Figure 1
The challenges observed in the functioning of the Aanchal mother milk banking practices.
Table 1
Matrix Elaborating Levels of Facility-Based Lactation Management Centers in Public Healthcare System
| CLMC* | LMC† | LSU‡ | |
|---|---|---|---|
| Other Name | Tertiary Milk Bank | Mini Milk Bank | Milk Storage Unit |
| Infrastructure | Elaborate setup for heterologous milk collection, screening, processing, storing and distributing DHM§. | Setup with homologous milk collection, storage and dispensing of milk for consumption by her baby. | Setup to store small quantity of processed milk on a consumption basis. |
| Location | Medical College with NICU¶ or Large District Hospital | District Hospital /Subdistrict Hospital /First Referral Units (FRUs) with functional SNCU# | At Subdistrict Hospital /CHC/PHC with high case load NBSU**. (all delivery points) |
| Complexity and Resource Intensity | Highest | High | Low |
| Responsibility | Act as an ancillary support to the Baby Friendly Hospital Initiative (BFHI). Act as a supply unit for Milk Storage Unit. | Provide lactation support to all mothers within facility. | To maintain continuum of care by providing round the clock breastfeeding support, lactational counselling and Kangaroo Mother Care (KMC) support to mothers. |
| Recommended Space | Approximately 350 square meters | Approximately 160 square meters | Any identified space for breastfeeding as per Mother Absolute Affection (MAA) guidelines. |
| Recommended Minimum Bedded | 20 bedded NICU along with SNCU | 12 bedded SNCU | High caseloads NBSU |
| Recommended Full-time Staff | Manager (1) Lactation Support Staff (5) (only female staff) Technician (1) | Lactation Support Staff (2) (only female staff) | No dedicated human resource. |
| Recommended Part-time Staff | Microbiologist (1) Hygiene Helper (one per shift) | Hygiene Helper (1) | |
| Recommended Existing Staff in facility to be utilized | Neonatologist (2) | Neonatologist (2) | FIMNCI Nurse†† and Doctor in-charge NBSU |
| Set-up cost (One time) | Rs. 33,114,00/- | Rs.9,75,000/- | Cost of deep freezer, foot-operated basin, glass bottles if not already available. |
| Recurring cost Per annum | Rs. 14,76,000/- | Rs.4,65,000/- | - |
[i] *CLMC-Comprehensive Lactation Management Center
†LMC-Lactation Management Center
‡LSU-Lactation Supply Unit
§DHM-Donor Human Milk
¶ NICU-Neonatal Intensive Care Unit
#SNCU- Sick Newborn Care Unit
**NBSU- New Born Stabilisation Unit
††FIMNCI- Facility based Integrated Management of Neonatal and Childhood Illness.
Reference: National Guidelines on Lactation Management Centers in Public Health Facilities, Child Health Division, Ministry of Health and Family Welfare, Government of India (2017)
| Sub-Categories | Verbatims |
|---|---|
| A. SYSTEM CHALLENGES | |
| “I came along with my mother-in-law. She is in her 60s. | |
| Structure | There is no sitting arrangement for her.” (M) |
| “Sometimes we try to manage activities at our own cost. | |
| There is always a shortage of recurring funds.” (H) | |
| Financial Support | “There should be the provision of the separate pool to protect established milk banks through constant funding.” (H) |
| “Mothers often fail to maintain hygiene which leads to contamination of the donated milk.” (H) | |
| “Every drop of milk is precious for a sick infant. We | |
| Operational process | screened all mothers and keep all hygienic practice throughout the process.” (H) |
| “Mothers post-pregnancy are weak and lethargic. Long waiting period makes them tired. They should be provided some refreshment.” (H) | |
| “During COVID times, families fear the risk of transmission of the virus. We were helpless in lack of any Disaster Management plan and frequently changing guidelines.” (H) | |
| Technical Process | “The laboratory should be functional inside mother milk bank with strong monitoring framework to ensure safety and avoid contamination.” (H) |
| “We filed complaints a couple of times for improper functioning of equipment, but nobody replies.” (H) | |
| Quality Maintenance | “Systematic database management is lacking.” (H) |
| “There is a lack of systematic communication channel for problem-solving.” (H) | |
| Human Resources | “It takes few minutes to counsel mother and families about benefits of donated human milk over formula feed. But there is the shortage of staff.” (H) |
| “To run mother milk bank efficiently, there is need of dedicated staff.” (H) | |
| Demand-Supply Ratio | “Donated human milk is a blessing for the child with no mother. We promote and encourage the mother to donate extra milk for orphans and abandoned child.” (H) “Motivating mothers to return for a donation once they leave hospital premises is challenging.” (H) |
| “I lost my baby. I want to donate milk to help other mothers with less milk, feed her baby properly. It is satisfying and provides peace.” (M) | |
| Knowledge about DHM & MMB | “Donating milk is an act of kindness. It will not only help me express more milk but will also help someone else’s baby to get food.” (M) |
| “Expressed milk should be discarded after few hours as it loses its properties.” (H) | |
| “We promote exclusive breastfeeding as this keeps child thriving and away from infection.” (H) | |
| “If I’m convinced that donating mothers are strictly screened…I don’t have any issue using donated milk for my baby.” (M) | |
| “If no judgment is passed, I will be happy to assist a mother feed her baby.” (M) | |
| Attitude (Willingness /Unwillingness to | “My milk is only for my child. It symbolizes my love for my child.” (M) |
| donate /utilize DHM) | “It sounds insane. How can I feed my child with someone else’s milk of other caste or no cultural values? What if my child inherits their values?” (M) |
| “I wish to donate, but fear my in-laws. They don’t allow me, saying that first feed own child properly instead of donating.” (M) | |
| “My relative donated when she was lactating. She motivated me to do so.” (M) | |
| “One family directly came to us enquiring for donated milk. | |
| We counseled them and gave lactational support to the mother and it had been successful. One should understand | |
| Practices (Barriers/ Influencers) | DHM isn’t a replacement of breastfeeding” (H) |
| “Some communities are rigid. They treat milk banking practices as sin. We need to educate them” (H) | |
| “Some mothers hide their breastfeeding problems. Fear of in-laws is a major contributing factor to this behavior.” (H) | |
| B. COMMUNITY-RELATED CHALLENGES | |
| “In our culture, feeding our child with someone else’s milk is a bigger obligation. We can’t bear this loan” (M) | |
| Awareness/Motivation | “Donated milk is not safe. It is a combination of milk of various mothers. Who knows if any one of them is infected? |
| We can’t take chance with our son.” (M) “Public leaders must take this agenda in community and create awareness” (H) | |