Saving African babies’ lives by banking mothers’ milk

Inside a tidy mint-green room in an old industrial park in Johannesburg, a row of freezers hums and sighs. Behind them, a silver machine the size of a dishwasher sloshes hot water over three dozen bottles of milk. A sign on the wall signals the room’s raison d’être.

Breastmilk is nature’s health plan, it reads. 

Around the world, milk banks like this one have sprung up as a solution to a public health issue that’s straightforward in itself but complicated to tackle. Breast milk can make the difference between life and death for many babies around the world, particularly those born prematurely. But getting that milk from point A – mothers who have more than they need – to point B – babies whose mothers don’t produce enough – can be expensive and complicated. 

“It’s a huge undertaking,” says Emily Njuguna, a pediatrician and public health specialist who helped set up Kenya’s first human milk bank at Pumwani Maternity Hospital, a public hospital in Nairobi. Bureaucrats initially scratched their heads at her pitch. Expensive imported pasteurization machines broke down and then sat unused for months. Big bills for milk collection, medical testing, and storage gobbled up limited funds. “But the benefits have been immense,” she says. 

Globally, scientists estimate that breast milk, with its one-two punch of nutrients and immunity-boosting agents, could save the lives of more than 800,000 babies and young children every year. In sub-Saharan Africa, which has the highest infant mortality of any region in the world, its benefits could make a particularly large difference.  

“It should make us all angry that in the countries around the world where we have the highest number of pre-term and low-weight newborns, there is also the lowest number of milk banks,” says Kiersten Israel-Ballard, a mother-and-child expert at the global health nonprofit PATH. 

Brazil leads the way

Indeed, a quick glance at a map of the world’s milk banks reveals this inequality starkly. There are hundreds of milk banks scattered across Europe, but only seven African countries – South Africa, Angola, Mozambique, Kenya, Uganda, Cameroon, and Cape Verde – host even a single operational bank.

“I saw a huge gap,” says Chinny Obinwanne, a Nigerian doctor who is in the process of setting up her country’s first milk bank in Nigeria’s commercial capital, Lagos. 

She was inspired to create a bank in part by a sobering statistic: In Nigeria, 1 out of every 8 children never reaches the age of 5. The country has the highest number of newborn deaths in Africa. Working as a lactation consultant, she thought that donated breast milk could make a dent in that problem by helping the most vulnerable – premature babies. It “gives them a higher chance of survival,” she says. 

For African health care systems trying to set up milk banks, there’s one country that stands out as a global exemplar – Brazil. 

Today, a full 30% of the world’s milk banks are located in Brazil, and they are considered a major factor in the country’s steep decline in child mortality, which plunged more than 70% between 1990 and 2013.

That story began in the mid-1980s, when a team of Brazilian officials led by a chemist named João Aprígio Guerra de Almeida set out to revamp a floundering milk bank system. 

They started by eliminating payments in exchange for donated milk, which had encouraged many impoverished women to sell milk they should have been feeding to their own babies. Then they made donation and supply simple, setting up hundreds of collection points and even enlisting firefighters to ferry donations from women’s homes to hospitals.  

When Mr. Almeida crunched the numbers, he found that medical-grade glass bottles to store milk were consuming more than 80% of his budget – so he replaced them with mayonnaise and coffee jars. He also swapped out imported pasteurization machines for locally made devices at a fraction of the cost.

And then he and his team went on a PR blitz. They enlisted popular soap opera actresses to explain the process and benefits of milk donation and persuaded the president to give a speech endorsing it. Flyers went out with the mail, and a toll-free hotline connected donors to couriers who collected milk straight from their homes.  

“The thing that really stands out in Brazil’s model is they said, ‘this isn’t about creating milk banks – it’s about creating a bigger system that supports lactating moms,’” says Dr. Israel-Ballard. Indeed, the country’s milk banks are housed inside “breastfeeding promotion centers,” which also provide advice and training to mothers who are struggling with breastfeeding. 

In recent years, Brazil has taken its milk bank show on the road, helping to set up banks in Portuguese- and Spanish-speaking countries around the world – including in Africa. But many gaps remain. 

Literally a lifesaver

In Nigeria, Dr. Obinwanne watched in 2021 as a friend of a friend died in childbirth, leaving premature triplets behind. She scrambled to find breast milk for the babies among her clients and friends, but two of the newborns died before she could test and distribute the milk. “I felt like I had failed those babies,” she says.

So she began pouring her own money into setting up the infrastructure of a bank, buying freezers and equipment to pasteurize milk. Late last year, she began to collect breast milk, but since the milk bank isn’t linked to any hospitals or clinics, she has struggled to spread the word about it to those who most need it. Only one woman has used the service so far.

For milk banks in other African countries, getting early buy-in from local health care systems has been crucial. Each year, for instance, the South African Breastmilk Reserve (SABR) in Johannesburg distributes milk to about 4,000 babies in neonatal intensive care units at public and private hospitals across the country.

On a recent morning, as milk underwent pasteurization in the next room, the SABR’s director spoke on the phone to a donor about her impact.

“You’ve helped save 26 babies so far,” Stasha Jordan said.

“Wow, that’s amazing,” said René Rheeder, an information technology professional who gave birth to her second son late last year. “I know that for these babies, this is going to be their kick-start in life.”