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Should Human Breastmilk be Sold?

Breastmilk is a body fluid. When mothers can’t breastfeed, for whatever reason, and doctors prescribe it for premature or low birth weight infants, who can’t tolerate bovine formula, ideally nonprofit milk banks are able fulfill this need. This is not necessarily what is happening. I am concerned that companies are buying breastmilk from mothers, adding fortifiers to it and selling it at a profit as breastmilk. Milk that has been fortified is no longer human breastmilk: It is formula, which is not the same. Feeding an infant from the breast is very different from feeding an infant bought formula from bottles, if we are considering the health of mother and child. This situation raises a number of questions. Should the sale of human breastmilk be regulated or restricted? Will the sale of breastmilk result in the deprivation of needy infants from poor families? If breast milk production continues should pressure be exerted on the producers to allow the donors a much greater share of the enormous profits reaped by the producers? (Last year Prolacta purchased and sold at least 2.4 million ounces of human breast milk.) We need more nonprofit milk banks to meet the increased need for breast milk for infants who are premature, low birth weight or sick with real breast milk, which has been donated. More people need to be made aware and consider if this situation is in the interests of the mothers and infants or the companies selling formula.

In light of this, we did a survey on a group of participants at the Second World Breastfeeding Meeting in Johannesburg, South Africa to examine some of the factors involved and learn more about how to protect mothers and babies. See the summary of our findings below.

You thoughts and comments are welcome and should be addressed to:


Survey: Analysis of the Sale of Human Breastmilk Globally 6/18/17

World Breastfeeding Conference
Johannesburg, South Africa, December 2016

Human breastmilk (HBM) is a body fluid sold as if it were food and its sale is mostly unregulated in many countries. Few countries have national regulations on how human milk is collected, the screening of who donates, who is the beneficiary, and how the donor milk is processed, distributed, and marketed. Breastmilk is inimitable. Its importance for infant health, growth and development is vital and its unique properties cannot be replicated (Baumslag). The increasing demand and commodification of HBM and the various ways in which the pharmaceutical and infant formula industries commercially exploit the critically important roles of human milk ingredients pose ethical concerns, such as: The practice of purchasing HBM cheaply from mothers in low-income countries or from mothers with economic need and selling it at a large profit; the impact on breastmilk access for lactating infants of donor mothers; and the lack of regulations on the collection, processing and the private sale online of donor human milk. Those working on the needs, supports and the protection of breastfeeding mothers and children are increasingly concerned about the commercialization of human milk and are calling for research, regulation and some protection and recognition (economic or otherwise) of donor mothers in low-income situations.

No formal or methodically gathered data exist to show if, how, or where HBM is sold. Many gray areas exist, such as the legality of selling it, regulatory and monitoring issues, and profiteering practices. There are now both nonprofit and for-profit milk banks worldwide and it is more difficult for milk banks to obtain HBM. Confounding this situation are multiple issues, including: A lack of clear-cut policies in many countries regarding the legality of selling HBM; an absence of regulations and their enforcement on the sale of HBM in countries where it is legal; a widespread need for education of mothers, field workers and medical professionals on the donation and sale of breastmilk; and finally the ethics and exploitation of donor mothers and their infants. More data on these issues are needed for the above-mentioned factors to be addressed.

In view of the sale of HBM (commodification of HBM) a survey was conducted at the Second World Breastfeeding Conference in Johannesburg, South Africa, in December 2016, which was organized by IBFAN and the South African Health Department. The survey was designed to explore the donation and commodification of HBM further, to try to ascertain its prevalence, legality, regulation and cultural attitudes on it. A total of 450 participants from 65 countries attended the conference. The survey instrument was made available through the registration center and participation was voluntary. Not all delegates from all countries participated, due to various logistical factors. Of the total sample of 117 respondents, half were from South Africa, the host country, so although this is not a representative sample, it has provided some indication of the needs and prevailing issues. The other half of the participants came from 33 different countries.


It is important to point out that both the responses provided and the comments reflect the perceptions and knowledge of each respondent. In many cases responses may be accurate, and in some instances, they may not be a true reflection of the facts. The responses reflect a lack of clarity and awareness as to the legality and regulations on the sale of HBM. They also showed the same lack of awareness as to the existence and types of milk banks (nonprofit vs. for-profit). Attitudes to the compensation of donor mothers for their breastmilk varied by geographical location and by culture. Approximately twice as many respondents thought women should not be paid as those who thought they should. A majority of participants expressed the need for more education of mothers as well as health workers regarding breastfeeding itself as well as available options for milk donor mothers.

In summary, the survey demonstrated a pervasive lack of knowledge of the many issues around breastfeeding, HBM donation and commodification, and identified areas for education. The less informed respondents requested more information and saw the benefits of being involved in the education of women so that they are not exploited and can better understand the need to help infants in need of donated HBM for their survival. Most of the respondents felt that it was important to pay donor women if their milk was being sold at a profit by someone else, rather than donated. Some respondents expressed the need to keep milk available for babies rather than for commercial purposes. The survey found cultural differences in attitudes to mothers selling HBM, but some field workers and researchers indicated that lactating women could use the cash for transport and to feed their families. However, many respondents felt that women undervalue their breastmilk and that HBM should not be sold. Areas for future research include: The legality of selling human breastmilk worldwide as a local issue and as an international issue; how best to provide more education to mothers and field workers; regulation and monitoring of the acquisition and sale of HBM by pharmaceutical and food companies in terms of economic exploitation and in terms of ethics; and the impact on the health of breastfed infants of donor mothers. Breastmilk is inordinately undervalued in the USA. In Australia, the GNP value of HBM is 3 million.


Mothers need to be better informed about their rights through education programs. They need to learn about the value of their milk and the inimitable value of breastmilk itself as a human fluid. Mothers also need to be offered other means of earning income instead of being exploited for their breastmilk. This would require involvement by various humanitarian and public health organizations, as well as governments.

There is a need to assess the status of breastfeeding in different countries and especially in rural areas. Information about prevailing regulations, monitoring, the presence and operation of milk banks and the availability of donor milk, and whether the sale of HBM is legal needs to be gathered and made more widely available. There is also a worldwide need to ensure that HBM is treated and regulated as a body fluid, not a commodity. Finally, better professional training and direct counseling services and more information and support for breastfeeding mothers should be provided. However, breastfeeding is far more than a monetary value: it is every baby’s birthright.

Contact for Questions and Comments:

Naomi Baumslag, MD, MPH ; Elisabeth Sterken, IBFAN; Glynnis Mileikowsky, BA

Copyright © 2017 by Naomi Baumslag

The Holocaust: Coercion was not Collaboration

Second International Scholar Workshop, May 7-11, 2017

Coercion is Not Collaboration

Ethics and Agonizing Decisions

Professor Naomi Baumslag, M.D., MPH
It is essential, in the interests of historical accuracy and objectivity, to recognize that coercion is not collaboration. The definition of collaboration varies and who is to judge how one can deal with oppression when your family is threatened. Some physicians committed suicide rather than violate the Hippocratic oath, while others were murdered.
Jewish prisoner doctors worked under incredibly harsh circumstances in brutal, inhumane confinement, which made it next to impossible to honor the Hippocratic oath by doing no harm and they saved lives to the best of their ability.
Doctors were coerced under extreme, life-threatening conditions. There was nothing voluntary about their status, nor was there an option for them to refuse to cooperate. Prisoner doctors had to make agonizing decisions and risk their lives. With sparse or no medical supplies and under unsanitary conditions, the doctors improvised ways to work around the constraints to try and save lives. They swapped charts to save healthy patients so that a prisoner who was at death’s door replaced one who could live. They recorded typhus cases as influenza. In the ghetto they ran a medical school and called it a sanitation school, as the Germans’ fear of typhus was so great. They diluted drugs, altered chart measures and where possible did less harm than they were instructed to. For example, if told to remove ovaries, they removed only one. Doctors performed abortions on pregnant women to save their lives because the Germans ordered pregnant Jewish women to be killed and Jewish doctors performed abortions unbeknownst to their Nazi supervisors.
There is ample evidence that Jewish doctors saved lives and took risks with their own lives to do so. Some even committed suicide, or refused to follow orders and were murdered. Many worked with the Resistance. Tragically, the Jewish prisoner doctors often had nothing to give their patients except some words of comfort. There were many Jewish doctors who strove to the best of their ability and managed to practice medicine under brutal Nazi coercion.
The following three little-known physicians and their actions and sacrifices under great risk underscore the efforts of a few that we know of.

Dr. Moses Brauns
Dr. Moses Brauns was a respected physician, epidemiologist and head of the Kovno ghetto’s sanitation and contagious disease department of the Jewish Council.On Oct 4th 1941 a reinforced squad of German police – 50 men and 100 Lithuanian participants – boarded up the small infectious disease hospital and burnt it, with 67 doctors, staff, and patients inside.
The burning of the infectious disease hospital and all the inmates made it imperative to avoid reporting cases or rumors of typhus in the ghetto. Dr. Brauns recognized that the greatest danger of typhus came not from lice but from the Germans’ attitude towards the disease. When cases were found it was it imperative to hide their existence, to delouse and isolate them and their families.
In October 1942 German soldiers with typhus returning home from the front were washed and treated in the Kovno ghetto. The Lithuanian Health authorities had Jewish workers wash and clean the soldiers, but vaccinated only the Lithuanian workers. When several of the Lithuanian workers contracted typhus a commission of Lithuanian doctors, suspecting typhus in the ghetto, came to inspect the ghetto hospital, and wanted to know how many typhus cases there were among the Jewish workers. Unbeknownst to them at the time of their visit, there were 29 cases of typhus, but they were not discovered because they were being nursed at home. The commission continued to search for cases, but found none. Dr. Brauns fought typhus while hiding it from the Germans and Lithuanians who might otherwise have destroyed the ghetto and inmates. His patients were given extra food rations, soap, and firewood for heat and were nursed at home. He secretly visited them twice a day. The home nursing had been handled so well that even ghetto inhabitants didn’t suspect there was typhus in the ghetto (personal interview with survivors). A total of 70 cases were diagnosed. These cases were not recorded and the cause of three deaths from the disease was falsified in the official report to the ghetto health committee. The visiting Lithuanian commission asked Dr. Brauns, an expert on typhus, to explain why there were no cases of typhus in the unvaccinated Jewish workers. Dr. Brauns replied that this was because the Lithuanian workers were vaccinated with a live lice preparation whilst incubating the disease. Dr. Brauns, by hiding the typhus cases, risked his own life, his family’s lives, his reputation as well as the lives of everyone in the ghetto. Dr. Brauns was a hero.

Dr. Ludwig Fleck
SS doctors assigned to concentration camps tended to be medically inferior with strong Nazi ties and personally self-serving. At the same time, prison doctors participated in the Nazi experiments unwillingly. Some prisoners survived to report what had occurred in their presence and to provide details of courageous acts of resistance.
Many of the prisoner doctors in Buchenwald concentration camp were experts in their field and came from well-known institutes. One such doctor was Dr. Ludwig Fleck, an accomplished scientist and philosopher, previously of the Lemburg Institute. When he was in the Lvov ghetto in 1942 he was faced with typhus in seventy percent of the inmates. As there were no vaccines or other resources available to them, he developed a typhus vaccine out of the urine of typhus patients.
In contrast to other doctors and researchers, Dr. Fleck demonstrated a superior ethic by first vaccinating himself and his family with the trial vaccine. He then vaccinated a group of 500 ghetto volunteers, as he had found his vaccine to be effective. As the vaccine was effective, he then used it for ghetto patients. When the Germans saw a report about his vaccine and asked him if it would be good for them. Even though he said it was made from Jewish urine, they arrested him and moved him and his family to Auschwitz and then to Buchenwald to Block 50 to make typhus vaccine for the troops.
Block 50 was a special isolated typhus vaccine development unit. When Fleck arrived in Buchenwald he discovered that the typhus vaccine being produced by Drs. Cielpielowski (in charge of the vaccine production block) and Professor Waitz was ineffective. To tell the authorities would have meant their certain death. So, unable to tell the authorities, the prisoner doctors continued the production of the ineffective harmless vaccine for the Wehrmacht, which was sent to the soldiers on the front and made a new vaccine, which was used for the Resistance.
Fearing sabotage and not trusting the prisoner workers, the Germans required control samples to be sent to the Pasteur Institute to be checked. However, with the help of the desk clerk who did the paperwork of the vaccine production unit, Fleck and his fellow prisoner doctors sent their high-quality, effective vaccine samples instead of the ineffective vaccine for testing. The tests proved positive, thereby allowing the ineffective vaccine to be sent to the front. As an act of sabotage, approximately 600 liters of the ineffective vaccine were produced and sent to the front and 30,000 soldiers were injected with this useless vaccine. At the same time, 69 liters of the effective serum were made for the prisoners and for the Resistance (Cohen and Schnelle).
Fleck had a wife and son in the concentration camp and had to be careful that the authorities were never aware of his resistance activities. Other prisoner doctors in the vaccine production unit were also in such a situation. Fleck, together with two other doctors, Dr. Cielpielowski (who was in charge of Block 50 vaccine production, Buchenwald) and Prof. Waitz falsified results, sabotaged vaccine production, and organized undercover resistance in the laboratory. Dr. Fleck was an extraordinary brilliant physician who under bestial circumstances managed to survive without compromising himself.

Adina Blady Szwajger
In September 1942, a 22-year-old Jewish senior medical student, Adina Blady Szwajger, who served as a nurse in the Warsaw Ghetto hospital gave lethal doses of morphine to several elderly patients and about 15 infants and children. She did this to spare them certain death at the hands of the Nazis, when she heard screaming downstairs as the German and Lithuanian guards were taking the sick from the wards and ruthlessly throwing them out. (Yodaiken R.E.)
Through her dedication and love, Swajger gave her patients a dignified death and denied the German murderers the satisfaction of slaughtering her charges at their leisure. (Yodaiken).
It is very important to examine the source of this coercion. It was exerted from the highest levels of influence—the pharmaceutical industry IG Farben, the German Hygiene Institute, various Nazi health and science research centers and medical schools searching for a vaccine against typhus. Much of the impetus behind the experimentation came from the IG Farben pharmaceutical conglomerate, Bayer, BASF and Hoechst, which were responsible for most of the coercion of poorly trained SS and German doctors, who in turn coerced and exploited prisoner doctors to run their dirty experiments on their untested drugs. All of this was to increase their profits. More attention needs to be paid to these unpunished criminals in these centers.
The coercion was apparent as early as 1939, but experimentation on native colonial populations in Namibia (then called German South West Africa) by German doctors and scientists in Germans medical and public health training centers actually began before that. It simply continued from 1939, with German doctors and the German pharmaceutical and drug industry experimenting on Jews with vaccines and drugs in the Csyste Hospital in the Warsaw ghetto (Baumslag). George Nauck, a pathologist in the Hamburg Hygiene Institute, had a typhus research unit in the Warsaw State Institute and Dr. Robert Kudeche tested vaccines on Jews. These Nazi doctors forced staff of Csyste Hospital in the Warsaw ghetto to test sulphonamide drugs in typhus cases for IG Farben, including a toxic drug called Uliron, which caused blueness (cyanosis) and death. According to Roland, German doctors threatened the Jewish doctors with punitive actions if they refused to cooperate as instructed. Nauck filmed the subjects and autopsied the dead.
The experimentation to find a typhus vaccine continued in the concentration camps, especially Auschwitz and in Buchenwald, where there was the special isolated typhus unit in Block 50, where they made and experimented with vaccines and many as-yet-untested drugs.
In conclusion, better ways of enforcing ethical codes and rules on experiments need to be devised. It is not enough to simply leave it to the health profession. It needs to be broader. An independent consumer oversight committee with the ability to enforce ethical laws and human rights is urgently required and continues to be relevant in today’s pharmaceutical industry and its ongoing financial ties with doctors and institutes.


Baumslag N. Murderous Medicine; Nazi Doctors, Human Experimentation and Typhus. Chapter 3. Jewish doctors struggle to conceal typhus and save lives, pp85-125. Praeger Press, 2014.

Cohen R.S. and Schnelle T. Cognition and Fact materials on Ludwik Fleck, Dordrecht: Reid D. Publishing Co, pp19-29, 1986.

Fleck L. Specific Antigenetic Substances in Urine of Typhus Patients, Texas Reports on Biology and Medicine 6: pp169-172, 1947.

Baumslag N. and Shmookler B. Typhus Epidemic Containment as Resistance to Nazi Genocide, pp39-48; in Grodin M. Jewish Medical Resistance in the Holocaust. Berghahn, New York, 2014.

Kogon E. The Theory and Practice of Hell. Berley Books New York, 1980

Lifton RJ. The Nazi Doctors: Medical Killing and the Psychology of Genocide,

Siegel S. Treating an Auschwitz Prisoner-Physician: The case of Dr. Maximillian S.; Holocaust and Genocide Studies, 28, NO3 pp450-481, 2014.

Siegel S. Changing Circumstances, Shifting Approaches; Jewish Prisoner Physicians in Nazi Concentration and Forced Labor Camps. Lecture Vienna Wiesenthal Institute for Holocaust studies, 2015.

Tory A. Surviving the Holocaust; The Kovno Ghetto Diary, pp141-143, Harvard University Press, Cambridge MA, 1990.

Yodaiken R. Moral Dilemmas Faced by Jewish Doctors During the Holocaust. Paper presented at the Medical Resistance During the Holocaust Conference, YIVO, New York, 1996.