A need for the inclusion of human milk sharing in infant feeding policy: A scoping survey

This research project explored infant feeding policies across the UK within health visiting services for the inclusion or exclusion of human milk sharing, and the level of knowledge and understanding of practitioners around this topic.

A mother and father (faces out of frame) bottle-feeding a baby

Overall, there is a lack of confidence in discussing peer milk sharing, and a lack of support in local policies that encourage and support such conversations. Recommendations for future practice are sought to help overcome stigma and taboo and to ensure that all parents can make an informed choice around feeding their babies.

Human milk is best for human babies, and the World Health Organisation (WHO) (2011) recommend that all babies receive breast milk for the first six months exclusively and then for two years to ensure optimum growth and development.

If a mother is unable to breastfeed, donor milk is recommended by the WHO before artificial milks are considered. In fact, many women wish to obtain donor milk for their babies when they are not able to provide this themselves (O’Sullivan, Geraghty and Rasmussen, 2018).

Human milk sharing is not a new concept and occurs today via regulated milk banks and unregulated online milk sharing sites. UK milk banks emerged in around 1985 as non-profit organisations to offer pasteurised milk to those wanting to use donor milk.

In the UK today, there are 15 regulated human milk banks (UKAMB, 2023), mostly situated in NHS hospitals, all affiliated with the Associations of Milk Banks, and all adhering to the National Institute for Health and Care Excellence (NICE) Guidance for Milk Banking: service information (NICE, 2010).

However, it is estimated that over 130,000 mothers participate in online milk-sharing networks (Perrin, Tigchelaar, Goodell, Allen and Fogleman, 2014), with tens of thousands of milk-sharing exchanges worldwide facilitated through websites annually (Gribble, 2014).

Keim et al. (2014) suggested that milk sharing is considered by 25% of women. However, there is a stigma around human milk sharing which can make people feel uncomfortable (Tomori, Palmquist & Dowling, 2016).

Whilst nurses work autonomously, they work under the Nursing and Midwifery Council (NMC) Code of Conduct (2019) which states that nurses must ensure that patients/clients can make informed choices.

However, with stigmatised topics, conversations can be very difficult, but addressing stigma is fundamental to delivering quality healthcare and achieving optimal health (Nyblade, Stockton, Giger et al., 2019), as stigma is a barrier to care (Katz, Ryu, Psaros et al., 2013).

To support conversations with patients/clients, professionals should be offered guidance through local policies (NMC, 2023). Professionals are then able to work within best practice guidance and the evidence base to provide safe and effective care.

This research aimed to explore infant feeding policies across the UK within Health Visiting services. It provides a snapshot in time, asking professionals what information and support they have in policy to support discussions around milk donation, and then their own level of knowledge and understanding of human milk donation.

This research is a scoping exercise to ascertain practices across the country and makes recommendations for future practice.