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October 27, 2013
Breast Milk Donated or Sold Online Is Often Tainted, Study Says
cottage industry has sprung up facilitating the sale and donation of human breast milk on the Internet, but a study published Monday in the journal Pediatrics confirms the concerns of health professionals over this unregulated marketplace.
James Estrin/The New York Times
The report found that breast milk bought from two popular Web sites was often contaminated with high levels of bacteria, including, in a few instances, salmonella. The amounts detected in some samples were sufficient to sicken a child.
“The study makes you worry,” said Dr. Richard A. Polin, the director of neonatology and perinatology at Columbia University, who was not involved in the research. “This is a potential cause of disease. Even with a relative, it’s probably not a good idea to share.”
After a spate of research showing that breast milk protects infants from infections and other ailments, health care providers in recent years have strongly encouraged new mothers to abandon formula and to breast-feed. But this can be a difficult challenge. Parents who have adopted, for instance, or have had mastectomies — or who simply do not produce enough milk — often rely on donated or purchased breast milk.
“Milk-sharing” Web sites host classified advertisements from women wishing to buy, sell or donate breast milk. “My daughter is two months old and has gained five pounds and grown three inches since birth!” reads one ad. “I have a serious oversupply and I am looking to free up room in my freezer.”
Some sites discourage paying for breast milk, while others actively endorse the practice. Advertisements from some sellers play up the convenience and price, which can be as low as $1.50 an ounce. But many women wish to donate milk simply to help out fellow mothers in need.
Rachel Holtzman, 31, a writer who lives in Brooklyn, had breast reduction surgery that unexpectedly left her unable to lactate. After giving birth to Levi, now 4 ½ months old, she turned to a network of women in Park Slope who were willing to donate their breast milk. It has been a largely positive experience.
“We worried at first,” she said. “We wanted to be mindful that the donors were healthy, but there was never a moment when we were afraid. We’ve had the milk of about 30 women and have never had a problem.”
Women who do not wish to rely on an informal network may turn to breast milk banks, which store and sell breast milk from donors. Thirteen banks in the United States and Canada follow voluntary guidelines set up by the Human Milk Banking Association of North America, which require that donors and donations be screened, and that milk be pasteurized.
But milk banks give priority to premature infants with significant medical complications, and the milk is available only by prescription. A bank will supply milk by prescription to healthy infants, but only if sufficient supplies are available — and they rarely are. The association’s banks distributed 2.15 million ounces in 2011, but the current annual need is 9 million ounces.
Even when it is available, milk from banks is expensive, as much as $6 an ounce, and the average intake of a 1-month-old is about 25 ounces a day.
All of this encourages new parents, often scrambling to find breast milk on short notice, to shop for cheaper or more convenient sources, and Web sites including onlythebreast.com and eatsonfeets.org have sprung up to fill the demand. In 2011, there were more than 13,000 postings on the four leading milk-sharing Web sites, according to Sarah Keim, an assistant professor of pediatrics at Ohio State and a researcher at Nationwide Children’s Hospital in Columbus, Ohio.
In using any of these services, the buyer relies on the representations of the seller. The new study suggests that may prove hazardous.
Dr. Keim and her colleagues collected 101 samples from milk-sharing Web sites, recording the sellers’ assertions about their own health and their methods of handling and storage. Then the researchers analyzed the bacterial content in the samples, comparing them with unpasteurized breast milk from screened donors at banks.
The researchers found that 64 percent of the samples from milk-sharing sites were contaminated with staph, 36 percent with strep, and almost three-quarters with other bacterial species. Three of the samples contained salmonella. Seventy-four percent of the samples would have failed milk bank criteria.
The unpasteurized milk bank samples were not entirely free of contamination either, but they were considerably cleaner than those from the online milk-sharers — 25 percent were contaminated with staph, 20 percent with strep, and 35 percent with other types of bacteria. Twenty-five percent of the milk bank samples contained no detectable bacteria at all, compared with 9 percent of the samples from milk-sharing sites.
“Most staph and strep are harmless at normal levels,” Dr. Keim said. “But some of the levels we found were very high.” Nine percent of the milk-sharing samples contained dangerous levels of staph, and a handful had unusually high strep levels. Salmonella “doesn’t belong in milk at all,” she said.
Dr. Keim gave high marks to the milk banks. “When you donate to one of the H.M.B.A.N.A. banks, you know it’s been processed and made safe for a baby who really needs it.”
All milk shipped from milk banks is pasteurized, which kills skin and gastrointestinal bacteria, as well as many viruses, including those that cause colds. But pasteurization also destroys some of the beneficial substances in breast milk.
Kim Updegrove, president of the milk bank association, believes that however well intended, informal sharing of breast milk can be hazardous.
“If you get milk from an unscreened sharer, you put your child at risk,” she said. “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.”
The Food and Drug Administration does not regulate the buying or selling of breast milk, but the agency discourages both online and person-to-person sharing. Only three states — California, Maryland and New York — regulate milk banks. New York, for instance, specifies rules for collection and storage of breast milk, and requires that donors be screened and periodically re-evaluated in a process overseen by a physician.
Dr. Keim said there is no way for a consumer to be certain what she is getting from an online source.
“We looked at everything a buyer could know herself — temperature, the condition of the containers, how long it took to ship, what sellers were saying in their ads — and only the time in transit had any effect on contamination.
“Buyers have no way of knowing even what they’re getting — it could be cow’s milk or formula.”