INFACT Canada: Health Canada's advisory lacks scientific basis

Mother’s milk and safe milk sharing: Health Canada’s advisory lacks scientific basis

December 7, 2010

The recent media focus on the mothers’ movement Eats on Feets has resulted in a Health Canada advisory warning mothers against the use of another mother’s milk unless it comes from a donor milk bank.

Health Canada’s advisory raises some important questions about the lack of scientific basis for their claims regarding the “risks” of human milk sharing.
The Health Canada advisory flies in the face of the recommendations by both UNICEF and the World Health Organization, that when a mother is unable to provide her own breastmilk, the milk of another mother is safer than the use of an infant formula. These principles are outlined in the World Health Organization and UNICEF Global Strategy on Infant and Young Child Feeding and the Baby-Friendly Initiative. Although these initiatives were endorsed by Health Canada, why are these important principles now deemed “risky”?

Health Canada claims

There is a potential risk that the milk may be contaminated with viruses such as HIV or bacteria which can cause food poisoning, such as Staphylococcus aureus. In addition, traces of substances such as prescription and non-prescription drugs can be transmitted through human milk. Improper hygiene when extracting the milk, as well as improper storage and handling, could also cause the milk to spoil or be contaminated with bacteria and/or viruses that may cause illness.

When mothers need a breastmilk replacement how does Health Canada consider the use of commercial infant formula products to be safer that the use of peer-to-peer informed milk sharing?
INFACT Canada is concerned that the Health Canada warning will dissuade mothers from providing human milk for their infants and encourage the use of commercial infant formula. The other alternative when mothers need a replacement for their own milk is the use of commercially produced infant formula. The risks associated with the use of infant formula products have been well documented. Mothers aware of these risks do not wish to expose their infants to such risks. These include increased prevalence of a range of infectious diseases and health conditions – ear infections, gastrointestinal infections respiratory infections, necrotizing enterocolitis, sepsis, meningitis, diabetes, childhood cancers, obesity, allergies – formula fed infants grow and develop differently from breastmilk fed infants, including cognitive and neural development.
While implying that formula is a preferable alternative to shared human milk, Health Canada fails to inform mothers that the risk of contamination by lethal and dangerous bacteria may exist in all powdered infant formula currently marketed in Canada. Has Health Canada warned parents that tins of powdered infant formula are not sterile and may contain Enterobacter sakazakii, a virulent and highly pathogenic contaminant that can lead to serious infections causing meningitis, necrotizing enterocolitis, sepsis and even death? Has Health Canada mandated that infant formula labels have warnings about the lack of sterility and that products must be carefully reconstituted at 70 degrees C to destroy the lethal Enterobacter sakazakii as recommended by the World Health Organization?
Additionally the Health Canada warning does not address the presence of the bacterium Salmonella species, a major cause for gastrointestinal infections, present in powdered infant formula. Should parents not be informed of the rather frequent recalls of infant formula products – the most recent for the presence of beetle parts in the formula? Furthermore there are many industrial contaminants found in infant formula such as heavy metals, plasticizers, including the plastic BPS present in concentrated formula.
Infant formula does not have the immunological constituents to alleviate against the risk of the built-in microbiological contaminants and the bacterial and viral contaminants related to formula preparation, handling, storage and feeding.
Health Canada’s advisory does not provide mothers with the information needed about the safe peer-to-peer informed sharing of milk. Nor does Health Canada provide access for mothers to the donor milk from milk banks that it deems safe and acceptable.
Currently there is only one milk bank in Canada at the BC Women’s Hospital and Health Centre in Vancouver. Donor milk from the BC Milk Bank has very limited access and is available on prescription only for high needs infants.
Although Health Canada’s policy statements recommend that infants be exclusively breastfed for the first six months of life and sustained breastfeeding to two years and beyond, adequate support systems need to be in place for mothers to achieve optimal breastfeeding practices. Mothers need to be able to access supplementary human milk for their infants for the full recommended time that infants and young children require human milk for optimal health, growth and development. A variety of social, cultural, health or economic reasons may necessitate that mothers have access to human milk in order to achieve this.
Mothers who wish to provide only human milk for their infants have no other means to access human milk than to establish their own method of safe milk sharing. Eats on Feets is a community-based movement of mothers meeting the needs of their infants based on a health screened and informed decision making process. Importantly many women have more than enough milk and have a deep desire to share with mothers and infants needing their milk.

Conclusions

Assessing and analyzing the risks (see ANNEX) of peer-to-peer informed milk sharing demonstrates the risks to be negligible. Peer-to-peer informed milk sharing is by far the safer means to provide replacement feeding when mothers own milk is unavailable.

However the risks of feeding infant formula to infants are well documented. Many mothers do not wish to expose their infants to the increased risks of infectious diseases, chronic diseases and growth and development anomalies, which have lifelong implications.
INFACT Canada urges Health Canada to provide guidelines to address the need for mothers who wish to donate their life giving milk to mothers who know this to be critically important for the health and well-being of their infants. Health Canada must recognize that informed milk sharing is not “dangerous” and must recognize that the alternative of using infant formula comes with a long list of documented negative consequences.
INFACT Canada urges Health Canada to facilitate a milk banking system across Canada that will provide full access for all mothers who wish to donate their milk and to mothers who need to make use of donated milk beyond the current limited “on prescription only.”
INFACT Canada urges Health Canada to establish centres where mothers can go to have their milk screened so they can feel comfortable and confident sharing their milk. As well Health Canada should review the capacity of blood banks to also screen human milk.
INFACT Canada urges Health Canada to provide the necessary funding and programme leadership to improve support systems for the establishment of lactation in the early weeks and months to help mothers overcome difficulties they may encounter.
Mothers need effective support systems to achieve the Health Canada recommendations for exclusive and sustained breastfeeding to ensure the highest attainable standard of health for their children. We will all benefit.

Elisabeth Sterken, MSc, RD
Executive Director
INFACT Canada
esterken@infactcanada.ca

With thanks to:
Jennifer Abbass Dick RN, BNSc, MN, PhD student, IBCLC, RLC
Linda Smith, BSE, FACCE, IBCLC, FILCA for their helpful comments.

ANNEX

It is important to compare the perceived risks and dangers of peer-to-peers informed milk sharing to the risks of providing infant formula as a replacement for a mothers own milk.

Peer-to-peer informed milk sharing

Viral and microbiological risks

• Mothers are screened and share their health data.
• The numbers of Canadian women of child bearing age who are HIV+ are few.
• The probability of an HIV+ mother, who has given birth, breastfeeds and donates her milk, is highly improbable. Moreover HIV+ mothers receive anti-retro-virals which significantly reduce the viral count.
• Human milk contains a multitude of complex antiviral and immune substances demonstrated to inactivate viruses such as HIV and reduce microbiological contaminants.
• Providing human milk exclusively is the best protection against viral and bacterial contaminants passing via the infant gut. Human milk provides a protective layer in the infant gut. It is in fact the introduction of infant formula into the infant gut that creates the risk of transmission. Mixed feeding of formula and human milk has been shown to be the greatest risk for viral transmission. The cow’s milk proteins in infant formula are a cause of gut damage providing a passage for viral (HIV, hepatitis B and C, HTLV 1 and 2, syphilus) and bacterial contaminants.
• Mothers can flash pasteurize donated milk to ensure that there are no viral or bacterial contaminants.(ref: Israel-Ballard K, Donovan R, Chantry C, Coutsoudis A, Sheppard H, Sibeko L, Abrams B. (2007). Flash-heat inactivation of HIV-1 in human milk: a potential method to reduce postnatal transmission in developing countries. J Acquir Immun Defic Syndr. 45: 318-23.)

Passage of prescription and non prescription drugs

• There are very few drugs that are contra-indicated during lactation. Most drugs do not enter her milk.
• Eats on Feets advises mothers on how to screens donors for prescription and non prescription substances.
• If a mother is breastfeeding her own child she will be aware of any contra-indicated substances. If her milk is safe for her own child it will be safe for the child she is donating her milk to.

Improper hygiene, storage and handling

• Human milk is the most effective and efficient protection against microbial contaminants. It contains, IgA, IgM, IgG, IgE, IgD factors, lactoferrins, lysozymes, oligosaccharides, immunoglobulins, interferon, mucins, bifidus factors, to name a few and many as yet undiscovered factors. It takes a lot to “spoil” human milk.
• Mothers are aware of the normal principles of hygiene, storage and handling.
• INFACT Canada • info@infactcanada.ca