Dr. Karleen Gribble: Biomedical Ethics and Peer-to-Peer Milksharing

Biomedical Ethics and Peer-to-Peer Milksharing

Human Milk News is honoured to host this guest post by Dr. Karleen Gribble, adjunct research fellow in the School of Nursing and Midwifery at the University of Western Sydney. This post is an adaptation of a PowerPoint Presentation outlining Dr. Gribble's application of six ethical principles to health worker / patient interactions in the area of peer-to-peer milksharing. 

Photo: Bart Everson

Health authorities in Canada, the US and France have publicly warned parents not to feed their babies peer-shared milk. Many health workers are unsure about how to respond to mothers who are considering being involved in peer-to-peer sharing of milk. Applying the principles of biomedical ethics to the problem may assist in guiding action.

Biomedical ethics can be used to explore actual or anticipated dilemmas in medicine and find reasoned, consistent, and defensible solutions to moral problems.

Principle 1: Autonomy- individuals should be supported to make health care decisions free from deceit, duress, constraint and coercion.

Health Workers are obliged to provide individuals with the information they need to make informed decisions. Limiting of information for the “good of the patient” is paternalistic and interferes with autonomy. Information should only be withheld in very limited circumstances: if the health worker believes that the sharing of information might seriously harm the physical or mental health of the individual or if the individual states that they do not want the information.


Principle 2: Veracity- patients and health workers must be honest with each other.

When parents seek information about alternatives to a mother’s own milk, health workers must discuss all alternatives including infant formula, banked donor milk, peer-to-peer shared milk and wet nursing in an unbiased and non-judgmental way.

Parents must discuss consideration or actual involvement in milk sharing with their health workers.

Policies that prohibit discussing the option of peer-shared milk with mothers could be considered as breaching the ethical principles of autonomy and veracity. They are also dangerous.


Principle 3: Beneficence- minimization of harm and risk and promotion of good outcomes.

The interpretation of “good outcome” depends upon the specifics of a situation and the beliefs and values of the individual. Individuals seeking health care are those who define “good outcome.”

In peer-to-peer milk sharing, beneficence might involve health workers providing information or directing the patient toward information on the correct way of storing and dispensing expressed breast milk or on flash heating or on medications and milk. It might also involve facilitating the sharing of medical records between milk donor and recipient.


Principle 4: Nonmaleficence- active avoidance of harm to the patient.

A health worker who dismisses, mocks, berates or derides an individual seeking advice or information about milk sharing and so humiliates or belittles them could be considered as having breached the principle of nonmaleficence.

A health professional who withdraws care from a mother or child because they wish to be involved in the peer-sharing of milk and does not ensure that appropriate alternate care is available could be considered as having breached the principles of nonmaleficence and the principle of autonomy.


Principle 5: Confidentiality- health providers must not reveal private information without consent.

While sharing of medical records may assist in reducing the risks of peer-sharing of milk, donor records cannot be shared with a potential recipient without the consent of the donor.


Principle 6: Justice- individuals must be treated fairly.

Aspects of justice to consider in the distribution of resources include: distribution equally, or according to need, effort, contribution, merit or notwithstanding ability to pay.

The application of Justice to milk sharing has proven contentious in North America where donor milk banks are experiencing shortages of milk.

Milk banks distribute according to need but payment is required.

Peer-to-peer donors distribute for free and to those who do not qualify for banked milk.

Both groups are applying justice but neither application is unproblematic. Such conflict is not uncommon in biomedical ethics and indicates that further discussion between the players involved is necessary.

Health workers cannot ignore, dismiss, discount or demonize peer-sharing without acting unethically. What then should they do?

• Educate themselves about the various options for infant feeding including the benefits, risks and costs of each option and the ways in which the risks and costs might be managed, reduced or eliminated 

• Be open and honest with mothers about each option and refrain from using pejorative terminology in relation to any option 

• When speaking to the media ensure that information is provided in such a way that it cannot be used to portray breastmilk as inherently dirty and dangerous and that the risks associated with other alternatives to mothers' own milk are considered.

Dr. Karleen Gribble is an adjunct research fellow in the School of Nursing and Midwifery at the University of Western Sydney. Dr. Gribble's research interests include adoptive breastfeeding, long-term breastfeeding, the impact of culture on breastfeeding, non-nutritional aspects of breastfeeding and models of care for newly adopted post-institutionalised children. Karleen speaks and publishes widely on these subjects to lay and professional audiences. Karleen is also active in advocacy and teaching in the areas of infant feeding in emergencies and the marketing of infant formula. In 2011 Human MIlk News profiled Dr. Gribble's research on infant feeding in emergencies in the developed world in #FirstWorldProblems, Are We Doing Enough to Protect Infants in Emergencies? Dr. Gribble has co-authored several papers on milksharing:

Biomedical Ethics and Peer to Peer Milk Sharing - Karleen D. Gribble, BRurSc, Ph.D., Clinical Lactation 20212

Milk sharing and formula feeding: Infant feeding risks in comparative 

perspective?  

Karleen D. Gribble, Bernice L. Hausman,  Australasian Medical Journal, 2012

Milk sharing: from private practice to public pursuit James E Akre, Karleen D Gribble and Maureen Minchin International Breastfeeding Journal, 2011

The World Milksharing Week 2012 Blog Carnival is hosted by Milk Junkies blogger Trevor MacDonald.

Participants:

Milk-Sharing: Safe Infant Feeding and Being a Human - Sustainable Mothering - Jake Markus 

The Lorax and Other Milksharing stories - MatriciativismoenelsigloXXI Jesusa Ricoy-Olariaga

Winning the milk lottery - PhD in Parenting,  Diana West, BA, IBCLC

Scared Milk-less - Peaceful Parenting - Lisa Van den Hoven

Overcoming Difference Through Milksharing - Milk Junkies, Trevor MacDonald

Biomedical Ethics and Peer-to-Peer Milksharing - Human Milk News, Karleen Gribble 

A Story of Peace and Healing - Normal, like breathing, Diana Cassar-Uhl

Milksharing and La Leche League - Feed the Baby LLC, Laura Spitzfaden

Supporting Families in Milksharing as an International Board Certified Lactation Consultant -  Nourish Breastfeeding Support, Amber Rhotan McCann 

"I wish I'd Known About Milksharing When..." - Complete Wellness Concept, Dinnae Galloway

Waiting for Milk Banks: A Matter of Life or Death - Human Milk News, Jodine Chase 

Powerful Images: Supplementing with Donor Milk - DoubleThink, Paa.la, Paala Anderson Secor

What is World Milksharing Week - Dinnae Galloway

 

Roby's Story - mom regains supply and goes on to donate

Human Milk News is featuring a milksharing story every day leading up to

World Milksharing Week 2012 (Sept. 24-30)

This story (which is posted in Spanish but you can use Chrome's translate feature to read it in English) is about a mom who used an at breast supplementer when her milk supply wasn't sufficient. She received donor milk and at the age of five months her child started to refuse the supplementer but still wanted to breastfeed. She discovered she was able to meet all his needs at the breast. Then, as time went on she discovered she has a surplus and was able to donate to another family!

Roby at his mother's breast, donor milk via an at breast supplementer.

Roby's StorySeptember 5, 2012 | Filed under: Stories and tagged with: WMW 2102My story begins with shared milk natural birth of my son, Roby. I suspected that perhaps would not have enough milk for him (never produced enough milk for my first baby), but I had a natural birth to increase chances of success in breastfeeding.He grabbed the breast immediately after birth, and was nursed when wanted from that time forward.... more

Surrogate mom describes her milksharing experiences

Human Milk News is featuring a milksharing story every day leading up to

World Milksharing Week 2012 (Sept. 24-30)

A surrogate mom provides milk for the child she birthed, and has milk to spare for the child of an adoptive mom. She also donates and wet-nurses a child whose mother cannot produce milk. Read what happens when she runs into this milk baby a year later!

Tiffany ~ Surrogate Mother and Donor (Canada)
September 7, 2012 | Filed under: stories and tagged with: WMW 2012It all started with a beautiful baby girl, S. As a gestational surrogate, I gave birth to S in 2010. S’s parents and I agreed enthusiastically that breastmilk would give S the best start in life, so after nursing S at the breast for the first 8 days of her life, I committed to pumping for the next several months. So began a daily routine that totalled 3 hours of pumping time, and weekly trips to the courier depot, to ship the Liquid Gold half way across the country. But my milk came in with a fury, and I had milk to spare.

Madre de leche - hijo de leche - from Uruguay

Human Milk News is featuring a milksharing story every day leading up to World Milksharing Week 2012 (Sept. 24-30)

Milksharing in Uruguay - read about Raquel's difficulty breastfeeding after breast reduction surgery and how she reached out to a doula friend who plugged her into a network of milk sharing mamas - "madre de leche" - who gave her milk to supplement what she was able to provide from her own breasts.

Raquel and San ~ Recipient: Much More Than Milk, Much More Than Breast, Uruguay
September 11, 2012 | Filed under: stories and tagged with: WMW 2012 | EditMuch more than milk, much more than breast.
I had a breast reduction operation 17 years ago.  I was told then that I could not breastfeed (who cared!).  Our bodies are amazing and when San was born I put him on my breast and I saw that I had some colostrum.  That was it.  I was determined to breastfeed him, even if it meant seeing my mother crying by my side telling me that my baby was going to starve to death.  The truth is that after 9 days, the baby had lost too much weight.

World Milksharing Week 2012 Blog Carnival!

Everyone loves a Carnival. This year Trevor MacDonald is hosting the World Milksharing Week 2012 Blog Carnival over on his "Milk Junkies" site. Do you have a blog in you about milksharing? Connect with Trevor, write a blog, he'll host it on his site, you'll host it on yours, you'll get to put up this Carnival Participants badge on your site, there will be links to other blog posts and it'll be one big happy.... carnival!

Participants:

Milk-Sharing: Safe Infant Feeding and Being a Human - Sustainable Mothering - Jake Markus 

The Lorax and Other Milksharing stories - MatriciativismoenelsigloXXI Jesusa Ricoy-Olariaga

Winning the milk lottery - PhD in Parenting, Diana West, BA, IBCLC

Scared Milk-less - Peaceful Parenting - Lisa Van den Hoven

Overcoming Difference Through Milksharing - Milk Junkies, Trevor MacDonald

Biomedical Ethics and Peer-to-Peer Milksharing - Human Milk News, Karleen Gribble 

A Story of Peace and Healing - Normal, like breathing, Diana Cassar-Uhl

Milksharing and La Leche League - Feed the Baby LLC, Laura Spitzfaden

Supporting Families in Milksharing as an International Board Certified Lactation Consultant -  Nourish Breastfeeding Support, Amber Rhotan McCann 

"I wish I'd Known About Milksharing When..." - Complete Wellness Concept, Dinnae Galloway

Waiting for Milk Banks: A Matter of Life or Death - Human Milk News, Jodine Chase 

Powerful Images: Supplementing with Donor Milk - DoubleThink, Paa.la, Paala Anderson Secor

What is World Milksharing Week - Dinnae Galloway

Human Milk News is featuring a milksharing story every day leading up to World Milksharing Week 2012 (Sept. 24-30)

Loralea and Emmalea

Loralea conceived her daughter Emmalea while undergoing chemotherapy for cancer. Yet, Emmalea was born healthy and Loralea breastfed her until the news of her cancer recurrence when Loralea was just two months old. She need more chemotherapy but was devastated to realize harmful chemotherapy chemicals would transfer through her breastmilk to her daughter. She would be unable to breastfeed and couldn't even continue her breastfeeding relationship by feeding Emmalea with an at-breast supplementer. She was heartbroken. Then she learned about milksharing from her lactation consultant and put out a request for donor milk.... read what happened next.

Loralea and Emmalea’s Story ~ Chemo = No SNS, TX, USA | August 25, 2012 
A year and a half ago I was diagnosed with stomach and uterine cancer. As if that wasn’t hard enough news to swallow, during the following days I learned that that my ability to have children after my treatment was going to be next to impossible. My gynecologist approached me about the possibility of freezing my eggs, but my oncologist was vigilant about starting cancer treatments as soon as possible, noting that the egg freezing process can sometimes be a very lengthy process. Fortunately, I’d been blessed with a son, James, who was nearing 5-years-old at the time, so I comforted myself by the fact that I had him, and nothing was really lost....more

Toronto's pending milk bank sparks controversies over delays leading to baby deaths, and who should get the milk

 

Toronto is finally getting a donor human milk bank, and it is not without controversy. Questions have been raised over how many babies have died in the six years it has taken for the milk bank to open, and now a family in Ottawa wants the milk bank to provide donor human milk for healthy, term babies as well as the premature babies it intends to serve.

The milk bank is scheduled to open this fall, six years after it was first proposed and a year after the Toronto government committed $1.2M towards it, reports the Toronto Star. The Star doesn't pull any punches: donor human milk could have saved the dozens of babies who died from necrotizing enterocolitis (NEC) while the milk bank was in the planning and research stages. The Star notes a milk bank in Calgary was up and running just 16 months after it was first proposed. The Star's story has triggered an opinion column in one of Canada's national dailies, the National Post, slamming the Ontario health care system for taking so long to establish the facility. Meanwhile, CBC reports, the mother of a healthy term infant in Ottawa who was unable to breastfeed arranged and paid for donor milk from another milk bank. She wants the Toronto milk bank to serve families with healthy children who can't receive their mothers' own milk, as well as the very low birth weight preemies and babies with bowel disorders the bank intends to target. CBC quotes Ottawa neonatologist Brigitte Lemyre who says, essentially, donor milk is a scare resource and the sickest babies should receive priority. CBC reports Lemyre also says there is no evidence donor milk benefits healthy babies. 

Calgary Mothers' Milk Bank's Facebook photo album tells the story - from equipment move-in day March 1 to the first official donation March 18 and the first delivery of pasteurized donor human milk to the Foothills Hospital on April 13 - 6 weeks.

The baby deaths in the years it took for Toronto's milk bank to get off the ground are a tragedy and the resulting controversy is likely to overshadow the issue of who should receive donor milk once milk banks are re-established across Canada. 

The delay in establishing the Toronto milk bank was one of the catalysts for the creation of milksharing communities on Facebook two years ago. Canadian breastfeeding advocate Emma Kwasnica and her network of moms from around the world decided to take matters into their own hands. Mothers were clamouring to donate, and were frustrated at being told there was no demand for their extra milk - instead of pouring it down the drain, they started offering it to families in need in their communities. They turned to the networking solutions of their generation to match families in need with mothers who had extra milk, and the resulting global Facebook milksharing network made news in the fall of 2010. 

Some health care professionals, concerned about possible risks of milksharing and realizing increased pressure on milk banks from NICUs was making less milk available to babies in the community, found themselves assuring mothers of healthy infants that infant formula is just fine for their babies. This of course is contrary to the messaging breastfeeding advocates have worked hard for decades to get out to the general public. Breast is not best, it's normal, and formula is not fine, it comes with increased risks for all babies, with of course the sickest being at most risk. 

One concern at the time was that the popularity of milksharing might reduce the number of moms who donate to milk banks. That concern appears to be unfounded, but when there is a shortage of donor milk in hospital freezers, or when policy glitches or funding issues keep the sickest preemies from receiving donor milk, emotions naturally run high.

On the eve of WorldMilksharing Week (Sept 24-30) USA Today explores the rising popularity of both milk banks and milksharing. Operator of the long-standing milk bank in San Jose, California, Pauline Sakamoto, says HMBANA milk banks distributed 2.1 million ounces in 2011, up from 1.5 million in 2009. And more milk banks are on the way -  Kansas City, Orlando, Portland, Missoula will all be getting milk banks soon. In Canada – a new milk bank collection depot is set to open in Edmonton, B.C.'s milk bank system is expanding, and efforts are underway to open milk banks in Saskatchewan and New Brunswick. Sakamoto and HM4HB's Kwasnica both note there is no rivalry between milksharing and milk banking, and acknowledge each practice brings different benefits and risks to a community.

As donor human milk is embraced both in the community and by neonatologists and health care authorities, more families will turn to milksharing, and more milk banks will open. In each community questions will arise:

• Why did it take so long to re-establish our network of milk banks after the AIDS panic in the 80s, and how many babies died during this time?
• Is there enough donor milk for all who want it? 

I hope we will be able to move away from kneejerk responses born of concern over safety and scarcity. We need to acknowledge and applaud the success that has come from decades of hard work on the part of breastfeeding advocates who have clearly convinced families and health care professionals of the value of donor human milk. We need to explore the issues that have arisen and develop thoughtful and sound, evidence-based policies to support the use of all donor human milk. 

It's time for stakeholders in North America - families who need donor milk, moms with milk to donate, advocates who support, protect and promote breastfeeding, health care providers, hospital administrators, policy makers, and anyone else with the authority and capacity to restore and improve the system - to come together. It's time we had appropriate policies and processes in place for funding and support for families who wish to use donor human milk when mother's own milk isn't available. Babies are dying in NICUs - and mothers are still pouring excess milk down the drain. 

The World Milksharing Week 2012 Blog Carnival is hosted by Milk Junkies blogger Trevor MacDonald.

Participants:

Milk-Sharing: Safe Infant Feeding and Being a Human - Sustainable Mothering - Jake Markus 

The Lorax and Other Milksharing stories - MatriciativismoenelsigloXXI Jesusa Ricoy-Olariaga

Winning the milk lottery - PhD in Parenting, Diana West, BA, IBCLC

Scared Milk-less - Peaceful Parenting - Lisa Van den Hoven

Overcoming Difference Through Milksharing - Milk Junkies, Trevor MacDonald

Biomedical Ethics and Peer-to-Peer Milksharing - Human Milk News, Karleen Gribble 

A Story of Peace and Healing - Normal, like breathing, Diana Cassar-Uhl

Milksharing and La Leche League - Feed the Baby LLC, Laura Spitzfaden

Supporting Families in Milksharing as an International Board Certified Lactation Consultant -  Nourish Breastfeeding Support, Amber Rhotan McCann 

"I wish I'd Known About Milksharing When..." - Complete Wellness Concept, Dinnae Galloway

Waiting for Milk Banks: A Matter of Life or Death - Human Milk News, Jodine Chase 

Powerful Images: Supplementing with Donor Milk - DoubleThink, Paa.la, Paala Anderson Secor

What is World Milksharing Week - Dinnae Galloway

News coverage, Toronto Milk Bank 

Ontario finally getting a breast-milk bank  
Toronto Star, August 31, 2012
Six years after it was first proposed for Ontario, a breast milk bank that could have saved dozens of vulnerable babies is still months away from completion. Vancouver has had a facility for more than three decades, and Calgary opened one in April after only 16 months of planning....more

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Mother wants donated breast milk from Toronto bank - Provincial milk bank to provide donated breast milk to ill newborn babies at Ontario hospitals
CBC News, Sept 5, 2012
Some parents want a new provincial breast milk bank to do more than provide donated breast milk to unhealthy babies, as it has proposed. The brand new provincial milk bank is set to open in January at Toronto's Mount Sinai Hospital in partnership with the Hospital for Sick Children and Sunnybrook Health Sciences Centre. ... more

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FULL COMMENT
Matt Gurney: Ontario’s healthcare system dithers while 

babies die 

Matt Gurney | National Post | Sep 4, 2012 10:11 AM ET | Last Updated: Sep 4, 2012 10:16 AM ET

There was an absolutely astonishing article over the weekend on the development of a new Ontario breast milk bank. The facility, to operate out of a Toronto hospital,
will house properly screened donations of human breast milk for babieswhose own mothers are, for whatever reason, unable to nurse their children. A facility such as this will keep babies alive and save taxpayers money.
Yet it has been stuck in limbo for no less than six years....more

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Use of mother's milk banks, milk-sharing skyrockets 

By Brian Shane, USA TODAY, Sept 2, 2012 

This time last year, Mother's Milk Bank in San Jose may have been able to send a month's worth of donated breast milk to hospitals in Alaska or Hawaii in a single shipment. Now many of those same hospitals can only get their milk by the week.... more

Woman donates to BC's milk bank and to local family

Human Milk News is featuring a milksharing story every day leading up to World Milksharing Week 2012 (Sept. 24-30)

This is the story of Olive Chan, who wasn't able to breastfeed but continued to pump to provide her baby with milk. She wound up with more than she could use and donated from her overflowing freezer to a local family, and to the BC milk bank.

The Story of My Milk: How I Stumbled into Feeding a Hundred Babies ~ Donor (Canada)
September 7, 2012 | Filed under: stories and tagged with: WMW 2012By Olive Chan
Being the idealist that I am, before I had Alena, I imagined our feeding times to be like this: myself as a gentle, nurturing mother looking affectionately at the sweet babe suckling at my breast as we nestled together in the rocking chair. A week after we brought her home, that picture could not be farther from reality. Well, everything except for the rocking chair. It was 6am in the morning, she was thrashing about and crying, I was hysterical and crying, and milk was everywhere but in her tummy.
Thus began the story of my breastmilk and how I stumbled into feeding a hundred babies....more

Canada looks to Japan's low NEC rate and use of only human milk in the NICU

Earlier this year Canadians for Health Research featured Dr. Shoo Lee as their researcher of the month. Dr. Lee is the head paediatrician behind the research into donor human milk use in the NICU in Toronto. Take a look at the full article to learn more about Dr. Lee's efforts - he's the founder of the Canadian Neonatal Network which unites neonatal researchers across Canada, and he's been instrumental in encouraging NICUs to adopt evidence-based practices in neonatal care, which is a factor in the resurgence of interest in the use of donor human milk in the NICU. Dr. Lee was at UBC and the University of Alberta before moving to Toronto. Of note is Dr. Lee's exploration into why Japan has succeeded in reducing the rate of necrotizing enterocolitis in premature babies - in Japan only human milk is allowed in the neonatal nursery. Japan's NEC rate is 0.5%.

Dr. Shoo Lee | Canadians for Health Research | Les Canadiens pour la recherche medicale
Scientific Director, CIHR Institute of Human Development, Child and Youth Health Professor of Pediatrics, Obstetrics and Gynecology - University of Toronto
Researcher of the month:
Leading the Vanguard in Neonatal CareOver the last 20 years, Canada has slipped from the top 5 in lowest infant mortality rate to rank 40th in the world.
“That’s unacceptable to me,” says Dr. Shoo Lee, a neonatologist and health economist, recently appointed as Scientific Director of the Canadian Institutes for Health Research (CIHR)’s Institute of Human Development, Child and Youth Health. “Canada is a rich country. Why are so many other poorer countries ahead of us? Not only that, in native communities, the infant mortality rate is 3 times higher than in the general population.”
Infant mortality isn’t the only problem that Dr. Lee wants to tackle in his new job. “We’ve had a 30% rise in prematurity rates in this country over the last 20 years. We need to pay attention and develop ways to deal with this problem.”
...
Breast vs cow’s milk in the NICUAbout 7% of very-low-birth-weight infants weighing less than 1500 grams at birth worldwide suffer from necrotizing enterocolitis (NEC). This intestinal infection is one of the single biggest killers of premature babies. In Canada, neonatal death rates from NEC have risen as high as 33%. The only country that has succeeded in reducing NEC is Japan, which currently has an incidence of 0.5%.
“Japan does not do evidence-based research, so we sent a delegation there to watch,” explains Dr Lee. “One of the things that impressed us was that they do not allow cow’s milk in the neonatal nursery. Only human milk is allowed. If the baby’s mother cannot produce milk, they use donor milk from another mother.”
By 7 to 10 days, every infant has been converted from intravenous fluid or parenteral feedings to full feedings of human milk. Conversion rates are typically slower in Canada. 
Projects were started in Vancouver and at Sunnybrook Health Sciences Centre in Toronto to feed only human milk to premature babies, unless mothers objected. Within 2 years, the incidence of NEC had dropped from 10% to 2% in Vancouver and from 8% to 1% at Sunnybrook.
“To me, this is good enough proof,” says Dr. Lee. “We are working to build human milk banks in the rest of the country and to supply all the babies who need it.”...more

Carla’s Story ~ “Booby-trapped” in the UK

Human Milk News is linking to a milksharing story each day leading up to World Milksharing Week 2012, Sept. 24-30, 2012.
Read about Carla, who fell for the "boobytrap" of asking for support to breastfeed and receiving advice to supplement with formula instead. She is unable to provide her baby with a fully supply of her own breastmilk but with support from donors she is able to supplement her little one's diet with one bottle of donor milk each day.

Carla’s Story ~ “Booby-trapped” Breastfeeding Relationship, UK  

August 29, 2012 | Filed under: stories and tagged with: WMW 2012

Well, my LO is 9.5 months old now, strong, healthy and happy and all thanks to the help we have been receiving from generous mamas who have been donating their stashes of milk to us ... more

Milksharing in Malaysia

In the days leading up to World Milksharing Week 2012, Sept. 24-30, Human Milk News will be posting a milksharing story each day. Today's story is from Malaysia and is about a woman who wasn't able to meet her breastfeeding goals with her first child and who vowed to breastfeed her second child for longer. She met a young mother who was struggling and offered to share her milk, and her milksharing journey began. It's an amazing story that opens our eyes to milksharing as well as to the Muslim tradition of milk kinship.

Maiza Catalina’s Story ~ A Donor: We Have Better Alternatives, Malaysia 

Maiza with milk-chair Firash, from WMW2012

September 3, 2012 | Filed under: stories and tagged with: WMW 2012Maizatul Azlina Binti Abd Mulok
Age: 32
Occupation: Veterinary Officer/Veterinarian
32-year old Malaysian Muslim mother Maizatul Azlina binti Abd Mulok only breastfed her first child up till the fifth month and the baby was given formula as early as a month old onwards. Maiza blamed herself for not being knowledgeable enough on expressed breast milk handling back then. When her second baby was born, she committed to breastfeed her baby for as long as possible.... more