27 million
births each year and only 50 operational milk banks.
Historically, implementation of effective regulated, coun-
try-specific, human milk banks have been slow to develop in
India. Initially, human milk banks were concentrated in the
western belt of the country because the first human milk
bank was established in this region, and the majority of milk
banks were modeled on this first one. The development of
milk banks has met with several challenges including
inadequate collaboration between obstetricians and pedia-
tricians, lack of lactation counselors, and limited awareness.
(37) There are also gaps in providing able leadership for
sharing best practices and robust procedures. However, the
changing landscape has facilitated an expansion in human
milk banks in some parts of the country.
INDIA-SPECIFIC STUDIES ON HUMAN MILK BANKING
A recent study conducted to understand current practices,
processes, infrastructure, personnel structure, and funding
mechanisms in human milk banks with minimum 1 year
of functioning (n¼16) revealed that standardization of
processes as well as data capturing and reporting were
urgently needed. (38) Only 25% of the study sites pooled
milk under laminar airflow. Sixty-two percent of the facilities
used steel containers for milk pasteurization and storage,
which is unique to India. Because steel is widely used in
homes and laboratories and has good conductivity, it results
in faster heating and cooling cycles. This helps preserve
milk nutrients better, especially its sensitive immunologic
components, because the duration of exposure to extremes
of temperature is curtailed. Steel can be easily cleaned and
sterilized by exposure to dry heat in a normal oven, there-
fore, it has been an obvious choice of milk banks in India.
Only 50% of milk banks had dedicated full-time technicians.
In the remaining milk banks, lactation counselors and other
Figure 1. Overview of newborn health in India compared to global statistics.
staff managed the processes. Only 31% of milk banks had
3 or more dedicated lactation counseling staff; thus, the
shortage of staff has been a stumbling block. Most of the
milk banks pooled donor milk from multiple mothers. All
the facilities used the Holder method of pasteurization.
Processed donor human milk was used within a week or
fortnight because of high demand in most of the sites. Milk
collection was between 3 and 6 L every day in most of the
facilities. The majority of milk banks reported a significant
demand-supply gap. Hence, as a step to help mitigate the
demand, select sites have recently developed satellite milk
collection centers. The need to discard samples because of
the presence of microbes after pasteurization was less than
5% at most study sites. (38)
Milk is predominantly collected at the facility level with
one-third of the sites collecting milk from camps and homes
as well. Donor milk collection in India is mainly from
mothers of preterm infants, hospitalized mothers after
delivery, and mothers who visit pediatric clinics for pediatric
immunizations. These mothers are mostly cross-sectional
donors. Longitudinal donation is not yet practiced in India.
Even home-based collection of milk is not common and very
few hospitals promote it. (38) Education for safe collection is
imperative for home-based collection because of the poten-
tial risks of voltage fluctuations and electricity failures.
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Only in-facility dispensation of donor human milk is
promoted and once the infant goes home, there is no source
of continuing human milk feeding if the mother cannot feed
her child. (38)
Nearly 85% of milk banks in India have been established by
nongovernment organizations, and only a handful had been
supported by the government. (38) However, within the last
2 years nearly 50% of milk banks have been supported by the
state governments. Rajasthan, one of the states with a high
neonatal mortality rate, has supported the setting up of 10 milk
banks during the last year. Similarly, the state government of
Tamil Nadu has supported setting up 7 milk banks. The recur-
ring cost of most milk banks is managed through hospital funds.
Various socioeconomic factors influence maternal moti-
vation and willingness to donate breast milk. Katke and
Saraogi reported that women at either end of the reproduc-
tive age spectrum and women with higher parity require
more motivation to donate breast milk. Furthermore,
milk donation can be promoted in India by teaching women
about the benefits of donor milk. (39) A recent study sur-
veyed mothers and influencers (fathers and grandmothers)
about barriers to breastfeeding, kangaroo mother care, and
providing donor human milk to preterm and sick neonates in
India. (40) This study found limited awareness about human
milk banks among mothers and influencers. Parents were
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 Figure 2. Mother Baby Friendly Initiative Plus model adapted for India’s health structure. (Adapted from reference 36.)
supportive about donating milk once they learned that it was
life-saving and did not compromise the supply to their own
infant. However, some parents had safety concerns about the
use of donor human milk and were not aware of milk banking
processes. Most grandmothers were not comfortable with
having their daughters/daughters-in-law donate milk or hav-
ing their grandchild receive donor milk because they felt it
may hinder supply for their grandchild. Most mothers shared
that physicians counseled them about their dietary intake
during antenatal care, but did not provide them with infor-
mation about breastfeeding. Few mothers shared the chal-
lenges they faced with feeding their preterm and sick infants.
Mothers who practiced kangaroo mother care were aware of
its benefits. Respondents shared that wet nursing is an old
practice. They found wet nursing to be helpful, as the infant
receives human milk and they are assured that it is not
harmful for the infant if practiced within the family. (40)
ROLE OF THE GOVERNMENT IN SCALING UP HUMAN
MILK BANKING IN INDIA
The government of India has acknowledged the role that
human milk banking can play in reducing neonatal mor-
tality and morbidity and held the first national consultative
meeting for formulating national guidelines on human
milk banking in 2013. Subsequently, the Indian Academy
of Pediatrics formulated a set of guidelines in 2013. (41)
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The government of India highlighted the need for formu-
lating operational guidelines with robust protocols and empha-
sis on implementation strategy, quality control mechanisms,
monitoring, and accreditation. The Ministry of Health and
Family Welfare took this initiative in 2014 and formed a group
composed of human milk bank experts, neonatologists, regu-
latory officials, and quality and public health specialists to
support this effort. Subsequently, the government launched
the “National Guidelines on Lactation Management Centers in
Public Health Facilities” in July 2017. (42) These guidelines
are part of a program focusing on breastfeeding launched by
the government of India called Mother’s Absolute Affection
(MAA). MAA in Hindi, the national Indian language, means
mother. The vision of the government is to make breast
milk universally available for all infants by establishing
comprehensive lactation management centers (CLMC),
lactation management units (LMUs) and lactation support
units (LSUs) at the facility level. The CLMC model is based
on the MBFIþ model (Fig 4).
The model builds on India’s public health system which is
a 3-tier system with primary, secondary, and tertiary levels of
care. The district hospital is an essential component of the
district health system and provides secondary level of care.
Every district has a hospital that is linked to health facilities
under the district such as subdistrict hospitals, community
health centers, primary health centers, and health subcenters.
Primary health centers are the cornerstone of rural health
Figure 3. States with operational human milk banks in India.

services, providing basic essential newborn care. They cater to will be set up at tertiary care facilities/medical colleges
a population of around 30,000 with the help of a medical with a functional NICU and high delivery load. This would
officer, pharmacist, and support staff. Community health function as a lactation support center to support breastfeed-
centers, catering to a population of 120,000 people, are the ing, as well as to safely collect, process, and provide safe
first level where specialists are available. They aim to provide donor human milk. Subsequently, CLMCs will be set up at
secondary level care with stabilization services for newborns.
First referral units are being developed by upgrading selected
community health centers and subdistrict hospitals where
24-hour emergency obstetric and child health services will
be provided. (43) Currently, there are 715 functional special
care newborn units, mostly at district hospitals, to reduce
case fatality among sick newborns and to function as
training centers for teaching newborn care skills. A large
number of secondary and tertiary care units responsible
for newborn care are usually within larger hospitals, many
even higher than the district level such as at the medical
college level.

SALIENT FEATURES OF THE NATIONAL GUIDELINES

LMCs are seen as an effort to promote the natural act of

breastfeeding and ensure availability of safe donor human Figure 4. Facility based lactation management at the three levels.
milk for sick infants when MOM is not available. A CLMC (Reprinted from reference 42.)

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 district hospitals that fulfill the prerequisites for establish-
ing one. These units will support breastfeeding mothers,
encourage kangaroo mother care, and support the forma-
tion of LMUs at first referral units/subdistrict hospitals.
These LMUs will facilitate the expression and collection of
MOM for her infant’s use. To maintain the continuum of
care, LSUs will be established at all delivery points by
forming a dedicated team of staff trained to provide round-
the-clock breastfeeding support, lactation counseling, and
kangaroo mother care support to mothers. (42)
The guidelines mandate informed consent by both the donor
and the recipient. Donor milk will only be dispensed with a
physician’s prescription and is recommended to meet the short-
and long-term needs of newborns admitted in NICUs/sick
newborn care units with the following conditions: 1) pre-
maturity, 2) low birthweight, 3) malabsorption, and 4) feed-
ing intolerance.
Donating human milk will be a completely voluntary and
nonincentivized activity, and this milk cannot be used for
any commercial purposes. The government is working on
developing a regulatory mechanism to prevent human milk
commercialization.
Human milk donation and dispensation will be done
only at specialized units within the CLMC with the highest
regard for safety and meticulous approach to ensuring
quality. The guidelines consist of evidence-based and
standardized technical protocols for donor screening
and collection, processing, storage, and dispensation of
human milk. Ensuring the quality and safety of donor
human milk is an important component of these guide-
lines. In addition, recommendations have been made to
minimize the risk of donor human milk to recipients. The
standards of quality have been stated in detail with a strong
focus on hygiene and handling of milk. The guidelines
enforce mandatory training of staff on a Hazard Analysis
Critical Control Points system, which is a management
system designed to address food safety from production to
consumption.
A National Human Milk Bank has been established
which will function as the national resource center to pro-
vide training, undertake quality audits, and ensure technical
support to establish new CLMCs and LMUs. Regional and
zonal reference centers will be established in each geo-
graphical zone at well-performing CLMCs, to assist the

TABLE 2. Suggested Initiatives for Technical and Policy Leaders to Improve

Access to Human Milk
Improve government ownership to meet recurring costs, address personnel shortages, and enhance community mobilization.
Mandate availability of standard operating procedures at facilities for uniform process implementation and to ensure safety.
Establish one national and few zonal reference centers to develop stringent systems for monitoring and evaluation, accreditation and quality control.
Develop a strong regulatory framework and effectively implement the same to prevent commercialization.
Generate local evidence on the CLMC model by undertaking research to determine knowledge, practices, and perceptions related to the establishment
of CLMCs in similar community settings and to explore the multidimensional aspects in opportunities and challenges for scaling up human milk
banking in India.
Develop robust behavior change communication strategies related to breastfeeding, kangaroo mother care, and donor human milk targeted
at mothers and influencers, starting from the antenatal period.
Provide skill-based training to medical practitioners and health care providers on the CLMC model.
Ensure counseling of pregnant women and lactating mothers by health-care providers and peer educators to promote early initiation of breastfeeding
in the labor room.
Use mother support groups to create a suitable environment for continued and sustained breastfeeding.
Slowly eliminate wet nursing, an ancient and deep-rooted practice, by generating intensive awareness about its adverse effects.
Establish satellite centers attached to milk banks to recruit more donors to benefit more infants.
Extend the guidelines to the private sector to ensure that infants born in the private sector (about 60% rural and 70% urban areas) are also covered. (44)
Gather technical and policy leaders to discuss steps to ensure access to donor human milk for all infants in need whether in the hospital or at home.
Develop technologies that improve quality systems and are easy to use and cost-effective to help human milk banks run safely and effectively not only in
India but other low-resource settings around the globe.

CLMC¼Comprehensive lactation management center.

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national resource center by serving as a technical resource
for nearby CLMCs, LMUs and LSUs. (42)
THE WAY FORWARD
Some noteworthy initiatives in the recent past have
been the use of the “green corridor” (organ donation van)
in Rajasthan to transfer milk to needy NICUs from the
collection centers in record time, as well as the establish-
ment of a mobile van equipped with a breast pump and a
refrigerator for collecting donor milk from mothers in the
community in the state of Maharashtra. The Human Milk
Banking Network of India has been established to share
best practices and create awareness among health-care
providers. Media engagement has also increased over
the past year and the issue is well covered across multiple
platforms.
As a next step, as policy and technical leaders work toward
implementing these guidelines to ensure that all infants have
access to human milk (both MOM and safe donor human milk),
it will be imperative that the following initiatives are taken
(Table 2).
Effective scale up of human milk banking systems in
India has significant potential. Estimates suggest that
30% to 50% of neonates admitted to the NICU and 10% to
20% of full-term infants are in need of donor human
milk to meet the short- or long-term lack of mother’s
milk. Increasing access to human milk has the potential
to help approximately 5 million infants. When combined
with enhanced breastfeeding methods, the impact could
be 10-fold. (38)
As human milk banking systems expand and strengthen,
this will not only have an impact on the immediate
health of neonates but will also have long-term positive
effects. India bears the highest global burden of neo-
natal births and deaths, therefore improvement in neo-
natal health indicators will help India and the world
achieve their goal of reduced neonatal mortality and
morbidity.
ACKNOWLEDGMENTS
Our special gratitude and acknowledgment is extended to
the policy and technical experts in India who provided
insights and guidance, which formed the basis of this
work. We also acknowledge the human milk banks in
India that are dedicated toward increasing access of
human milk to all infants by promoting breastfeeding
and providing safe donor human milk, and saving infant’s
lives.
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American Board of Pediatrics
Neonatal-Perinatal Content
Specification
• Know the advantages and disadvantages of the use of donor
human milk.
References
1. Kramer MS, Kakuma R. The optimal duration of exclusive
breastfeeding. A systematic review. Geneva, Switzerland: World Health
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 Human Milk Banking: An Indian Experience
Sushma Nangia, Ruchika Chugh Sachdeva and Vandana Sabharwal
NeoReviews 2018;19;e201
DOI: 10.1542/neo.19-4-e201

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 Human Milk Banking: An Indian Experience
Sushma Nangia, Ruchika Chugh Sachdeva and Vandana Sabharwal
NeoReviews 2018;19;e201
DOI: 10.1542/neo.19-4-e201

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