Monetizing human breast milk, recognizing unpaid labor to improve female and infant health

30 Mar 2023 --- If the unpaid labor of human breast milk were to be monetized, it would contribute to an increased GDP while increasing nutritional intake from infants in rewarding life’s first food system, according to an international team of Australia and Vietnam-based researchers. 

By increasing production and creating a new market, we sit down with the study authors on the arising of recognizing such a market as paid labor, and if there are adverse health effects in purchasing breast milk from another person.

“We don’t want to emphasize the monetary value. We want to emphasize the scale of women’s production and productivity for children. That’s not recognized unless you put a number on it, preferably with a dollar sign,” Dr. Julie Smith, honorary associate professor at the National Center for Epidemiology and Population Health, Australian National University, tells NutritionInsight.

“Breastfeeding is not the problem here, poverty is,” says Smith.

“Our attempt to try to value breastmilk is for policymakers – it’s for the ministry of finance, for them to be able to recognize and compensate for the time and effort by women that are breastfeeding,” Roger Mathisen, director of Alive & Thrive East Asia Pacific and FHI solutions innovation incubator, tells NutritionInsight.

Smith says that women should be given the opportunity to choose by taking a more extended leave or having breastfeeding-friendly workplaces.Paid maternity leave
Mathisen stresses that some countries have no paid maternity leave. “In some countries, it’s up to the employers, and that might affect if they hire women or not, creating discriminatory practices around hiring. So it’s important that this is publicly financed.”

“If six months exclusive breastfeeding is recommended, it requires proximity meaning that the mother and baby need to be together, which means paid maternity leave needs to be at least six months,” adds Mathisen.

Smith says that this doesn’t mean that women should be obliged to stay at home for that period but should be given the opportunity to choose by taking a more extended leave or having breastfeeding-friendly workplaces.

“Since 1919, the international labor organization convention on maternity leave has called for paid maternity leave and breastfeeding rights. It’s not a new thing. It has been recognized for over 100 years that women give birth and need leave to protect their and their infant’s health through breastfeeding. It’s essential and well established to millions of women who give birth yearly.”

“Breastfeeding is the pointy end of showing how health and well-being of women and children need to be facilitated with a re-organization and a re-think on workplaces and how we work,” says Smith.

“Breast milk has not been valued as a food, and breastfeeding mothers as producers, but we often hear about farmers when talking about food production. But it’s not recognized that breastfeeding mothers and breast milk are the first food system – and they have not been invested in,” says Mathisen.

“When it’s not measured, it’s not prioritized or invested in,” he emphasizes.

Monetizing for policy
Although the tool puts a value on human breast milk, the researchers stress that they are not suggesting that it should or shouldn’t be bought and sold, but that it is exchanged at a price and fresh milk is the most similar to what mothers themselves would provide.

The study argues that one liter of breast milk is worth US$100, and the lost breast milk annually amounts to US$2.2 trillion.

The tool uses data from official breastfeeding surveys and UNICEF. To give the breast milk monetary value, Smith further explains that “the tool did it as an economist would approach the problem.”The tool calculates potential production as the lost milk, explains Smith.

“The nearest market equivalent is fresh mother’s milk, which milk banks exchange in Norway. This is used because they have a market exchange model within the human milk banking system. They charge a fee, which is around US$100 a liter.”

She details that the Norwegian price for human breast milk is relatively low, as in other countries, it can reach up to US$400 a liter. 

“It’s a lower bound estimate, and it’s not saying that women are buying and selling milk in Norway. It’s simply saying that this is the best market price estimate we can get, the proxy price for breast milk,” says Smith.

The lost milk
The study details the differences between countries in lost volume of milk. Pointing to high-income countries such as Ireland, with 4 million liters produced, 80% of the milk was lost. Additionally, in Norway with 11 million liters, the US with 605 million and Australia with 51 – two-thirds of milk is lost.

Smith explains that the tool calculates potential production as lost milk.

“If 98% of women are unable to breastfeed, which is the case in Norway, but if 98% were able to breastfeed, then this is the lost value. It’s the biological capability as we see it, which is accepted in ethnographic and historical studies.”

“So the lost milk is the difference between what could be produced if women were supported to breastfeed and what is produced,” says Smith.

“Global production was around 35.6 billion liters a year. This represents just under half the potential production if women and children 0–35.9 months were universally enabled to breastfeed optimally. Valuing the lost milk at around US$100 a liter represents a monetary loss of production of US$2.2 trillion annually,” the study reads.

Mathisen stresses that misinformation about infant formula and exploitative marketing are barriers to breastfeeding.Risks versus benefits
While highlighting that women have been breastfeeding other women’s children for millennia and that it’s still a common practice in certain countries, Smith further details that exchanging milk carries risks.

“It has to be pasteurized because bacteria grow in milk and can be transmitted. Some specific viruses can be passed on in milk, but it’s possible to pasteurize it, including at home – you remove them.” 

“On balance, it’s nearly always better for the mother to give the baby human milk than commercial milk formula because of the whole range. You will need to get the epidemiology in perspective,” adds Smith. 

Studies conducted in Western countries show that women regulate who they take milk from, and exchange is more common at the local level. When questioned if this is a safe practice, Smith says it depends on various factors, such as how old the infant is.

“The milk must be super safe if it’s a premature baby. Especially for vulnerable babies if we are talking about milk banking. If it’s a nine-month-old that needs extra milk because the mother has returned to work, it’s a healthy baby, and if she knows the person, there might still be risks, but those risks need to be put in comparison to the risks of not breastfeeding.”

Mathisen further details barriers to breastfeeding, such as the labor market and misinformation about infant formula, as exploitative marketing has led parents to think it is good.

“Parents are being bombarded with inappropriate marketing and misinformation about baby formula or commercial milk formula, but also pacifiers and feeding bottles, directly competing with human breast milk. That’s a US$55 billion industry with billions of dollars in the marketing budget.”

“Then we can look at the small amount of money that goes to protecting, promoting and supporting breastfeeding. That’s why it needs to be regulated, because it’s not fair. They [the industry] seek commercial profit while we seek improved public health outcomes,” Mathisen notes. 

By Beatrice Wihlander