I thought I knew all there was to know about the International Breast Milk Project. Apparently, there’s more.

The International Breast Milk Project was a project created by Jill Youse to donate breast milk to HIV+ orphans in an orphanage in Africa named iThemba Lethu. On the IBMP’s “About” page, they state, “The International Breast Milk Project is the first organization in the world to provide donor breast milk from the United States to babies orphaned by disease and poverty. The first batch of donor milk arrived to the iThemba Lethu orphan home in April 2006.”

Upon reading this, you might get the impression that these African orphans would never receive breast milk if not for the valiant efforts of Jill Youse and the International Breast Milk Project.

That’s exactly what Prolacta wants you to think. The rest of the story may surprise you.

iThemba Lethu, the orphanage made world-famous by the hoopla surrounding the International Breast Milk Project, has received breast milk, donated from South African moms and pasteurized by their own South African breast milk bank, since August 2001. The bank was funded entirely by UNICEF, and the person who made this happen is a South African woman named Anna Coutsoudis. At times, the South African breast milk bank has even had more milk than the children needed.

Prolacta had nothing to do with this.

So why create the International Breast Milk Project in April 2006 at all? There was no dire need for it. The African orphans of iThemba Lethu were already receiving plenty of donated breast milk. They were thriving, not starving, like the International Breast Milk Project has implied. The South African milk bank didn’t need rescuing; it was tremendously successful all by itself, for almost five years before Jill Youse came along. The children were all getting the breast milk they needed, and pretty efficiently, too, with a local milk bank supplied by South African donors. A milk bank that often enough had more milk than the children needed. They didn’t need milk from the United States, though of course they weren’t going to turn it down.

Here’s another question. Why, instead of creating the International Breast Milk Project (which was totally unnecessary since the problem it addresses had already been solved), didn’t Jill Youse create the United States Breast Milk Project, whereby she donates breast milk to needy orphans right here in the USA? Aren’t there HIV+ orphans in this country who need breast milk and aren’t getting it? Hmmmm… Maybe because giving away Prolacta’s product for free in this country would set an undesirable precedent for the company’s future. After all, if you just give it away, then why should anybody pay for it? How do you determine who’s destitute enough to receive free milk and who must fork out the $184.83 per ounce? Prolacta’s target market is, after all, babies in the NICU, all of whom can be considered “in-need.”

Or maybe it had nothing to do with that, and everything to do with the positive public relations shipping milk halfway around the world would generate. Yep, that’s probably more like it.

The great irony here is that the International Breast Milk Project may actually undermine South Africa’s existing breast milk bank in the long run. If iThemba Lethu gets all its milk from the International Breast Milk Project and not from South Africa’s own breast milk bank, what motivation do South African women have to continue donating? What incentive is there for the milk bank to continue to improve, if all the work of acquiring and pasteurizing the milk is done beforehand? Do this for long enough, and the old “Give a man a fish vs. Teach a man to fish” parable comes to life in reverse. With enough free milk from the International Breast Milk Project, the art of milk banking in South Africa may eventually die off.

It would be one thing if the International Breast Milk Project had been created in the absence of an already existing milk bank. But that’s not the way it happened.

Edit (7/24/2007): It has recently come to my attention that iThemba Lethu houses a total of six children. SIX. From all the media coverage, you’d think there were hundreds, if not thousands, of HIV+ babies in the orphanage receiving breast milk from the International Breast Milk Project, but it’s only six??? Six children who were already being provided with breast milk from their homeland? How much sense does it make to create a multi-million-dollar program to feed six infants breast milk from another continent when they’re already getting breast milk from their own in-house milk bank?

It is shameful how the IBMP and Prolacta can get away with all this subterfuge.

I did a quick Google search to see if Prolacta Bioscience was up to its usual shenanigans again. Apparently, it is. In addition to soliciting breast milk donations directly on prolacta.com through milkbanking.net, creating the National Milk Bank to funnel all the milk donated there into Prolacta, and hijacking the International Breast Milk Project so that 75% of all donations to the IBMP go to Prolacta, they’ve got yet another scheme. They “partner up” with a birth center or lactation center so that breast milk donors are duped into trusting Prolacta.

The donated milk gets processed as human milk fortifier (a product that has not been proven safe yet; published medical journals regarding its safety either do not exist or are very obscure) and the recipient gets charged $184.83/ounce.

Here are some examples of organizations that sell their their milk to Prolacta, same as the National Milk Bank and International Breast Milk Project do:

• Milkin’ Mamas Breast Milk Bank
• The Mother’s Touch Lactation Consulting
• The Birth Connection Milk Bank (alternative site)
• The Family Birth Center
• Southcoast Midwifery and Women’s Healthcare
• Miami Maternity Center

If you donate to any of the above places, to milkbanking.net or the National Milk Bank, know that your all your milk will go to Prolacta Bioscience. Prolacta will then process and sell the milk for $184.83/ounce. If you donate to the International Breast Milk Project, 75% of your donated breast milk will stay in the United States to be sold for $184.83/ounce.

Edited (7/26/2007): Please read or listen to this public radio report on Prolacta that confirms much of what I’ve already written.

If you want to donate to someplace where your milk will actually help a baby (and not a for-profit corporation), consider donating to a HMBANA bank. They have no affiliation with Prolacta Bioscience, and can only charge recipients what it costs to process the milk, which is usually around $3.50/ounce.

If you’d like to donate your breast milk directly to a baby in need, join MilkShare. Milkshare is a group created by Kelley Faulkner in 2004 to hook up women with surplus breast milk with women who would like donated breast milk for their babies. It is a low-cost alternative to milk banks for the recipients, as they only have to pay for shipping for the milk. For donors, it can be very satisfying to be able to know exactly who the recipients of their milk are.

It seems that this subject is one that I cannot stop blogging about. There is still so much to say. It bugs me that the National Milk Bank sells every single ounce of donated breast milk they receive to Prolacta Bioscience (I’m not even sure the National Milk Bank wasn’t created by Prolacta; maybe it was! Update: apparently it was.) Yes, all the milk goes to “help treat babies in the NICUs,” but only if someone can foot the bill for it, and the price is very steep ($6.25/milliliter, or $184.83/ounce). Milk from non-profit milk banks also goes to “help treat babies in the NICUs,” and for far less money (around $3.25/ounce). The same stringent quality control and the same outcomes for patients who receive breast milk come from non-profit milk banks as from for-profit ones, with the only difference being that everyone can benefit from non-profit milk banks. The same cannot be said for for-profit ones.

Considering that none of the donors are getting compensated for their trouble and that they’re not even being told the whole story of what happens to their milk when they donate to the National Milk Bank or the International Breast Milk Project, you could say I’m a little ticked off about the whole thing.

Would it bother me as much if the donors were compensated and made aware of how much of a profit would be made? Maybe not, but that scenario is unlikely to happen. Actually, it still would bother me, because Prolacta’s product is so egregiously overpriced for a product that’s marketed “for the nutritional needs of premature and critically ill infants” that it seems almost criminal. Speaking of which, for me to find out the asking price of Prolacta’s human milk fortifier took some substantial investigating. It’s not like they list prices on their website. Many articles and and blogs mistakenly report the price to be around $35-40/ounce, which is only an average taken after you’ve added in your own pumped breast milk to their human milk fortifier. The actual price is $6.25 per milliliter, or $184.83 per ounce. It’s supposed to be a secret, so…. Tell everyone you know, especially anyone considering donating to the National Milk Bank, The International Breast Milk Project, and Prolacta Bioscience. If word gets out about their prices and what’s really happening to the milk that comes into their hands, their supply will drop in a hurry, forcing them to revise their business practices.

Want to donate your milk to a place where it will actually do some good? Find the non-profit milk bank closest to you.

Or donate your milk directly to a mom in your neck of the woods.

Before I continue with this, I need to point out that when I say “non-profit” milk banks, I mean all milk banks that are members of the Human Milk Banking Association of North America.  When I say “for-profit” milk banks, I’m referring to The International Breast Milk Project,  the National Milk Bank, and any other milk bank or organization that serves a for-profit company.  Although The National Milk Bank and International Breast Milk Project are technically non-profit entities, they both serve Prolacta Bioscience, a for-profit company specializing in processing and selling a product made out of donated human milk.

Non-Profit Milk Banks

For-Profit Milk Banks

Overall, I’d say that while it’s great that research is conducted a lot more quickly with for-profit milk banks, non-profit milk banks are better for society overall. Obviously anyone working for Prolacta Bioscience, the National Milk Bank, or the International Breast Milk Project would disagree with this assessment, but you’d probably be hard-pressed to find anyone outside these contrived organizations who’d say for-profit milk banks are a good idea for the majority of babies.

I’ve given this a lot of thought. The International Breast Milk Project is a project that sends breast milk to feed starving HIV+ orphans in South Africa. It was founded by Jill Youse, a lactating mother who had gallons of surplus breast milk she’d pumped for her daughter. She wanted to do something good with the milk, so she found an orphanage in South Africa called iThemba Lethu which houses children with HIV/Aids, got some money together for shipping, and started donating her breast milk to them. She told her friends and family and they chipped in to help. This was in April of 2006. Now the International Breast Milk Project hopes to donate thousands of ounces every year to needy HIV positive African orphans. Sounds really good, right?

However.

There are details I’ve become aware of (this blogger helped uncover some facts and effected enough change to get straighter answers out of IBMP’s FAQ page) and other things I’ve thought of since first reading about it that have given me pause.

It costs a lot of money to ship, well, anything, to Africa from the USA. Shipping milk is especially expensive because it is so heavy and because a fairly large amount gets consumed by each baby very quickly (about a liter per day per baby). One woman and her family and friends alone wasn’t going to cut it. From everything I’ve read, she turned to non-profit milk banks for help processing the milk (pasteurizing, testing, re-freezing, shipping, etc.) and they refused, probably because processing and shipping the milk is so expensive, and because there are so many needy babies right here in the USA that could use donor breast milk. Also, they just don’t have the monetary resources for such an endeavor.

Since the non-profit milk banks couldn’t help her (probably too much red tape for such a project anyway), she sought help elsewhere. Prolacta Bioscience, a for-profit milk processing entity, offered to process the milk for free. With the support of Prolacta, now the project could get underway. Somehow Oprah found out about what was happening (I wonder how…Was this the plan from the beginning? Donate to Africa so that Oprah would want to showcase the project?), and Jill Youse’s efforts were recognized on her show.

Then the Oprah effect took place: suddenly Prolacta…, I mean, The International Breast Milk Project, was literally flooded with breast milk donations. It’s estimated that over 50,000 ounces of breast milk were donated, with the intent that it would all go to needy HIV-positive orphaned African babies.

All of that donated milk, according to the International Breast Milk Project website, ended up being donated to Africa. But after May 31, 2007, only 25% of what is donated to the International Breast Milk Project goes to Africa. The other 75% of donated breast milk goes straight to Prolacta Bioscience, who then resells for a profit it to NICUs here in the USA as human milk fortifier.

On the IBMP’s FAQ page, it states that Prolacta does not sell human milk fortifier by the ounce, so it’s hard to get a price for it. I called up a local NICU here in Texas and tried to find out what the price for Prolacta Bioscience was. I was told, “I’m very sorry but I’m not allowed to give out that information.” I asked, “What kind of information?” The clerk’s answer, “Any information.” Huh? I’m pretty sure asking about the price of human milk fortifiers used by the hospital doesn’t violate any HIPAA regulations, but whatever. Maybe their legal team advised them not to divulge anything out of fear of being sued. Typical.

Undeterred, I then phoned a pediatrician friend of mine who’s done quite a bit of work in NICUs. He told me that for some preemies who are fed breast milk, sometimes fortifiers (bovine milk-based) are added to the breast milk to boost its calories. He said the two biggest manufacturers of breast milk fortifiers are Similac and Enfamil. He also mentioned that Similac and Enfamil donate large amounts of their products (formula and fortifiers) to hospitals, so that’s usually what the hospitals use when fortifiers are called for. He had never heard of Prolacta Bioscience.

After talking to him, I was even more confused. What’s better, to have two powerful formula companies maintain control over the nation’s (the world’s?) hospitals, thereby standing in the way of baby-friendly initiatives and perpetuating the bottle-feeding culture? Or is it better to allow Prolacta Bioscience to take advantage of the charity of generous lactating mothers in order to try and take over the human-milk-fortifier market? Ye-gads, I’m not sure there’s an easy answer to any of this.

I never found out what the price of the human milk fortifier Prolacta sells was, but I’ll keep looking.

Something struck me, though, as I was perusing the FAQ page for the International Breast Milk Project. It mentioned that for the 75% of donated milk that Prolacta gets to keep, Prolacta pays the International Breast Milk Project $1 per ounce. (The money gets used by the IBMP to fund breast milk banks in Africa, which is in the long-run a lot more cost-effective than shipping milk from the USA to Africa.) What occurred to me as I was reading this was, why doesn’t Prolacta pay the donors $1/ounce? Wouldn’t it be a lot cleaner for them, image-wise? They wouldn’t have to hide behind a charity to try to legitimize their business this way. Just be up-front and tell women, “We’ll give you $1 for every ounce of breast milk you donate to our company.” Prolacta already sets up all prospective donors with a free hospital-grade pump, at-home blood testing, free shipping for the milk, DNA testing for the milk received and each mother who donates (to make sure what they’re donating is actually human milk and not cow milk poured into Lansinoh bags, among other safeguards). Prolacta is already paying $1 for every ounce received from the International Breast Milk Project. Why not give it directly to the women who donate? It seems more fair that way; they’re the ones doing all the hard work. Perhaps they should keep both options open: one for the women who would like some of their milk and efforts go to help African orphans, and the other for women who need the extra cash. This could be a win-win, with a little tweaking (like maybe making 100% of what’s donated to the IBMP go to Africa, for example). Perhaps if a member of Prolacta’s executive team gets wind of this idea, maybe it’ll come to fruition.

Another item of interest: my pediatrician friend went over the information provided by Prolacta for the human milk fortifier made from 100% human milk. He said it seemed like the osmolality of their human milk fortifier was a little high to be safe. Translation: the concentrated human milk seems a little too concentrated, which could potentially cause problems like dehydration or renal failure or worse, like depletion of the free water in the baby’s blood causing really bad things like swelling of the brain and brain damage. (Makes me wonder how safe the formula-company-made milk fortifiers are…) He also noted that there weren’t any clinical trials of Prolacta’s product in use that he could find, which further made him suspicious of recommending it for any of his patients. Hmmm… Seems like this human milk fortifier made out of 100% human milk, while it sounds like a great idea to the uninitiated, might need a few more years of research.

Important note: Although what I’ve written may make it sound like I don’t agree with the International Breast Milk Project, I have to admit that even 25% of what’s donated to the IBMP going to Africa is still better than 0%. Without Jill Youse’s idea, ZERO babies in Africa would be benefiting from this. I’m not blogging about all this to give Jill Youse a hard time. I think her original idea of sending breast milk to Africa is a commendable one. I do think it’s important to bring up these questions, though, especially for those who would want to become donors to the project.

Personally, if I had a large stash of milk to donate, I’d probably find someone right here in my hometown, a local mom, who could use it for her baby. It’s a lot more cost-effective, I’d know exactly where my donation was going, and while it’s admirable to look out for babies halfway around the world, there are babies right here who need breast milk too. I know first-hand the heartache of not being able to provide all the breast milk my baby needs, and I also know the profound, down-on-my-knees gratitude I’ve felt at receiving donated milk for my daughter. To ease even one mother’s suffering – I don’t think I’d be able to pass up that opportunity.

To donate breast milk locally: http://milkshare.birthingforlife.com/. Milkshare is an online service that can hook up women who need breast milk for their babies with those who have a surplus of it. Please read up on the risks and benefits of receiving raw breast milk on the MilkShare site before signing up as a recipient. (Breast milk donors can sign up free, but breast milk recipients must pay $15 for the service – an absolute bargain, if you ask me.)