I was recently sent this link on comparing donor milk and formula feeding, and the risks thereof. It discusses both disease transmission, likihood, as well items such as holder pasteurisation. Comparative analysis of formula feeding and donor milk
A lot of parents never even attempt to donate to a milk bank, whether it be because there is not one near them, they don't know about them, or they want to make milk available to babies who do not meet the criteria for recieving milk from the milk banks.
Also, many do it for no recompense, which means many do not have the incentive to stretch the milk by adding to it. Also, in a lot of cases, the donor is willing to provide medical history.
This article discusses why why should look more to donor milk. It is incorrect to state that formula and breastmilk are equal and lead to equal outcomes. Formula is an AMAZING invention, and a literal lifesaver, but to imply there is no difference between the two is not true.
I want to address each of your items as you bring up some really good points.
1. Milk banks – absolutely we need more donors. Too many moms are not aware of milk banks and the need for donations, or they do not have access to a milk bank to donate to. We only have 24 milk banks total in North America…that leaves huge swaths of potential donors without a legitimate place to donate to. However, even if we addressed the access issue, we would still have large numbers who cannot donate due to failure to pass safety checks, and inability to produce sufficient amounts for donation. Most moms have “well regulated” supplies – enough to feed their baby and keep a modest/decent freezer stash on hand. I suspect those moms who make tons of milk…plenty for their child, and their own stock, and a bunch extra to donate are not typical. But still…if we increase access to the banks, we would definitely see a boost in supplies for preterm and ill infants in hospitals (the babies who actually need it most).
2. Regarding alterations of milk and lack of compensation – while the sellers are definitely the most unscrupulous lot in the informal sharing of milk, it is important not to mistake good intentions for safety. As the recent study out of Florida just showed, even very conscientious donors were routinely skipping out/missing major steps to ensure the safety of their donations. This can be remedied to some extent by education, but it shows that best intentions and being a “good person” don’t equate to safety or proper handling of milk. Donors aren’t typically preparing milk in sterile labs with a PhD in microbiology. They are regular people pumping, storing, and handling milk in regular living spaces. Contamination happens. Changes in health status, like STD infection, happen. We can’t make public health recommendations for parents based on overly optimistic hopes about the lay donors’ knowledge, medical status, and commitment to food safety.
3. As far as the comparative analysis goes, I found the concept of the paper extremely interesting although it is pretty clear to me from reading it that the authors are purposefully downplaying the risks of unscreened breastmilk while upselling the risks of formula. The authors seem to be writing specifically to convince people formula is just as bad as opposed to writing a truly objective cost analysis. This isn’t unusual when you see who the author is – Gribble is a known breastfeeding ideologue. This wasn’t done by some epidemiologist interested in objectively tracing risk through a population…it was done by someone who already believes breastmilk is best no matter what and from someone who supports peer to peer milk sharing. A few things tipped me off to the bias in this article…for every risk section associated with breastmilk there is a corresponding “but formula is bad too!” section. For the section on HIV, the risk of contracting such a devastating illness is dismissed as “rare” or unrealistic ways to “get around the risk” are given – intensive screening procedures like that imposed by milk banks, pasteurization - as if this is somehow a reasonable/totally manageable thing for the population at large to do and for a government to sanction. The author conveniently mentions absolutely nothing about the countless babies infected with HIV in developing nations, often through breastmilk, and why we are so strict about body fluids handling and donation today. The paper makes BIG CLAIMS about the harms of infant formula but then sparsely cites them (often only giving 1 or 2 outdated citations). A true cost analysis would use far more frequent research and would include more information on potential confounders, likelihood of being able to implement safety precautions in the population, etc. This just reads as a bizarre defense for encouraging the swapping unscreened body fluids instead of a real comprehensive risk assessment.
Regarding their “risks” of formula - A lot of their sources are really old and very cherry picked…like from the 90s, which is a bit odd because the paper was published in 2012 (it should also be noted that this was published 4 years ago and the AAP still came out against peer to peer milk sharing this year...so clearly the concerns still exist or have gotten worse). Research on long term health outcomes has come a long way since the 90s, with a lot more focus on socioeconomic status as a huge confounder for health. Most of the “risks” in the risks of formula section of this paper are controversial and highly impacted by socioeconomic status. The authors mention absolutely NOTHING about the confounding relationship between SES and formula use. That is crazy. Everyone in public health knows that SES is a huge predictor for all sorts of outcomes and yet the author says absolutely not one thing about the confounded relationship. The SIDS stuff is true…there is a protective effect of breastfeeding, but again it could be SES related, and it is MODEST. The author makes it seem like there is this big protective effect, but the truth is that breastfeeding is one of the least likely protective factors for SIDS. It is beat out by sleep position (back), sleep environment (own crib, no bedding), pacifier usage, etc. The allergy stuff has been called into question too – the author’ sources are from the late 90s but more recent research has revealed that introducing solid foods and formula before 6 months (between 4-6mo) might actually be protective against allergies, and there have been a number of studies showing no impact of breastfeeding on asthma and related illness. And as far as the intelligence/cognitive piece? Holy moly. Only two sources. Did you see the first reference? It was a study of PRETERM infants from 1992. Preterm infants are well known for struggling developmentally regardless of their food source…and it’s from 1992…well before a lot of the newest developments in infant formula. A lot of the infant formula back in the 70-80s was definitely not up to snuff…infant formula looks totally different today. You can't compare the two and yet the author kind of glosses over the fact that infant formula today is not the same stuff as it was decades ago. This whole infant feeding stuff is muddy and yet the author cites outdated and limited sources to make it seem like it is so obvious that formula is just as risky as feeding unscreened milk to your baby. This analysis would have been better if the author was up front and honest about all of the confounding factors, controversial evidence, difficulty implementing these protective procedures around screened milk, and used recent research using more rigorous methods.
4. You seem to think this thread is implying there is no difference between breastmilk and formula. Nothing in this thread says that. Breastmilk and formula are very different, and are not equal on all measures. Previously in the thread we discussed the known benefits of breastfeeding around infection risk, preterm infants and necrotizing enterocolitis, and benefits to mother. Breastmilk has unique bioactive properties and there is a reason it is recommended as the preferred nutrition source. No one here is saying there aren’t downsides to formula – there are. Formula prep has extra food safety concerns when compared to nursing, and formula lacks the cool bioactive properties found in breastmilk (which may or may not matter long term…research is still being done). It can be dangerous or deadly in developing nations where lack of access to clean water exists, or where mothers often do not have a steady supply of formula. It is also not recommended as the first choice for preterm infants due to increased risk of NEC. But the truth is that most of the benefits of breastmilk and the “harms” of formula have been grossly exaggerated to the public. Breastfeeding does not prevent your baby from experiencing SIDS, obesity, cancer, or ensure that you are better bonded to your baby. It probably has nothing to do with your IQ or future success. People like Gribble are using limited, muddy, mixed or sometimes flat out questionable evidence to portray formula as scary and bad and risky, while exonerating breastfeeding as this near perfect good - so good, it doesn't even need to be formally screened before being fed to an infant! They never tell women about all the studies that show no benefit to breastfeeding or exclusivity (and there are many). Women are being told that their babies will be sick, fat, and stupid if they drink any formula at all even though the research on long term outcomes is muddy and mixed at best. Women are being told that using unscreened breastmilk is SAFE simply because it is breastmilk. Babies are being underfed because of fears about formula. This is crazy town. The AAP also believes in the nutritional profile of breastmilk, and recommend exclusivity as best, but they still do not recommend peer to peer sharing and they still think formula is the better option over unscreened donor milk. That says something.
This thread is both breastmilk and formula positive
because both are great ways to feed a baby – not equal on all measures, but both great options due to their unique strengths. Breastmilk has bioactive properties. Formula allows you to not starve your kid if you can’t breastfeed. Nursing is convenient if it works well. Formula allows a woman to have a baby that is just as healthy, smart, and happy as a breastfed baby without being strapped to an infant or pump 24/7. These complimentary choices are also not mutually exclusive and it is very possible to use both to get the benefits of both methods. The info in this thread supports using mother’s own milk, milk bank donated breastmilk, or infant formula as safe infant feeding options in developed nations, a position carried by the AAP and other major medical organizations.
I support exclusive breastfeeding, majority breastfeeding with supplementation, combination feeding, comfort nursing, pumping, etc. I support breastfeeding for 1 day or 2 years or whatever duration mom wants. The things I do not support in relation to breastfeeding are 1) underfeeding a baby to preserve exclusivity, 2) peer to peer milk sharing due to its potential safety risks, and 3) overexaggerating the benefits of breastmilk with questionable evidence in order to support breastfeeding promotion or guilt/scare mothers into breastfeeding or breastfeeding exclusively. I cannot support these things because they cause measurable harm to infants and mothers (physically and psychologically) and/or create a situation where harm is likely to occur.