The Human Breast Milk Market
The market for human breast milk starts with demand from hospitals for pre-term infants. The American Academy of Pediatrics writes:
The potent benefits of human milk are such that all preterm infants should receive human milk. … Mother’s own milk, fresh or frozen, should be the primary diet, and it should be fortified appropriately for the infant born weighing less than 1.5 kg. If mother’s own milk is unavailable despite significant lactation support, pasteurized donor milk should be used.
The demand then continues with a belief that human milk might have properties that are useful to adults as well. Some biomedical companies are involved in research, and there is apparently a subculture of bodybuilders who believe that consuming human milk helps them build muscle.
What are the sources of supply to meet this demand? One source is donations that happen through the 19 locations of the Human Milk Banking Association of North America, as well as other donor organizations. But there are also for-profit companies emerging like Prolacta Bioscience and International Milk Bank which buy breast-milk, screen and test it, sometimes add additional nutrients, and then sells it to hospitals. There are also websites that facilitate buying and selling breast-milk.
This market is one where prices are fairly clear: the for-profit companies typically offer moms $1.50- $2 per ounce for breast milk, and end up selling it to hospitals for roughly $4 per ounce. Quantities are less clear, although for a rough sense, the nonprofit Human Milk Banking Association of North America dispensed 3.1 million ounces of breast milk in 2013, while a single for-profit firm, Prolacta, plans to process 3.4 million ounces this year.
Any product that involves a mixture of donated and paid-for elements is going to be a source for controversy, and when the product involves fluids from the human body, the controversy is going to ramp up one more level. Here are some of the issues:
Many people have a gut-level reaction that human breast milk for neonatal children is the sort of product that should be run on the basis of donations. But two concerns arise here, as enunciated by Julie P. Smith in “Market, breastfeeding and trade in mother’s milk,” which appears earlier this year in the International Breastfeeding Journal (10:9).
许多人都有一种直觉反应，他们认为提供给新生儿的母乳应当是一种基于捐赠的产品。但正如Julie P. Smith在今年早些时候发表于《国际母乳喂养期刊》（10:9）上的文章《母乳的市场、喂养和交易》所表明的，这会带来两个问题。
As Smith writes: “Human milk is being bought and sold.Commodifying and marketing human milk and breastfeeding risk reinforcing social and gender economic inequities. Yet there are potential benefits for breastfeeding, and some of the world’s poorest women might profit. How can we improve on the present situation where everyone except the woman who donates her milk benefits?” There are a number of ideas to unpack here.
First, a substantially expanded supply of breast-milk would improve the health prospects of pre-term infants. Donated breast-milk doesn’t seem able to fill the need.
Second, it’s not clear why mothers should be expected to pump, save and donate breast milk for free, when the rest of the health care system is getting paid. In some practical sense, the social choice may come to paying the health care system to address the sicknesses that infants experience from a lack of breast milk, or paying mothers for breast milk.
Third, there are real issues here involving social inequalities. Earlier this year in Detroit, a company called Medolac announced a plan to purchase breast milk. It received a hostile open letter with a number of signatories, starting with the head of the Black Mothers’ Breastfeeding Association. The letter read, in part:
[W]e are writing to you in the spirit of open dialogue about your company’s recent attempts to recruit African-American and low-income women in Detroit to sell their breast milk to your company, Medolac Laboratories. We are troubled by your targeting of African-American mothers, and your focus on Detroit in particular. We are concerned that this initiative has neither thoroughly factored in the historical context of milk sharing nor the complex social and economic challenges facing Detroit families. … Around the country, African-American women face unique economic hardships, and this is no less true in our city. In addition, African American women have been impacted traumatically by historical commodification of our bodies. Given the economic incentives, we are deeply concerned that women will be coerced into diverting milk that they would otherwise feed their own babies.
Medolac withdrew its proposal. Without getting into the language of the letter (“commodification” and “coercion” are not being used in the sense of an economics class), the basic public health question remains: Given the very substantial health benefits of breast milk for infants, can it make sense to offer mothers a financial incentive to sell their breast milk? Especially knowing that this incentive will have greater weight for mothers in lower income groups?
Fourth, the economic choices involves in breastfeeding are inevitably intertangled with other choices that face nursing mothers. Julie Smith points out that there are a variety of incentives to encourage early weaning of infants, like the promotion of infant formula and baby food products, combined with laws and rules affecting how quickly new mothers will re-enter the workforce. Reconsidering these incentives in a broader context, with an eye to encouraging breastfeeding in all contexts, could potentially lead both to more breastfeeding and to greater supplies of donated breast milk. Smith writes;
‘The market’ fails to protect breastfeeding, because market prices give the wrong signals. An economic approach to the problem of premature weaning from optimal breastfeeding may help prioritise global maternity protection as the foundation for sustainable development of human capital and labour productivity. It would remove fiscal subsidies for breast milk substitutes, tax their sale to recoup health system costs, and penalise their free supply, promotion and distribution. By removing widespread incentives for premature weaning, the resources would be available for the world to invest more in breastfeeding.
Finally, in an internet-based economy that excels at connecting decentralized suppliers and buyers, there is no chance that the paid market for breast milk is going away. At least some of the market–say, the demand from body-builders–is likely to remain shadowy. But for neonatal infants and research purposes, it is useful for the bulk of the breast-milk market to come out of the shadows so that it can be subject to basic regulations, assuring that the breast milk isn’t adulterated by cow’s milk, microbes, or worse.
If you’d like another example of the potential for economic markets in bodily fluids, I discuss the arguments concerning how to increase the supply of blood in “Volunteers for Blood, Paying for Plasma” (May 16, 2014). A proposal for using the recently dead as a source of blood donations is here.