With information abounding on the health benefits of breast milk for infants, a growing number of under-producing mothers are eschewing formula and instead turning to online marketplaces to buy breast milk directly from other moms. In the past year, somewhere around 55,000 women sold their excess breast milk online, up from 13,000 in 2011. Business may be booming for sellers, but parents on the buying end really have no idea what they’re feeding their children, and experts are loudly warning that the risks far outweigh the benefits. http://www.dreamstime.com/royalty-free-stock-photos-father-giving-baby-daughter-bottle-milk-home-image37636388Simply put, breast milk sold online has the potential to contain unwanted bacteria or viruses, could come from someone using illegal drugs or nicotine, or may be fraudulently supplemented with cow’s milk. In some cases, it’s all of the above. For now, the U.S. Food and Drug Administration (FDA) does not regulate online breast milk sales, but the agency simply takes the position that parents should not purchase breast milk from strangers online, especially considering that breast milk can transmit anything from flame retardants to HIV. Quantifying the exact risk has been the work of researchers at Ohio State University for several years now. Earlier this month, they released a new study that found 10 out of 100 bottles of breast milk purchased online were fraudulently mixed with cow’s milk. It’s well known that cow’s milk doesn’t offer the nutritional value and antibodies of breast milk, which is why so many parents prize breast milk above formula derived from cow’s milk in the first place. There’s also the risk of the child suffering an unexpected allergic reaction. But, at its core, the study reinforces the fact that parents really don’t know what they’re getting when they buy breast milk from a stranger. And when breast milk sells online for anywhere from $1 to $2.50 per ounce — roughly 100 times more expensive than cow’s milk — there’s an economic incentive to scam. The problems run much deeper than cow’s milk, too, said Jesse Kwiek, Ph.D., associate professor of microbiology at Ohio State and co-author of the cow’s milk study. In 2013, Kwiek’s team at Ohio State released another study that found nearly 75 percent of breast milk purchased online was contaminated with significant amounts of unwanted bacteria and viruses such as Staphylococcus (64 percent), Streptococcus (36 percent), Cytomegalovirus (24 percent), and even Salmonella (3 percent). Even Conan O’Brien mentioned the study in his nightly monologue: “This moves breast milk up to number nine on the list of body fluids you might not want to buy online.” Kwiek sums up the potential problems with buying breast milk online as the “4 Ds”: Disgust (bacteria and viruses), Dilution (cow’s milk), Drugs (both narcotics and pharmaceuticals), and Deception (seller claims to be a non-smoker, for example, but tests show nicotine in the milk). “Bottom line, you just don’t know what you’re getting,” he said. http://www.dreamstime.com/stock-images-closeup-beautiful-baby-nursing-bottle-close-up-photo-girl-drinking-milk-image39246184Without alternatives, online marketplaces meet demand Studies show that breastfeeding supplies infants with an ideal nutritional complement, builds stronger immune systems, and has a lower incidence of disease later in life when compared to children who nurse on formula. But if a new mom isn’t able to produce enough milk on her own, she often has limited options for obtaining it elsewhere. In recent years, online marketplaces such as Only the Breast have emerged to bridge the gap between under-producing mothers and their over-producing peers. Mothers with excess breast milk post classified ads that often include information on the amount of milk they have and their lifestyle habits related to smoking, drinking and eating. “NYC Mom Selling 1,000 Ounces of Frozen Breast Milk,” reads one typical ad.  Another states, “Healthy and active first-time mom. Fresh or frozen available.” For both Ohio State studies, the research teams purchased their samples anonymously on Only the Breast, the largest online marketplace for breast milk. The administrators of Only the Breast post clear advisories to self-pasteurize milk purchased online before feeding it to children. They also provide detailed guidelines for sellers on handling and shipping milk, and they advise buyers to screen their donors by clearly communicating before purchasing any milk. “The vast majority of Only the Breast members are honest, abide by our terms, and are simply looking to provide safe milk for babies in need,” a spokesperson for the company told Food Safety News in an email. Considering that the Ohio State studies used milk purchased anonymously without communicating with the sellers, Only the Breast’s administrators say that might have skewed the results. At the same time, the company does not have any safety measures in place and does not mediate sales in any way. Given that there’s no way to absolutely guarantee safe milk, even with a communicative seller, health experts agree that formula is a less risky alternative than milk purchased online. “When you buy without processing or verification for safety, you’re playing Russian roulette with your child’s health,” said Kim Updegrove, executive director of the Mother’s Milk Bank in Austin, TX, and board member and former president of the Human Milk Banking Association of North America. “With formula, at least the risks are known,” she added. Milk banks can meet only the most critical need The Human Milk Banking Association of North America (HMBANA) is a network of nearly 20 nonprofit breast milk banks in the U.S. and Canada. They provide free breast milk from healthy mothers to babies in the most dire need — namely, premature and severely underweight babies. In fact, their target demographic is babies weighing less than 3.5 pounds. The priority is to reach babies for whom breast milk isn’t just a healthy option, but could make the difference between life and death. “Healthy milk is a scarce resource,” Updegrove said. “It’s the same with heart transplants. You take a scarce resource and get it to the patient who needs it the most.” But infants in critical conditions have essentially no immune system, and so the milk banks go to great lengths to screen donors and test the milk from the few who qualify. First, prospective donors answer questions about their medical history and habits. Ever had hepatitis? Sorry, you’re out. Smoke nicotine products, or drink an average of more than two ounces of alcohol per day, and you also don’t qualify. Taking antibiotics disqualifies mothers, and even herbal supplements scratch you off the list. Mothers who pass the verbal screening get blood work done to check for communicable diseases such as HIV and syphilis. And, finally, if everything is approved, their milk is tested microbiologically and nutritionally before being pooled and pasteurized to eradicate bacteria and viruses. The pasteurized milk receives further testing and is only dispensed after showing zero risk. “Since 1985, when contemporary milk banking was created, we’ve had zero negative outcomes in babies,” Updegrove said. “No one has gotten a cold, not even a fever.” For children who don’t meet that critical criteria, parents have far fewer options. In fact, for many the only option is formula or online breast milk. Even for some children who do have a critical need, donor milk is not always available. Another study from the Ohio State team looked into who was purchasing breast milk online and found that more than 20 percent of parents sought milk for children who were underweight, in poor health, or suffering from a medical condition. Updegrove said that while she deeply sympathizes with parents in that position, formula is still their safer option. HMBANA has plans to expand milk banks to more major cities in the coming months and years. They’re also working on outreach to more healthy mothers who would be capable of donating their milk but may not know how badly the milk is needed. Ultimately, Updegrove said, the plan is to get healthy breast milk to every child who doesn’t have enough. “If every healthy mother gave milk to a milk bank today, we’d be able to offer milk to every infant,” she said. “It’s the one call to action I wish every woman could hear.”