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Mothers are buying breast milk online — because they don't have better options

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But what are the risks?

Beverly Goodwin

Add this to the list of "things you can buy online": a stranger’s breast milk.

Online milk exchanges — unregulated sites where breast milk is bought, sold, and donated — have taken off in recent years, with multiple websites facilitating transactions between moms with milk to spare and those in need. Despite the long list of milk-seeking ads by adult men — some simply pervy, others interested in the purported health powers of breast milk — researchers say the bulk of the market is moms unable to breastfeed or produce enough milk.

Milk from untested sources, like the ones on online markets, comes with risksThe long list of the benefits of breast milk — ranging from protection against childhood infections, to a lower risk of diabetes and obesity, to higher IQ and income as an adult — have made lactation a high-stakes game for new moms. But milk from untested donor sources, like the ones on online markets, comes with risks. Viruses, including HIV and cytomegalovirus (CMV), can be transmitted, and without pasteurization, there is also the potential for harmful levels of bacteria like Staphylococcus or even Salmonella. In 2013 a research group led by Dr. Sarah Keim of the Nationwide Children’s Hospital found that about three-quarters of samples bought online would have failed the standards for bacteria levels at a donor milk bank, and a follow-up study released this month, also led by Keim, showed that 10 percent of online samples were diluted with cow’s milk or formula — a potentially serious problem for newborns with a dairy allergy.

But traffic to online markets has continued to rise as more moms look to the internet for help. Across the US, online transactions have more than doubled in the past three years, from around 22,000 in 2012 to about 55,000 today, according to Jesse Kwiek, Associate Professor of Microbiology at the University of Ohio and a co-author of the recent Keim study.

Support for breastfeeding mothers hasn't kept paceCreators of sites like OnlyTheBreast.com frame the online exchanges as an alternative to pricey donor milk banks, which screen and pasteurize milk. That site had about 27,000 members last year and is adding about 800 more each month. While men are helping to drive this increase, it could also be a symptom of a bigger issue: as the emphasis on the importance of breastfeeding has risen, support for breastfeeding mothers hasn’t necessarily kept pace.

only the breast

Danielle Pitman, a 24-year-old single mother in Pennsylvania, signed up for Only The Breast after noticing that her four-month-old’s eczema cleared up after drinking breast milk, which was donated by one of her friends. Pitman, a full-time student who also works as a waitress, said that after breastfeeding became unbearably painful and pumping several times a day too time-consuming for her busy schedule, she switched to formula with her doctor’s support. She cried for a week over the decision to switch to formula and lied to friends about having a lactation issue to stem what she said was harsh judgement over "not trying hard enough." But her son quickly developed a rash after the switch, and at about $50 for a two-and-a-half day supply, the doctor-recommended formula was difficult to afford. Eventually, through Only The Breast, she found a mom a short drive away offering her extra supply for free.

"I thought about the risks a lot.""I thought about the risks a lot," she said of the online-sourced donation, but eventually decided to use the milk after meeting the family. Still, she says the process made her so anxious that she wouldn’t do it again and is consulting with her doctor about other options. "I think I just got lucky," she said. She hadn’t known about non-profit donor milk banks, but wouldn’t have been able to afford the $3.75 to $5 per ounce cost of donor milk anyway, Pitman said.

Only 15 donor milk banks, all run by the Human Milk Banking Association of America (HMBANA), serve the entire country with screened and pasteurized breast milk. Unlike the milk traded online, donor banks must meet FDA regulations. The organization distributed about 3.3 million ounces of milk last year, mainly to infants in neo-natal intensive care units, but it’s always short on supply, says Pauline Sakamoto, president of HMBANA. The banks are unable to meet the demands of other, non-life-threatening cases, like moms who have undergone mastectomies, have other issues that prevent breastfeeding, or simply need a supplement to what they can produce.

"a lost supply."Cost is another issue. Donor milk entails a service fee of up to $5 per ounce — which is rarely covered by insurance, according to Sakamoto. The Affordable Care Act (ACA), passed in 2010, has a mandate for breastfeeding support, including breast pumps and lactation consultants and other services deemed "medically appropriate," but the law is vague on exactly what is covered.

milk bottles

Milk bottles (RustyClark)

For Sakamoto, women selling their excess milk on online exchanges represent "a lost supply" for hospitalized babies in need. But for women like Ashleigh Baruch, a mother of three who sells her excess milk on Only The Breast, casual sharing sites are a necessary, but imperfect, alternative to milk banks. Compared to formula or expensive donor milk, she calls the online exchanges and the risks that come with them "the lesser of two evils."

"No one is truly honest about how hard it is.""We all know that breastfeeding is the best, but there is a lot of ignorance for men and first-time mothers," said Baruch, who often spends up to eight hours a day either breastfeeding her baby or pumping. "No one is truly honest about how hard it is."

Like other women I spoke to, she says there are a lot of scam artists trolling the sites, and the majority of requests she got were from men for "the weird stuff." She’s made about $3,000 to $4,000 over the last six months selling excess milk at a premium of $6 per ounce for male buyers, or $2 an ounce for moms.

Buyer beware For now, the onus of safety checks — through donor blood or milk tests and pasteurization — falls on online buyers. Only The Breast offers safe buying tips and encourages milk pasteurization, but the site, like others of its kind, operate under the "use at your own risk" model. When The Verge contacted the site for comment on this article, site administrators pointed to their published advice on online buying and said, “The vast majority of OTB members are honest, abiding by OTB terms and are simply looking to provide safe milk for babies in need.”  Only The Breast does not take responsibility for any harm stemming from milk exchanged through the site, according to its terms of use, and because all online exchanges are unregulated, site owners are not obligated to report incidents or bad actors to authorities. In 2010 the FDA warned against purchasing milk online, but stopped short of officially regulating milk exchanged on the sites.

According to Sakamoto, if they had more donors and more cooperation from insurers, they would be able to serve the market that might instead go online: women with breastfeeding issues, or healthy babies with special needs; even men seeking the medical benefits of breast milk.

"Our country, our culture needs to support breastfeeding moms," said Sakamoto. "However we can do that."