The first Human Milk Bank in Brazil was created in the 1940. The former National Institute of Childcare, now known as the Fernandes Figueira Institute (IFF/FIOCRUZ), launched a series of units that spread all across Brazil, with the sole objective of supplying human breast milk.
In 1987, IFF signed its first cooperative commitment to become the Brazilian National Reference Center for Human Milk Banks. By the late 1990s there were already 150 such banks in the country, and this growth underscored the need for more investment in administration. In 1998, the first project was drafted for the Network of Human Milk Banks (rBLH in Portuguese). “We were already working as a network, but we decided to systematize this operational model,” explains network coordinator João Aprígio de Almeida.
The Network of Human Milk Banks was a project of the Brazilian Ministry of Health, created with the mission of promoting maternal and infant health. The work integrates and builds partnerships to reduce neonatal mortality and improve breastfeeding rates. This operation involves networking between the National Reference Center for Human Milk Banks under IFF and each State Reference Center (CREBLH).
Today, each state of Brazil has a CREBLH, responsible for orienting the Network’s activities, implementing them in the human milk banks situated in their cities. Meanwhile, the National Center transfers guidelines and scientific innovations to the states, receives requests from the local milk banks, and develops solutions to problems that emerge in the milk banks’ routine work.
The Network is now part of the National Policy on Maternal Breastfeeding and is not limited to obtaining human breast milk. Its activities include collection, processing, and distribution of human milk to premature and low birth weight infants, in addition to promoting maternal breastfeeding and providing orientation to support breastfeeding.
In the 1990s, the World Health Organization (WHO) launched the global initiative Health for All by the Year 2000, which provided for evaluations of public activities in the health of women, children, and the elderly by the early 2000s. “The evaluation showed that the Brazilian Network of Human Milk Banks was one of the initiatives that most contributed to the improvement of children’s and adolescents’ health in the world, collaborating effectively to reduce mortality and morbidity. In addition to the award and recognition, the result was the work’s increased visibility in the international scenario,” says João Aprígio.
Since then, FIOCRUZ together with the Brazilian Cooperation Agency (ABC) provides technical and financial support for the installation and training of milk banks around the world, through bilateral or multilateral agreements. In 2015, the Network of Human Milk Banks became the Global Network of Human Milk Banks, and its global health guideline became part of the Sustainable Development Goals. Today, more than 20 countries belong to the network, with a presence in South and North America, Europe, and Africa.
“We continue to do our work in Brazil, heading the public policy for Human Milk Banks in the Unified Health System (SUS). We are the reference unit for direct consultancy to the State Health Departments. We are also the only agency responsible for training teams to work in milk banks and are also responsible for this work on three continents,” highlights the coordinator.
Maternal breastfeeding and the importance of human milk banks
Human breast milk is considered the most complete food for the infant. Even so, breastfeeding practice has not been established to the desired extent. “Whether she wants to or not, the pregnant woman is going to produce breast milk, but there’s a difference between producing milk and making breastfeeding feasible. Biological determinism is proper to the human species, while breastfeeding depends on social conditioning factors. So breastfeeding is biologically determined and socio-culturally conditioned, and the social conditioning factors tend to outweigh biology,” João Aprígio explains.
According to the coordinator, a preterm newborn is not immunologically and biologically prepared to face life. It needs a food with the characteristics of a medicine, which is not found in infant formula. “Only a functional food can assist in the processes of maturation of the infant’s system, including maturation of its immune system, in addition to increasing its defense factors. Breast milk helps the infant’s evolutionary life cycle (which was interrupted in intrauterine life) to continue in extrauterine life, receiving the components that only breast milk can offer,” states João Aprígio, emphasizing this moment when the human milk bank intervenes.
An indispensable focus of the Network is thus to address the importance of social awareness that stress prevents many women from breastfeeding their infants. “The issue of stress needs to be addressed. But while the mothers themselves are not producing the milk their infants need, their infants need human milk donors in order to survive,” he comments.
Cohort studies have shown that children receiving exclusive breastfeeding for at least six months, or for up to two years of age or longer, have higher mean IQs than those exposed to early weaning. This difference in IQ lasts throughout life. “If we believe that building a more just society in the future depends on the capacity to invest in childhood, breastfeeding has to be the first step,” he concludes.
A history with FIOTEC
Together with the project for the creation of the national network in 1998, a partnership was established with FIOTEC, at the time still called the Foundation for Teaching, Research, Technological Development, and Cooperation in the National School of Public Health (Fensptec). Since then, the foundation has supported projects in the Network of Human Milk Banks through a relationship based on professionalism and trust.
“We are contemporaries of FIOTEC. I thus consider it essential, extremely important, first because of the management flexibility that FIOTEC provides. The service provided by FIOTEC is fundamentally important,” says Paulo Maia, head of Management and Information for the Network of Human Milk Banks and coordinator of projects with FIOTEC.
Maia further adds, “Equally important is the foundation’s precise accounting, which is excellent for the project coordinator, knowing that all the expense outlays are accounted for as earmarked.”