MUMBAI — On a recent afternoon, 27-year-old Ashwini Agarwal adjusted her sari as she emerged from the crowded outpatient department at the Lokmanya Tilak Hospital, a public facility that houses the oldest of India’s roughly 14 breast milk banks, established a quarter of a century ago.
She had just donated her breast milk to the bank, to be consumed by another patient’s newborn, a woman who would be unable to breastfeed her own child.
Mrs. Agarwal’s second child was delivered at the hospital four months ago through a caesarean operation, and for a few days after the birth, she was unable to breastfeed her own child. Her newborn was fed mother’s milk from the bank in the initial days.
“The doctors told me how important it was,” she said, expressing her relief that they had breast milk in house.
Her husband, who accompanied her to the appointment, was surprised.
“You mean it was another woman’s milk?” he asked. “Is that even safe?”
Dr. Armida Fernandez, 70, who helped to start the bank in 1989 and now runs her own nonprofit, said that the answer to this common reaction was simple.
“If you can feed the child cow’s milk or goat’s milk, which are from a different species, how can you object to feeding another mother’s milk?” she said. “It is the closest substitute to the birth mother’s milk.”
A Lancet series published this year noted that nearly 780,000 babies under 4 weeks of age die every year in India, many from preventable causes. The report recommended promoting breastfeeding as a way to keep babies safe from infections. The World Health Organization recommends initiating breastfeeding within the first hour of birth when a child can particularly benefit from breast milk’s unique antibodies, though in India about 70 percent of babies do not receive breast milk in that time period. Many Indian women are not able to breastfeed because of a lack of awareness about proper breastfeeding methods, complications during pregnancy or malnutrition.
In a country in which infant mortality poses a challenge, running the bank has been an exercise in overcoming if not a cultural taboo, at least unfamiliarity. The practical challenges of operating the bank have ensured that it has remained a limited initiative with no immediate plans of expansion.
In 1977, when Dr. Fernandez took over the neonatology department, she was trying to figure out how to reduce infant deaths at the hospital. Of the premature babies born in the hospital who died, usually the cause was infection. At that time, the babies were being fed formula milk, which increases a newborn’s risk of infection.
In 1986, on a fellowship at hospitals in Britain, she recalled seeing breast milk banks in Birmingham and Oxford for the first time. The idea immediately appealed.
In Britain, breast milk donors were volunteers, educated and well-off with access to refrigerators, Dr. Fernandez said. They could collect milk at home and drop it off at the bank.
“We had to modify all that I saw to suit our situation,” she said, including the fact that the mothers at Lokmanya Tilak came mostly from the slums, and did not have access to refrigerators.
The idea of feeding a newborn another woman’s milk was not immediately accepted by all. Dr. Fernandez recalled a case in which a woman refused the milk because of the social status of many of the other mothers that visited the hospital. Some Muslim mothers said that they believed breastfeeding establishes a relation, so it was improper to take milk from a woman outside the family.
The initial funding for the project came from the Taj Group of Hotels, one of the largest hotel chains in the country, which agreed to provide the infrastructure and finance the bank for five years.
After the initial funding ran out, Dr. Fernandez approached the municipal body that runs the hospital but was met with skepticism.
“How can you feed one mother’s milk to another?” one official asked.
Dr. Fernandez had to get creative in her argument. She cited the popular Hindu myth of the god Lord Krishna, who was separated from his biological mother at birth and nursed by another woman. The example, at once familiar and reverent, struck home, and eventually, the breast milk bank was allocated money from the hospital’s budget.
Dr. Jayshree Mondkar, who heads the hospital’s neonatology department and oversees the bank’s operations, said that breast milk banks outside India, including the ones visited by Dr. Fernandez, offered their services to a large community. At Lokmanya Tilak, however, the bank is barely managing to provide breast milk to its own patients, and struggles with a staff shortage.
After the milk is collected, it is pasteurized and then tested. The pasteurized milk can be stored for as many as six months, but usually it is consumed within a week.
“We almost never have any surplus,” said Sujata S. Jadhav, a technician at the hospital.
Part of the limitation stems from supply: All of the milk is sourced from lactating mothers who are either admitted there or come for checkups and are coaxed into donating.
“Mothers who come only for the purpose of donating breast milk are very rare,” Dr. Mondkar said.
Dr. Mondkar is convinced that establishing banks at larger hospitals, which cater to patients from a wide region, would be worthwhile, with some help from the government. In Brazil, for example, there is a national network more than 200 breast milk banks.
“There is a benefit to the baby, the mother, the family to society and the nation,” Dr. Mondkar said. “We really do need them.”
Reporting for this story was supported by the OneWorld-POSHAN Fellowship grant.