Brazil's breast milk banks are a sound investment in the future of the country, offering a high rate of return by giving health and survival to the smallest of its citizens.
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In 2012, well ahead of the 2015 target, Brazil reached Millennium Development Goal 4 – reducing the under-5 mortality rate by two thirds. Disparities across Brazil mean that work remains to be done, particularly in some impoverished communities and among marginalized groups, including Afro-Brazilians and Brazil’s indigenous people, where under-5 mortality rates still need to be reduced.
Breast milk banks across the country are providing life-saving support for premature babies.
By Kent Page
FORTALEZA, Brazil, 15 November 2013 – Except for the shuffling of new mothers and nurses in protective gowns and slippers, it’s very quiet in the neonatal intensive care unit at Cesar Cals Hospital. Thirty or more incubators and small plastic cribs each hold a tiny, premature, high-risk baby who is struggling to survive.
In Fortaleza, Ligia, who is breastfeeding her daughter, donates to one of Brazil’s breast milk banks, ensuring that babies whose mothers cannot breastfeed still reap the health benefits of breast milk.
Thanks to an innovative breast milk bank programme, chances are very good that they will survive. Across the country, these breast milk banks are giving the highest return rate of any bank in the world – helping to reduce mortality among premature babies.
Alternative feeding sources, alternative feeding techniques
Essential to newborn health, breast milk provides key nutrients and also boosts immunity, protecting infants against diarrhoea, respiratory infections and other life-threatening illnesses. But, some women are unable to provide this sustenance – or sufficient amounts of it – for their infants. Banked breast milk can help make up the difference.
Paula Nunes, a new mother, has been making life-saving withdrawals from the bank for her daughter Alice Maria, who was born prematurely at the hospital. “I have enough breast milk to feed my baby in the daytime. But sometimes, at night, I don’t seem able to produce enough milk, and that’s when my baby can benefit from the women who have donated to the milk bank,” she explains. “I feel so blessed that, as soon as I can produce extra milk, I will be sure to donate it to help other mothers like me.”
Women like Paula, supplementing their milk with donated milk, or who are unable to provide their own breast milk directly, must learn alternative means of feeding their infants. Nurses on hand at the hospital help the new mothers, teaching them how to administer breast milk through a small, hand-held drip vial and connected feeding tube. Inserted orally, the tube extends directly to the baby’s stomach.
Paula's baby Alice Maria was born prematurely. Here, Alice Maria benefits from warmth and bonding with Paula while consuming nutritious breast milk that was withdrawn from the breast milk bank.
“The nurses have shown me how to collect my milk and then to feed my baby through the tube,” says Paula.
A donation for life
In another neighbourhood of Fortaleza, far away from the hospital, Ligia, a mother of four, wants to make a deposit. She rings a toll-free number. The breast milk bank’s pickup and delivery car is now on its way to Ligia’s home, with a driver, nurse and the special equipment needed to collect Ligia’s breast milk safely.
Ligia heard about donating breast milk on Viva Vida (Long Live Life), a radio programme of Pastoral da Criança, a faith-based organization with more than 200,000 volunteers in Brazil working together to combat child mortality and malnutrition. “I thought, ‘Well, I have so much milk. Why should I keep it when other mothers need it?’” explains Ligia. “That’s when I started donating, and I’ve been doing so ever since.”
In fact, breastfeeding has long been a natural way of life in Ligia’s home. “My eldest daughter is now 12 years old, and I breastfed her until she was 4. Just look at how big and bright she is!”
Soon after the milk bank nurse arrives, Ligia takes a break from her chores and sits down in the kitchen to get ready to give another donation of her breast milk. Her 5-year-old son Levi sits beside her on a chair, and her 15-month-old daughter Lais curls up on her lap. As Lais starts feeding from her right breast, the nurse helps Ligia begin the simple procedure to collect milk from her left.
A health worker uses a feeding tube to administer breast milk to a premature baby under intensive care, at Cesar Cals Hospital, Fortaleza. The workers teach the feeding technique to women who are unable to breastfeed their infants.
“This is one of the most beautiful things in the world you can do,” says Ligia with a smile. “It makes me feel so good to be able to donate my breast milk and know that I’m helping other women and their babies. It’s just wonderful!”
Complementing the benefits of the breast milk banks, Cesar Cals Hospital also participates in the Kangaroo Mothers initiative – an innovative approach for the care of premature or low-birth-weight babies who need special attention, but not intensive care.
Research has shown that the optimal place for babies to be breastfed is in close contact with their mothers – a technique resembling a kangaroo joey in her mother’s pouch.
Warmth and healthy lactation are the basic foundations of the method. But, more than anything, it is the loving and close relationship established between the mother and child that helps premature and low-birth-weight babies to survive. The mother’s voice, heartbeat and breathing all serve as enriching neurological and cognitive stimuli, while the constant physical contact improves the baby’s respiratory and cardiac rhythms.
And, while health experts still provide support and any needed supervision, it is the mother – not doctors or nurses – who feels in charge of and responsible for her baby’s care.
For Paula, who was been keeping Alice Maria wrapped snugly close to her chest, the method has an added benefit: Her hands are free to hold the breast milk-filled drip vial and tube when she feeds Alice Maria, who responds by reaching up far enough with her tiny hands for Paula to bend her neck and give them a gentle kiss.
Breast milk banks in Brazil – and beyond
According to Paulo Bonilha, Coordinator of the Children’s Health Programme at the Ministry of Health, Brazil has the largest network of breast milk banks in the world. “We have more than 210 breast milk banks across every state in the country,” he says. “Brazil has also created an important network outside our borders, and now most South American countries have their own milk banks that were developed by Brazilian health workers.
“And, last year,” he continues, “we created the first human milk bank in Africa – in Cape Verde – and we hope to help create more milk banks in other African countries, doing so with low-cost technology that helps to save the lives of premature babies.”