Pasteurising mother’s milk: A simple solution to a complex problem

Joanna Lovatt

The World Health Organization estimates that if every woman optimally breastfed her baby the lives of 800,000 young children could be saved every year. So why can’t we achieve optimal breastfeeding? 

Breastfeeding counselling is usually a successful nutritional intervention in Bangladesh, where young or under-educated mothers don’t necessarily learn otherwise about the benefits of exclusive breastfeeding. When they discover that feeding their babies solid food or formula before six months of age can actually put the child at risk of illnesses like diarrhoeal disease, mothers are often eager to opt for feeding only breast milk. 

 

So when the breastfeeding counselling did not lead to better breastfeeding patterns among working mothers in low-income urban areas of Bangladesh’s capital, Dhaka,icddr,b researchers knew there was a problem. 

 

Why were these women struggling to breastfeed? 

Juggling a baby and a full-time job can be challenging anywhere in the world, but in Bangladesh the rights afforded to working mothers lag way behind. There are approximately 3.2 million women employed in the ready-made garments industry alone, making it the single largest employer of women in the country. These women are currently allowed four months of paid maternity leave, but most re-join work two or three months after they give birth. The working mothers also work long hours, and many factories do not have crèche facilities for young children to enable mothers to bring their children to work. 

 

However, a young baby needs to be fed regularly, more than several times a day. For these women, exclusive breastfeeding—recommended by the World Health Organization for all babies from birth to six months—is practically impossible.

It’s not that they don’t believe in the benefits of breastfeeding, says Dr Sabrina Rasheed, a scientist and breastfeeding and infant nutrition expert at icddr,b. It’s that they simply do not have opportunity and resources to do it.

 

The above infographic was created by icddr,b.

Data sources: Reuters, Unicef, Daily Star.

Clearly there is a need to apply the technology that has liberated working women in other parts of the world, like breast pumps (used to express milk in advance) and breast milk pasteurisation machines (used to extend the shelf life of the milk so that it can be safely used to feed babies at a later time). 

 

For Michaela Collins and Scott Genin, global health students at the University of Toronto, the challenge lay in choosing a technology suitable for the context of working women in Bangladesh and in transferring this technology to make it acceptable in such countries. The key tasks at hand were to choose low cost machinery, to reduce the machine’s reliance on water and to ensure that thepasteurisation process can still make milk safe for households that lack reliable refrigeration facilities. 

 

With the support of Grand Challenges Canada, Michaela and her colleagues have teamed up with icddr,b’s Dr Rasheed to successfully create a prototypepasteurisation machine, and they are now to testing it in Bangladesh. The icddr,b team have recently installed 10 breast pumps and a pasteurisation machine atInterfab Shirt Manufacturing Limited, an enterprise of  Viyellatex Group in Dhaka, to allow women to pump their breast milk while at work. This project aims to enable women to take home the pumped milk, which stays safe for eight hours. This will then provide nutrition for children while the mothers are at work in the afternoon, or later in the evening. 

 

Dr Rasheed recalls that it took several iterations before the pasteurisation machine began to work as expected. The success of making the breast milk safe relied on both innovative engineering from the University of Toronto team as well as context-specific scientific expertise from the icddr,b team. icddr,b, for example, discovered a soil-based pathogen that was not destroyed by the heating process and so they now use alcohol swabs to clean and sterilise the women’s skin before pumping milk. This single step near doubled the time for which the milk is safe, says Dr Rasheed.

 

Photo © icddr,b / Shahidul AlamDRIK

The project is called Mother’s Milk, and it aims to address one of the most salient public health problems facing the developing world – malnutrition. South Asia, in particular, faces a large hunger burden with about 281 million undernourished people.  Poor nutrition causes nearly half of all deaths of children under five years of age. 

But according to the World Health Organization, if every child was optimally breastfed during the first 23 months of life then 800,000 children’s lives among children under five could be saved every year. 

 

Good nutrition is an important part of the sustainable development agenda, which was launched at the United Nations General Assembly in September 2015. Sustainable Development Goal 2 calls for the end of all forms of malnutrition, including stunting and wasting, by 2025. Promoting exclusive breastfeeding by making workplaces child-friendly will be critical to achieving this target, says DrRasheed.

“If a woman has to sacrifice her income to care for her child then it will hurt the entire family. Lower household income means less money to spend on good quality, nutrient-dense food,” she continues.

“But we can already see that the women enrolled in this project are saving money because they are buying less formula, and they are staying home from work due to child illness less often.”

As part of the project, the working mothers will also receive micronutrient tablets, health and hygiene education, and referral support for sick children to icddr,b’s Dhaka Hospital. 

The Mother's Milk project aims to raise awareness and interest within Bangladesh, especially among advocates like the Bangladesh Breastfeeding Foundation , on ways to support working mothers as they return to work after birth. This could include adding breast milk supportive technologies like breast pumps and pasteurization machines to the benefits package for women in the workplace. 

It could be beneficial for the employers too: greater staff retention means less money spent on training new employees, and, in the ready-made-garments sector especially, improved staff welfare will satisfy concerned international buyers.

If successful, the project could prompt the widespread adoption of breast milk pasteurisation in other countries that want to safeguard the health of infants and empower their rapidly growing female workforces.

Mother's Milk is funded by Grand Challenges Canada with support from the Office of the UN Special Envoy for Financing the Health MDGs and the Swiss family-owned company Medela, which provided the breast pumps.