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PE7.8 | Human Milk Bank — SDL Guide (Part 2)

Human Milk Banks in India: Policy and Implementation

India's commitment to human milk banking has grown substantially since the first HMB was established at Lokmanya Tilak Municipal General Hospital, Mumbai in 1989. The policy framework has evolved from individual hospital initiatives to a national guideline, with the National Health Mission (NHM) / Ministry of Health and Family Welfare (MoHFW) publishing operational guidelines for Lactation Management Centres (LMCs) in 2017. These guidelines specify the physical infrastructure, equipment, staffing, and SOPs required for a functional LMC, which combines lactation support (helping mothers establish breastfeeding) with HMB services.

Under the NHM LMC guidelines, every tertiary and secondary-care public hospital with a Sick Newborn Care Unit (SNCU) or NICU is encouraged to establish an LMC. The target beneficiaries are preterm infants (<32 weeks or <1500 g) admitted to the NICU whose mothers cannot provide sufficient milk. Key features of the NHM LMC model include:
• Integrated services: Lactation counselling, postnatal support, breastfeeding education for mothers, and HMB services are co-located.
• Equipment: Hospital-grade electric pumps, pasteuriser (water-bath type for Holder method), bacteriological testing capability or linkage, cold storage (refrigerator + deep freezer).
• Staffing: A trained lactation counsellor/nurse, available six days a week; medical officer oversight.
• Donor recruitment: Postnatal ward mothers with surplus milk; community donors.

As of 2023, India has approximately 70–80 operational HMBs/LMCs, predominantly in government teaching hospitals in Maharashtra, Karnataka, Gujarat, Rajasthan, Delhi, and Tamil Nadu. The Breastfeeding Promotion Network of India (BPNI) provides technical support, training, and quality standards.

Ethical and cultural considerations: Donor milk use raises complex issues in the Indian context. Some families — particularly from certain religious traditions (including some Islamic jurisprudence schools, which recognise 'milk kinship' or rada'a) — may have concerns about the identity of the donor or the concept of receiving milk from an unrelated woman. These concerns are real and must be respected without dismissing them. The standard practice in India is anonymous donation — donors and recipients are not identified to each other — which addresses most privacy concerns, though it does not resolve milk-kinship beliefs for those who hold them. Informed consent from parents is mandatory before dispensing donor milk.

The competency PE7.8 specifically includes visiting the nearest HMB. During your clinical posting in paediatrics, you should identify whether a functional HMB or LMC exists in your teaching hospital and, if so, observe the processing chain first-hand — from the pasteuriser to the storage freezer to the bedside dispensing record.

Self-Assessment

The human milk bank exists to fill a precise and important clinical gap: ensuring that the most vulnerable preterm infants receive human milk — with its protective HMOs, growth factors, and residual immunological activity — when their own mothers cannot provide it. The Holder pasteurisation process (62.5°C, 30 minutes) is the cornerstone of HMB safety, eliminating HIV, CMV, HTLV-1, and all bacteria while largely preserving the nutritional and prebiotic components that make human milk superior to formula for preterm gut protection. The limitations of pasteurisation — loss of live cells, reduced lactoferrin, inactivated lipase — explain why mother's own milk remains the gold standard and why the HMB occupies third place in the hierarchy, not first. India's NHM LMC framework has established a growing national infrastructure, with anonymous donation, serological screening, bacteriological quality control, and priority dispensing to VLBW infants as its operational pillars. The cultural and ethical dimensions of donor milk — especially milk kinship — require sensitive, informed counselling. Test your recall with the questions below.