Got (Breast) Milk?: The Pursuit of Modernity in Philippine Human Milk Banks

            In the past five years, Philippine news on human milk banks in the nation has increased. The government seems to be investing a lot of effort into establishing these banks and encouraging women to donate their excess breast milk. They justify the need for milk banks by explaining that they are for the benefit of vulnerable babies who, for some reason, cannot access their mother’s milk. Furthermore, the natural calamities that regularly befall the Philippines makes most people’s environments unconducive for a formula milk diet. Despite these official explanations, I argue that a broader cause for the proliferation of milk banks is the result of the government’s desire for the Philippines to participate in two types of modernity: technological and medical. They attempt to achieve these goals through the avenue of public health and the rhetoric of ideal motherhood.

What are milk banks?

            Similar to blood banks, human milk banks (HMBs) are storage facilities that house donor milk for patients who need it. Often these patients are premature babies whose mothers are unable to produce sufficient or any milk[1]. The nutrients in breast milk are particularly vital for the healthy development of such infants, who are already in a precarious position due to their premature gestation. As such, these banks are usually attached to a hospital with a neonatal intensive care unit[2]. The first HMB was established in Vienna in 1909, as an alternative to much more unreliable wet nurses[3]. Since then, HMBs have flourished across the world[4].

            The Philippines has the highest number of human milk banks in Southeast Asia. Initially, the Philippine HMBs were only operated by government hospitals: the first bank was established at the Philippine Children’s Medical Center in the nation’s capital of Manila in 1996[5]. The second and third are also in Manila while the fourth is in the Zamboanga Peninsula, but is funded by UNICEF[6]. In March 2013, Makati City housed the first local government unit (LGU)-run HMB (i.e. the first bank to be run on a local government office level)[7]. A study done in 2016 estimated that the archipelagic country had 6 HMBs[8]. Currently there are at least 16 of them distributed across the country with banks in Luzon, the Visayas and the Zamboanga region[9]. So far, two more are in the works[10] - one of them will be Mindanao’s first HMB[11].

            What can be inferred from all of this information? First, the increased attention to achieve an even distribution of milk banks across the Philippines indicates an obvious government interest to enable most residents to have access to them. Second, the flourishing of HMBs is recent; in the past two years, the number of HMBs has more than doubled, with a particular rise in LGU-run banks[12] (which supports the government’s goal of increasing access). I argue that both are reflections not only of the Philippine government’s recognition of the importance of HMBs, but more importantly, of its desire to participate in certain kinds of modernity.

Technological and Medical Modernity

             Operating human milk banks enables the Philippine government, on both national and local levels, to participate doubly in a technological modernity and in a medical modernity. I will elaborate on what I mean by “technological” and “medical” modernity below[13].

            Milk banks are a Westernized biomedical invention, which usually means up-to-date technology is crucial for them to work. HMBs require a lot of different technological equipment and processes to run smoothly and safely. Indeed, technology is heavily involved from the start, when donor mothers are recruited. In order to qualify for milk donation, volunteers are heavily screened, which includes a thorough medical check-up with blood tests and laboratory tests for various diseases[14]. Furthermore, donors must have freezers in their own homes to store their milk before donation, implying that people have to already possess a certain level of technological modernity in order to donate. Once delivered to the bank, the milk is pasteurized, screened before and after pasteurization, and stored in specialized containers in the bank’s freezers[15]. The pride the Philippine government, especially the LGUs, have in their HMBs’ modern technology can be seen in their newspaper articles, such as “fully equipped with imported equipment, including a human milk pasteurizer and storage made in England”[16] and “the country’s first milk bank to have a fully-computerized system”[17]. Emphasis is clearly placed on the fact that the equipment is imported (read: higher quality) and the highly technological nature of the HMB.

            The medical nature of HMBs fulfils another aspect of modernity, specifically the ability of the Philippines to attain and maintain global healthcare standards. From long ago, the country has committed to following the standards set by globally recognized organizations such as WHO. Proof of this lies in the Philippine Milk Code, the first of its kind in Asia. The Code was enacted in 1986, a short “five years after the WHO International Code of Breastmilk Substitutes by the World Health Assembly to combat aggressive marketing of breastmilk substitutes”[18] while promoting breastfeeding. Then in 2009, the Philippine government enacted the Expanded Breastfeeding Promotion Act to increase advocacy efforts. One of the new changes in the Act is the explicit encouragement of health institutions to set up HMBs[19]. News articles tend to highlight that the HMBs follow WHO standards of operation[20]. The Philippines is clearly serious about achieving medical modernity; establishing HMBs supports this goal.

Achieving Modernity

            According to the 2013 National Nutritional Survey, only 34% of infants under the age of 6 months are exclusively breastfed despite its institutionalized Milk Code[21]. From that year on, the government has left no rock unturned to promote breastfeeding. In Philippine media, HMBs are often portrayed under the light of public health. I believe that the global pro-breastfeeding movement is an important reason as to why HMBs are becoming so popular. The media often reports on the public breastfeeding events to normalize it[22] and widespread grassroots efforts to educate people on the benefits of breast milk and the disadvantages of formula milk[23]. Earlier this year, the Guardian published the results of an investigation, showing that formula milk companies use aggressive and clandestine methods to target mothers living in the poorest parts of the Philippines[24]. This is a direct violation of the country’s Milk Code. The government responded almost immediately; The Guardian published another article about the Health Department launching an investigation the very next day[25], showing the commitment the Philippines has to achieving medical modernity. Milk banks are very useful in this agenda, for even if a mother cannot breastfeed, she can turn to donor breast milk instead of formula milk. Moreover, if women are already breastfeeding, it becomes more convenient to donate.

            This pro-breastfeeding movement is also changing the notion of what ideal motherhood looks like. The discourse in the news tells women that the desired kind of motherhood is one where both babies and mothers benefit. Apart from mentioning the medical benefits to their babies, phrases such as, “I feel great breastfeeding my baby because I’m giving her the best milk in the world”[26], place emphasis on the mother’s perspective. This impresses upon Philippines women that good mothers don’t just breastfeed, they enjoy it. The establishment of HMBs changes the meaning of motherhood even further (at least for those who breastfeed). What does it mean for mothers to provide breast milk for children who are not their own? The rhetoric used seems to underline the adjective “share”, rather than “donate”. For example, the theme of Cebu City’s first milk-letting activity was “Share Your Love, Share Your Breastmilk”[27]. Motherhood is now transformed into a very attractive endeavour of providing for other children, in addition to one’s own, through the self-production of breast milk – an age-old symbol of maternal love. Because this new ideal is tied closely to the existence of HMBs, the Philippines therefore is able achieve both the technological and medical modernity that comes with the banks.  

Conclusion

            In the Philippines, human milk banks serve as a fascinating intersection of different aspirations – modernity, technology, healthcare and motherhood. The Natural Nutritional Survey is conducted every five years, so the next report is due to be released this year. Hopefully, the Philippine government’s efforts will bear fruit and the new HMBs will contribute to a rise in the number of people feeding babies breast milk, regardless of its source. As The Guardian article showed, it is one thing to desire to reach technological and medical modernity; it is another as to whether the country is successful in this endeavour. For vulnerable infants, this difference is frighteningly important.

            Nonetheless, the possible social repercussions of the new meanings of motherhood built by HMBs warrant future investigations – while mothers who “share” their breastmilk are able to bask in the expanded dimensions of maternal care, what does this mean for the mothers who cannot donate or are recipients of the milk? How will they feel about their own motherhood? Moreover, at least some banks require interested recipients to pay processing fees and provide a cooler with ice to transport milk[28]. This smacks of inequality; recipients must already be wealthy enough in order to use the HMBs. It seems an overlooked aspect of the national drive to technological and medical modernity is that certain people will be left behind. Furthermore, the transactional nature of using HMBs speaks to another problem scholars have brought up, namely the commodification of life, where children, and now breastmilk, are seen as products produced by the labour of mothering[29]. These issues, if left unaddressed, possess the potential to create an even more harmful and neglectful Philippines for mothers and infants.

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