The Human Breast Milk Market
母乳市场
The market for human breast milk starts with demand from hospitals for pre-term infants. The American Academy of Pediatrics writes:
母乳市场起源于医院早产儿对母乳的需求。美国儿科学会写道：
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.
“母乳具有诸多益处，所有早产儿都应当接受母乳喂养。……母亲自身的乳汁，无论新鲜的还是冷冻的，都应该是婴儿的主要食物，而且对于出生时体重低于1.5千克的婴儿，应该在其饮用的母乳中适当添加营养成分。如果在相当程度的泌乳帮助之后，母亲仍无法给婴儿提供母乳，那么就应当使用他人捐献的经过巴氏杀菌法消毒的母乳。”
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.
有些人相信，母乳的某些特性可能对成年人同样有益，这使得对母乳的需求进一步扩大。一些生物医药企业参与了对母乳的研究，同时，在健美圈有种亚文化，认为母乳有助于增强肌肉。
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.
有哪些供给源来满足这些需求呢？来源之一是北美母乳银行协会19个驻地以及其他一些捐赠机构所得到的捐赠。但现在也出现了一些新兴的营利性公司，如“Prolacta生科”和“国际母乳银行”，他们收购母乳，在进行筛选、测试（有时还会添加一些额外的营养成分）后出售给医院。此外，还有一些方便母乳买卖的网站。
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.
这是个价格相当透明的市场：那些营利性企业通常为每盎司母乳向妈妈们支付1.50-2美元，最后以大约每盎司4美元的价格出售给医院。但市场上母乳的数量就没那么透明了，不过从以下数据中可以得到一个大致的概念，非营利组织北美母乳银行协会在2013年配发了310万盎司母乳，然而，今年仅Prolacta一家营利性企业就计划处理340万盎司。
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:
任何同时涉及捐赠和有偿元素的产品都会引来争议，而且，当产品包含来自人体的液体时，争议便会再上一个层次。相关问题包括：
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.
Smith写道：“人们买卖母乳。将母乳和母乳喂养商品化、市场化，存在加剧社会不平等和性别间经济不平等的风险。然而，母乳喂养有潜在的益处，而且一些世界上最贫困的妇女也可能因此获益。现状是，除了捐赠母乳的女性外，人人都会受益，我们如何才能改善这种状况？”这里面有一些观点可供探讨。
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.
首先，母乳供给的大量增加将提升早产儿的预期健康水平。捐赠的母乳数量似乎供不应求。
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.
第二，你很难解释清楚，为何在医疗保健系统的其余参与者都能得到报酬的情况下，母亲们却要挤出乳汁保存起并进行捐赠，而这一切都是无偿的。从实践意义上说，社会选择可能是：要么向医疗保健系统付钱，以解决婴儿因缺乏母乳而导致的疾病，要么向提供母乳的母亲们付钱。
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:
第三，这里涉及了社会不平等这个大问题。今年早些时候，在底特律，一家名为Medolac的公司宣布了一项收购母乳的计划。它收到了一封联名反对的公开信，牵头者是黑人母亲母乳喂养协会负责人。信中提到：
[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.
“我们本着公开对话的精神写这封信，谈谈贵公司近期的计划，你们在底特律招募非洲裔美国女性和低收入女性，让其出售母乳给贵公司——Medolac实验室。你们把目标对准非洲裔美国母亲，并且专注于底特律地区，这些让我们倍感困扰。我们担心这一举措既没有全面考虑母乳共享的历史背景，也没有考虑到底特律家庭所面临的复杂的社会和经济挑战。……全国非洲裔美国女性都面临着巨大的经济困难，我们这座城市中的情形也是如此。此外，历史上对我们非洲裔美国女性身体的商品化，已经让我们遭受过巨大的创伤。我们对女性将出于经济利益而被强迫出售本将用来喂养自己孩子的母乳深感担忧。”
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?
Medolac收回了计划。不去深究这封信的措辞（“商品化”和“强迫”不是在经济学课堂里的意义上使用的），也还有基本的公共卫生问题：鉴于母乳对婴儿健康所起到的至关重要的作用，向母亲们提供金钱上的激励，让她们出售母乳是否合理呢？尤其是当知道这些激励将会对较低收入群体的母亲们产生更大的影响时，其合理性又如何呢？
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;
第四，母乳喂养中的经济选择不可避免地与摆在哺乳期母亲们面前的其他选择复杂地交织在一起。Julie Smith指出，有多种不同因素鼓励母亲们给婴儿提早断奶，例如婴儿配方奶粉和婴儿食品的广告，同时，还有影响产后母亲重回劳动力市场的法律法规。在更全面的背景下反思这些激励，同时着眼于全面鼓励母乳喂养，这可能会在带来母乳喂养增加的同时，也带来母乳捐献供给的增加。Smith写道：
‘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.
“在保护母乳喂养问题上市场失灵是因为市场价格给出了错误的信号。解决过早断奶与最优母乳喂养时间这一问题的经济学方法可能有助于优先考虑全球母道保护，将它作为人力资本及劳动生产力可持续发展的基础。这一方法将消除对母乳替代品的财政补贴，对其征收消费税以补贴医疗系统的成本，并对免费供应、促销和分发母乳替代品的行为进行处罚。通过消除普遍的过早断奶的激励因素，全社会的资源将被更多地用在母乳喂养投资上。”
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.
最后，在一个以互联网为基础的经济体系中——它特别善于将分散的供应商和买家联系起来——购买母乳的市场不可能会消失。至少一部分市场很可能仍会处于灰色地带，比如来自健美者的需求。然而对新生儿和研究而言，让母乳市场的主体走出阴影是有益的，这样它就能受到基本的监管，以确保母乳中不被掺入牛奶、微生物或者其他更不该加入的物质。
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.
如果你想了解有关体液的潜在经济市场的另一个例子，我在《无偿献血，有偿使用血浆》（2014年5月16日）一文中对如何增加血液供应的各种观点做了讨论。一个关于采用新近死亡者的血液作为捐献来源的提议在此：http://www.realclearscience.com/blog/2015/07/a_simple_solution_to_end_blood_shortages.html。
翻译：陈小乖（@lion_kittyyyyy）
校对：沈沉（@你在何地-sxy），慕白（@李凤阳他说）
编辑：辉格@whigzhou