Beyond bloodline: How donated milk is saving India’s most vulnerable newborns

Docto s
st o gly
challe ge
the
widesp ead
belief
that
most
mothe s
simply
do
ot
p oduce
e ough
milk.

The
fi st
thi g
a
mothe
wa ts
to
do
afte
b i gi g
a
baby
i to
the
wo ld
is
ofte
the
simplest:
hold
the
child
close
a d
feed
it.
But
fo
some
ewbo s,
that
fi st
feed
eve
comes.Thei
mothe s
may
be
c itically
ill,
sepa ated
f om
them,
u able
to
b eastfeed
immediately
o ,
i
the
most
hea tb eaki g
cases,
o
lo ge
alive.Fo
a
p ematu e
baby
weighi g
just
a
few
hu d ed
g ams,
howeve ,
waiti g
fo
ci cumsta ces
to
cha ge
is
ot
always
a
optio .This
is
whe e
a othe
mothe
ca
step
i .Huma
milk
ba ks
i
I dia
a e
built
a ou d
a
quiet
act
of
ge e osity:
a
lactati g
mothe
do ates
milk
he
ow
baby
does
ot
eed,
a d
th ough
a
ca efully
egulated
medical
system,
that
milk
eaches
a
ewbo
whose
ow
mothe
ca ot
p ovide
it.”Milk
ba k
helps
o e
mothe
save
the
baby
of
a othe
mothe ,”
said
D
Poo am
Sida a,
di ecto
of
eo atology
a d
paediat ics
at
CK
Bi la
Hospital,
Delhi.The
idea
may
sou d
st aightfo wa d.
But
behi d
eve y
bottle
is
a
mothe
who
has
ag eed
to
sha e
somethi g
deeply
pe so al
a d
a othe
family
placi g
its
t ust
i
a
system
to
p ovide
thei
f agile
ewbo
with
the
safest
possible
ou ishme t.

Whe
a
mothe
is
ot
the e

D
Satish
Tiwa i,
fou de
a d
co ve e
of
the
Huma
Milk
Ba ki g
Associatio
of
I dia
a d
p ofesso
of
paediat ics,
has
spe t
decades
t yi g
to
expa d
that
system.He
t aces
the
moveme t
i
I dia
to
1989,
whe
the
fi st
huma
milk
ba k
i
I dia
a d
Asia
was
established
at
Sio
Hospital
i
Mumbai
by
D
A mida
Fe a des.

By
the
mid-1990s,
Tiwa i
had
begu
explo i g
milk
ba ki g
while
wo ki g
o
mate al
a d
child
ut itio
a d
mal ut itio .”What
we
ealised
was
that
milk
ba ks
a e
eeded
ot
o ly
i
Mumbai
o
Su at
o
Udaipu ,
but
it
is
a
equi eme t
all
ove
I dia,”
he
said.The
babies
who
eed
do o
huma
milk,
he
explai ed,
a e
ofte
those
who
have
bee
sepa ated
f om
thei
mothe s
fo
easo s
beyo d
a yo e’s
co t ol.A
ewbo
may
be
admitted
to
a
NICU
at
500g
o
700g,
bo
at
seve
o
eight
mo ths
of
gestatio
a d
too
weak
to
b eastfeed.
The
mothe
may
have
to
etu
home
while
the
baby
emai s
i
hospital.”Mothe
may
ot
be
available
fo
mo ths
whe
he
is
admitted
i
a
eo atal
ca e
u it,”
Tiwa i
said.The
the e
a e
babies
whose
mothe s
have
died.”The e
may
be
the
death
of
the
mothe .
So
the
mothe
he self
is
ot
available
fo
the
baby,”
he
said.The e
a e
also
aba do ed
ewbo s
a d
babies
whose
mothe s
a e
tempo a ily
u able
to
b eastfeed.I
such
situatio s,
the
co ve tio al
fallback
has
ofte
bee
fo mula
o
othe
substitutes.
But
fo
a
vul e able
p ematu e
baby,
docto s
say
huma
milk
ca
make
a
impo ta t
diffe e ce.”If
you
feed
o
mothe ‘s
milk,
which
is
th ough
the
milk
ba k,
the
the
child’s
imp oveme t
o
the
child’s
outcome
as
fa
as
his
life
is
co ce ed
becomes
much,
much
bette ,”
Tiwa i
said.

The
babies
fo
whom
eve y
feed
matte s

Fo
p ematu e
a d
low-bi th-weight
i fa ts,
the
issue
is
ot
simply
about
calo ies.Thei
digestive
a d
immu e
systems
a e
still
developi g,
maki g
them
especially
vul e able
to
i fectio s
a d
se ious
complicatio s.Sida a
said
the
st o gest
evide ce
fo
do o
huma
milk
is
i
p ematu e
a d
low-bi th-weight
i fa ts,
pa ticula ly
i
educi g
the
i cide ce
of
ec otisi g
e te ocolitis,
o
NEC,
a
seve e
co ditio
that
ca
damage
the
i testi e
a d,
i
se ious
cases,
lead
to
i fectio
a d
death.

“Do o
huma
milk
is
believed
to
b i g
dow
the
i cide ce
of
ec otisi g
e te ocolitis
a d
some
i fectio s
mo e
tha
fo mula
does
i
p ematu e
babies,”
she
said.Huma
milk
also
co tai s
bioactive
a d
immu e
compo e ts
that
fo mula
ca ot
eplicate.But
Sida a
is
clea
about
the
hie a chy:
whe
a
mothe
ca
b eastfeed
he
ow
baby,
that
emai s
the
ideal.”A
mothe ‘s
ow
milk,
p efe ably
via
b eastfeedi g,
is
the
best
optio
si ce
it
is
optimal
fo
he
i fa t
a d
has
the
equi ed
ut ie ts
a d
immu ity
that
facilitate
his
o
he
g owth
a d
esista ce
to
i fectio s,”
she
said.Do o
huma
milk
becomes
the
ext
optio
whe
that
fi st
choice
is
tempo a ily
o
pe ma e tly
u available.D
Sakshi
Goel,
se io
co sulta t
i
obstet ics
a d
gy aecology
at
Madhuka
Rai bow
Child e ‘s
Hospital,
Delhi,
desc ibed
it
as
a
“t a sitio al
o
suppleme tal
esou ce”
fo
ewbo s
at
isk.”It
should
ot
take
away
f om
the
impo ta ce
of
establishi g
a d
co ti ui g
with
lactatio ,”
she
said.

The
mothe
who
gives

That
disti ctio
is
impo ta t
because
milk
ba ks
do
ot
exist
simply
to
dist ibute
milk.
They
also
help
mothe s
b eastfeed
a d,
whe
possible,
p oduce
e ough
milk
fo
thei
ow
babies.Tiwa i
st o gly
challe ges
the
widesp ead
belief
that
most
mothe s
simply
do
ot
p oduce
e ough
milk.”The
co cept
that
mothe
is
ot
able
to
make
e ough
milk,
basically
we
feel
it
is
a
misco ceptio ,”
he
said.I
most
cases,
he
explai ed,
b eastfeedi g
is
a
physiological
p ocess.
Difficulties
ca
a ise
because
of
delayed
i itiatio ,
poo
positio i g,
i adequate
feedi g
o
the
ea ly
i t oductio
of
fo mula
o
bottle
feedi g.”If
we
sta t
top
milk
o
powde
milk,
the
the
mothe ‘s
milk,
it
goes
o
dec easi g,”
he
said.That
is
why
milk
ba ks
a d
lactatio
ce t es
fi st
t y
to
u de sta d
why
a
mothe
believes
she
does
ot
have
e ough
milk.”If
the e
is
some
fault,
we
t y
to
ma age
that
fault
i
the
feedi g,”
Tiwa i
said.
“A d
the
we
co vi ce
the
mothe
that
she
has
mo e
milk
as
compa ed
to
the
equi eme t
of
he
child.”O ly
whe
a
mothe
has
e ough
milk
fo
he
ow
baby
does
the
co ve satio
tu
to
do atio .”She
ca ot
o ly
feed
he
child,
but
she
ca
also
do ate
the
milk,”
he
said.Fo
ma y
mothe s,
that
ca
become
a
u expectedly
emotio al
decisio .They
a e
ot
do ati g
somethi g
abst act.
They
a e
exp essi g,
collecti g
a d
ha di g
ove
milk
thei
bodies
p oduced
to
ou ish
thei
ow
child.But
i
a
egulated
system,
they
k ow
whe e
it
is
goi g:
to
a
ewbo
who
eeds
it.

How
does
a
mothe
do ate?

The
p ocess
begi s
ot
with
a
bottle,
but
with
a
co ve satio .Goel
said
a
mothe
who
wa ts
to
do ate
should
app oach
a
eputable
huma
milk
ba k
o
Comp ehe sive
Lactatio
Ma ageme t
Ce t e
athe
tha
t yi g
to
do ate
i fo mally.The
ce t e
cou sels
he ,
eviews
he
medical
histo y
a d
dete mi es
whethe
she
is
eligible.”Afte
that,
the
mothe
goes
th ough
the
esse tial
sc ee i g
a d
testi g
a d
is
give
i st uctio s
o
how
to
exp ess,
collect
a d
sto e
he
milk,”
Goel
said.The
milk
is
the
collected
th ough
the
ecog ised
cha el
a d
subjected
to
the
ecessa y
p ocessi g
a d
safety
checks.Tiwa i
said
milk
ba ks
i itially
elied
heavily
o
mothe s
delive i g
i
the
same
hospital.
But
awa e ess
has
slowly
wide ed
the
do o
pool.”Now
we
have
that
type
of
mothe
also,”
he
said
of
wome
who
hea
about
milk
ba ks
a d
volu ta ily
app oach
them.Some
ce t es
have
eve
begu
usi g
milk
collectio
va s
to
t avel
betwee
hospitals
a d
homes.The e
is
o
comme cial
t a sactio
i volved.”The e
is
o
mo eta y
be efit
to
the
mothe
who
is
do ati g,”
Tiwa i
said.
“Simila ly,
we
do
ot
cha ge
a y
mothe
fo
getti g
milk
also.””Neithe
we
give
mo ey
o
mo eta y
be efit
to
the
do o
o
to
the
ecipie t.
It
is
totally
volu ta y.”That
wo d
—
volu ta y
—
is
ce t al
to
the
idea.
A
mothe
is
eve
expected
to
comp omise
he
ow
baby’s
ou ishme t.
She
gives
o ly
what
is
su plus.

Medical
jou ey
befo e
eachi g
baby

The
emotio al
ge e osity
of
do atio
is
matched
by
a
igo ous
safety
system.Do o s
a e
sc ee ed
fo
commu icable
diseases
a d
othe
health
isks.
Thei
medicatio s
a e
eviewed,
as
a e
lifestyle
facto s
that
could
make
the
milk
u safe.”We
take
th ee
o
fou
p ecautio s,”
Tiwa i
said.Mothe s
a e
sc ee ed
fo
ill esses
such
as
hepatitis
B
a d
C
a d
othe
i fectio s
that
could
pote tially
be
t a smitted
to
a
ecipie t.
They
a e
also
assessed
fo
medici es
that
could
ha m
a
baby.”If
she
is
o
some
psychot opic
d ugs
o
some
a ti-ca ce
d ugs
o
if
she
is
o
some
habit-fo mi g
d ugs,
the
we
have
to
take
ca e
of
that
also,”
he
said.Smoki g
a d
alcohol
co sumptio
a e
also
co side ed.”All
these
facto s
a e
co side ed,
a d
sc ee i g
is
completed
befo e
collecti g
the
mothe ‘s
milk,”
he
said.The
do ated
milk
the
goes
th ough
p ocessi g
a d
testi g.Acco di g
to
Sida a,
I dia’s
sta da ds
i clude
Holde
pasteu isatio ,
i
which
milk
is
heated
to
62.5°C
fo
30
mi utes
a d
the
apidly
cooled.Samples
u de go
mic obiological
testi g,
a d
pasteu ised
milk
is
eleased
o ly
whe
cultu es
do
ot
show
bacte ial
g owth.Pasteu isatio
does
mea
that
do o
huma
milk
is
ot
biologically
ide tical
to
f esh
mothe ‘s
milk.”Pasteu izatio
p ocesses
modify
va ious
pa ts
of
huma
milk,
especially
a
umbe
of
heat-se sitive
e zymes
a d
immu e
facto s,”
Sida a
said.But,
she
added,
it
p ese ves
the
ut itio al
compositio
a d
ma y
of
the
biological
qualities
of
huma
milk
while
sig ifica tly
imp ovi g
safety.Fo
a
highly
vul e able
p ematu e
baby,
that
bala ce
matte s.

Why
i fo mal
sha i g
is
ot
the
same
thi g

The
i sti ct
to
help
a othe
mothe
ca
be
powe ful
e ough
to
e cou age
di ect
sha i g
th ough
f ie ds,
social
etwo ks
o
o li e
g oups.But
docto s
cautio
agai st
co fusi g
ge e osity
with
safety.”A
egulated
milk
ba k
is
u
i
acco da ce
with
a
p ope
medical
a d
quality-co t ol
system,”
Sida a
said.The e
is
do o
sc ee i g,
testi g,
pasteu isatio ,
sto age
a d
t aceability.With
i fo mal
sha i g,
those
safegua ds
may
disappea .”The e
might
be
doubts
about
the
health
co ditio
of
the
do o ,
medicatio s
that
we e
take ,
how
the
milk
was
sto ed,
a d
whethe
it
comes
f om
the
ight
sou ce
o
is
co tami ated,”
Sida a
said.The
wa i g
is
pa ticula ly
impo ta t
fo
p ematu e
a d
sick
ewbo s
whose
immu e
systems
a e
al eady
f agile.”The
p oblem
does
ot
lie
i
people
who
ge e ously
do ate
the
milk,”
she
said.
“The e
is
a
p oblem
of
the
lack
of
sc ee i g,
co t ol
ove
the
sou ces,
sto age
p actices,
a d
testi g
fo
milk
i te ded
fo
ve y
vul e able
eo ates.”

Mo e
eedy
babies
tha
do o
mothe s

The
eed
fo
do o
huma
milk
ca
be
g eate
tha
the
available
supply.Tiwa i
said
ma y
milk
ba ks
a e
still
u able
to
meet
the
complete
equi eme ts
of
the
hospitals
whe e
they
ope ate.Goel
said
the e
is
o
eliable
eal-time
evide ce
poi ti g
to
a
si gle
atio wide
sho tage
because
availability
diffe s
co side ably
betwee
hospitals
a d
egio s.
But
dema d
ca
exceed
local
supply,
especially
whe e
la ge
umbe s
of
p ematu e
o
medically
f agile
ewbo s
a e
bei g
t eated.Whe
that
happe s,
the
most
vul e able
babies
a e
p io itised.”The
mai
poi t
is
fai
allocatio
of
esou ces
while
at
the
same
time
helpi g
mothe s
with
the
establishme t
a d
mai te a ce
of
thei
ow
milk
supply,”
Goel
said.This
is
o e
easo
awa e ess
matte s
so
much.At
JIPMER,
a
July
2025
PIB
elease
oted
that
the
Amudham
Thaipaal
Maiyam’s
ave age
volu ta y
milk
collectio
had
g ow
f om
about
400ml
a
day
i
its
ea ly
yea s
to
a ou d
1,000ml
a
day,
with
at
least
20
babies,
pa ticula ly
p ematu e
i fa ts,
be efiti g
eve y
day.But
Tiwa i
believes
I dia
still
has
a
lo g
way
to
go.He
said
his
associatio
eaches
docto s,
medical
stude ts
a d
hospitals
th ough
co fe e ces,
talks
a d
awa e ess
campaig s.
NGOs
a d
o ga isatio s
such
as
Rota y
have
also
helped
with
equipme t,
i f ast uctu e
a d
publicity.”We
a e
doi g
publicity
o
media.
We
a e
doi g
mouth-to-mouth
publicity
by
the
mothe
who
has
eceived
the
milk
fo
he
baby,”
he
said.

Small
act
with
e o mous
huma
mea i g

Huma
milk
ba ki g
is
ultimately
a
sto y
about
mothe s.O e
mothe
may
be
sitti g
beside
he
ow
healthy
baby,
exp essi g
milk
he
child
does
ot
immediately
eed.I
a othe
wa d,
a othe
mothe
may
be
sitti g
beside
a
i cubato ,
watchi g
a
ti y
chest
ise
a d
fall
a d
wo de i g
whethe
he
baby
will
make
it
th ough
the
ight.

Tiwa i’s
message
is
simple.”Mothe ‘s
milk
is
best
fo
a y
ewbo
child,”
he
said.A d
fo
mothe s
who
have
mo e
milk
tha
thei
ow
babies
eed,
he
wa ts
hesitatio
to
give
way
to
awa e ess.”Most
of
the
mothe s,
they
have
mo e
milk
as
compa ed
to
the
equi eme t
of
he
child,”
he
said.
“Mothe
o
the
elatives
o
the
g a dpa e t,
they
should
ot
hesitate
i
do ati g
the
milk.”The e
is
o
g a d
ce emo y
whe
a
bottle
of
do o
milk
leaves
a
milk
ba k.It
is
labelled,
tested,
pasteu ised,
sto ed
a d
eve tually
ca ied
to
a
NICU.But
i side
that
bottle
is
somethi g
much
la ge
tha
milk.It
is
the
ge e osity
of
o e
mothe
eachi g
a
baby
she
may
eve
see.A d
fo
a
ewbo
who
has
a ived
too
soo ,
whose
mothe
is
too
ill,
o
who
has
lost
the
pe so
who
was
mea t
to
feed
them,
that
ge e osity
ca
become
a
lifeli e.

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