Motive clouds milk donation

and sold online, with fewer or no checks on quality or contamination. It’s becoming a lot more complicated than simply sharing.

In 2015 Sarah Keim, an epidemiologist at Ohio State University, published an analysis of 102 samples of breast milk she’d purchased online. Eleven contained significant amounts of cow’s milk. “That is a concern,” she says. “We were surprised to find the extent of that problem.” Once money becomes involved, she adds, it becomes more likely that people will adulterate breast milk to make a quick buck.

But more than that, does paying for donated milk change the nature of the relationship between the women involved?

In late 2014 Medolac, an Oregonbased company, partnered with the Clinton Global Initiative to reach out specifically to low-income Detroit mothers and pay them for their breast milk. Although these payments were to compensate donating mothers for their time and effort, the idea behind this particular scheme seemed to be that, if cash-strapped women could make money from their milk, then more of them might breastfeed their children, if only to keep producing milk.

A local African-American mother, Afrykayn Moon, who strongly supported breastfeeding, immediately cried foul. The idea that the ability to earn money from breast milk would encourage low-income mothers to breastfeed their children was “absurd” to her.

“If I’m breastfeeding but my electric bill needs to be paid or my rent needs to be paid or my water bill needs to be paid, and I know I can sell my milk to this company and then I can get my bills paid, well guess what I’m going to do,” she says. “I’m going sell my milk to keep my bills up, and not a drop of that milk is going to go to my child.”

With Detroit’s low rate of breastfeeding and one of the country’s highest rates of infant mortality (15 out of every 1 000 children in the city die before their first birthday), Moon says that the city needs every last drop of breast milk.

The move also brought back a sinister association to Moon. Enslaved black women were often used as wet nurses for white children, leaving them unable to provide milk for their own children. “This is the face of slavery coming back,” she says.

Georgetown University philosopher and bioethicist Rebecca Kukla says, although some tactics used by companies might be perceived as exploitative, there’s nothing inherently unethical about a woman selling her breast milk. “There’s a difference between what someone does out of economic necessity and what they do as a private choice to make their life work,” she says.

It’s the choice 33-year-old Detroit mother Andrea Short made. She breastfed her first child, Jaden, with no difficulties, but when her daughter Johanna was born, she wouldn’t latch on. So Short began to pump to feed Johanna breast milk with a bottle. Soon, however, Short had pumped way more than Johanna would ever need and was running out of freezer space to store the milk. That’s when she found out that Medolac was willing to buy her milk.

Over several months, Short sold more than 148 litres of milk that Johanna wasn’t using, providing her young family with needed income. Although both Short and her husband, Jonathan, work full-time — she in a hospital and he as a firefighter — the family relies on welfare benefits to make ends meet. With part of the money from Medolac, Short bought a swing for their front porch that gives her children a safe place to play.

“I was grateful for the money and the opportunity I had,” she says.

Short, who is biracial, says she represents Medolac’s target audience and resents the implications that mothers who sell their breast milk would do so at the expense of their children. “I will always put my children first,” she says. “Always.”

Blood and tissue donation work entirely on altruism; many people think breast milk should be no different. John Honaman says the Human Milk Banking Association of North America sees no place for profiting from breast milk, and thinks the system is at its best when mothers who have received donated milk decide to donate in turn.

“If we were faithful to the needs of a community, we would always want to be in a position whereby the need is associated with the supply because you have a perfect circle,” he says. “Moms need to give; kids need to receive.”

Morgan Bryan is a schoolteacher in Houston. She saw the benefits of an all-human milk diet for her twin boys, Austin and Jonah, who were born at 24 weeks. Her milk hadn’t come in and with the agonising stress of watching her tiny, vulnerable infants barely cling to life, she had trouble producing any milk at all.

So when the doctor asked the Bryans if they would be okay with their children receiving donor human milk, they didn’t hesitate.

“I didn’t ever think twice. They had multiple blood transfusions and it’s the same thing. And if that is what they needed, that is what we’re going to give them,” says Bryan. “I was so excited that [they] could take milk, I was in immediately.”

Several days later, Bryan was producing enough milk to be able to feed her sons with her own. The twins also received a fortifier made from donor human milk. As a result, Austin and Jonah sailed through the high-risk period for necrotising enterocolitis.

At eight weeks, Austin died of an unrelated infection, but Bryan was so grateful for the donor milk her sons had received that she donated her own excess milk to the Texas Children’s Mothers’ Milk Bank.

“There’s just a nice feeling,” she says, “because I know that my kid needed it at one point and I know that when you’re sitting in the neonatal ICU and you can see all the other babies, you know that those babies are getting it as well.”