AMA Debates Policy on Informal Milk Sharing Amid Formula Shortage

A draft policy calling for the American Medical Association (AMA) to “discourage” informal milk sharing faced an onslaught of opposition from nearly a dozen physicians, most of them parents, during the AMA’s House of Delegates meeting on Sunday.

So many delegates opposed the policy that one of them, Ajanta Patel, MD, who introduced herself as a breastfeeding mother, suggested flipping the policy entirely to “promote informal milk sharing. Since it sounds like that’s what the House actually wants to do.”

The debate began when the Medical Student Society introduced a draft policy calling for the AMA to “discourage the practice of informal milk sharing,” when the practice does not meet the same health and safety standards as milk banks — for example when it does not involve screening donors or pasteurization.

The proposed policy also called for the AMA to encourage breastfeeding mothers to donate to regulated human milk banks and urged more research into the “status of milk donation” in the U.S. and ways to increase donation rates.

Breast milk protects infants from a range of diseases and conditions, such as bacteremia, urinary tract infections, lower respiratory tract infections, necrotizing enterocolitis, and sudden infant death syndrome, noted the draft resolution.

“Donor human milk provides nutrients comparable to a mother’s own milk, yielding positive effects on neurodevelopment and tolerance of feedings,” the authors of the resolution wrote.

Raymond Tu, MD, a delegate from Washington, D.C., applauded the authors of the resolution for tackling a timely issue.

Given the current formula shortage, Tu said, Medicaid enrollees are extremely confused about how to feed their babies, asking, “Can I use cow’s milk? … Can I add Gatorade to my milk?”

But “informally shared milk, especially that’s sold or given by a stranger does have risks due to lack of medical screening of the donor and safe storage practices,” noted Zarah Iqbal, MD, MPH, who supported the resolution on behalf of the American Academy of Pediatrics (AAP). She also noted that while some breastfeeding moms donate their milk, others have begun selling their milk on Facebook and Craigslist.

Melissa Garretson, MD, another AAP delegate, also spoke in support of the resolution, and cited the Academy of Breastfeeding Medicine’s position statement on the issue. “Internet-based breast milk sharing is not recommended under any circumstances,” she noted.

Garretson also favored an amendment put forward by the Women Physicians Section calling on the AMA to encourage human milk sharing “along with the development of standards that promote both safe and equitable access.”

Speaking on behalf of her delegation, Carolynn Francavilla Brown, MD, an alternate delegate from Colorado and a “lactating parent,” argued that informal milk sharing has been painted in a bad light.

“There’s nothing nefarious going on here,” she said.

The milk that is being shared is “clean, well-stored,” and “without medication or supplements,” said Francavilla Brown. “It is milk that is good enough for their own baby. There is no reason it wouldn’t be good enough for someone else’s baby.”

She said “we need to examine why we have an ‘ick’ factor around this,” arguing that the real problem is a form of “cultural bias.”

In response to the criticism the proposal was receiving, Anna Laucis, MD, MPhil, of the Women Physicians Section, which supports the resolution, offered an amendment calling for the AMA to encourage human milk sharing and highlight the importance of developing standards that “promote both safe and equitable access.”

While much of the concern around informal milk sharing centered around strangers and internet-based sharing, Garretson also stressed the importance of medical screening and safe storage, no matter who the donor is.

A woman may think, “‘my best friend’s milk is fine for me,'” Garretson said, but “your best friend may not want to tell you that they’ve been taking antidepressants for a number of years, and they shouldn’t have to tell you that.”

Kavita Arora, MD, MBE, delegate for the Young Physicians Section (YPS), who opposed the resolution but supported the Women Physicians Section amendment, noted that “any amount of breast milk given safely … is still better than formula.”

She also argued that milk from many who are on antidepressants is safe.

“We can thread this needle,” she said. Arora called for creating a set of questions to ask potential donors during the informal milk-sharing process, such as “What is your HIV status?” and “What is your hepatitis C status?”

“These informal guides are much better than regulating and commercializing milk sharing,” Arora said.

Alicia Reyes, MD, speaking on behalf of the YPS added that “we as members of the YPS as well as our progeny … have benefited from informal milk sharing” and therefore her section opposed the resolution as written.

Finally, Siri Holton, MD, a delegate from the American College of Obstetricians and Gynecologists, and also a lactating parent, shared the story of a medical school colleague who lost her life to postpartum depression, leaving behind a newborn.

Because the deceased mother badly wanted her child to be breastfed, around 20 mothers stepped up and formed a “milk train” providing time-stamped bags of breast milk to be frozen and thawed for the woman’s infant son, as the Star Tribune noted in a story last December.

For Holton’s 3-month-old baby girl, “I am fortunate to be able to provide her with my own breast milk,” she told MedPage Today in a follow-up phone call. “And if something were to happen to me or if I was no longer able to provide breast milk for my infant, I would certainly seek out safe peer-sharing of breast milk from my trusted friends or colleagues.”