Micaela Collins is co-principal investigator on the Stars in Global Health project “Mothers’ milk pasteurization for Bangladesh garment workers.” The project’s principal investigator is Dr. Sabrina Rasheed, a breastfeeding and infant nutrition expert working out of the International Centre for Diarrhoeal Disease Research, Bangladesh.
World Breastfeeding Week 2015, from August 1 to 7, will mark the 22nd anniversary of the Mother-Friendly Workplace Initiative (MFWI). Conceived by the World Breastfeeding Association, the campaign rightly positions the combination of women’s productive and reproductive roles as ‘a health issue, an economic issue, a labour issue, and a human rights issue.’ Mother-friendly workplaces have multiplied globally, and the benefits of the program cannot be denied. From reduced absenteeism, to lower healthcare insurance costs, to an improved corporate image, the accumulated literature reveals that the benefits of breastfeeding-friendly workplaces go beyond the mother/child dyad. Yet, the theme of this year’s World Breastfeeding Week – Breastfeeding and Work: Let’s Make It Work! – indicates that there is still a great deal of work to be done before working mothers the world over can be provided with truly supportive work environments.
The magnitude of the problem is no more apparent than in the developing world, where mother-friendly workplaces are relatively uncommon, and sub-optimal breastfeeding practices can have immediate and dire consequences. In Bangladesh alone, over 9,000 infants die each year due to nutritional, diarrhoeal and typhoidal diseases secondary to insufficient consumption of breast milk and over reliance on complementary foods. The country’s success in surpassing its Millennium Development Goal should not be minimized, and there are a plethora of private and public programs championing the benefits of proper breastfeeding practices. However, there is a dearth of institutional and societal supports tailored to the needs of working mothers.
In May, I was in Bangladesh, where I visited a garment factory in Dhaka. The women I spoke to, though they had only sparse knowledge of proper breastfeeding practices, were painfully aware that breast milk was the best source of nutrition for their infants. The reality was that they worked ten to twelve hours a day, six days a week, and they couldn’t bring their infants to work with them, nor did they have breast pumps (or, in some instances, even refrigerators) to express and store their milk. Now, consider that the women I spoke with are only a handful of Bangladesh’s estimated three million female garment factory workers; that the majority of these working women are of reproductive age and that there are an average of 2.2 children per family in urban centres. It is impossible to deny that these circumstances present a problem of considerable magnitude. This problem was the impetus for the development of the “Mother’s Milk Bangladesh Project”.
Expression containerOur initial idea was to provide post partum garment factory workers with breast pumps to express their breast milk while at work. We soon realized that this only created another problem. While the breast pumps could ‘piggyback’ off of garment factories’ relatively stable electrical supply, many women did not have a safe way to store their breast milk after expression, or the facilities at home to properly sterilize expression containers. We needed to find a way to keep breast milk safe for consumption after sitting at room temperature for several hours or overnight. Eventually, we settled on pasteurization. The process, long used by human milk banks, kills viral particles and significantly impairs the growth of bacteria. There is only a small body of work on the benefits of breast milk pasteurization (as milk banking fell out of vogue after the emergence of HIV and has only recently rebounded), but numerous studies have indicated that pasteurized breast milk left at room temperature for extended periods exhibits minimal – if any – bacterial growth.
With this in mind, we set out to design and prototype an inexpensive, small-scale pasteurization device that did not require water, except for small amounts needed for sterilization procedures. Our program will allow working women to express their milk at work and have it made shelf-stable for extended storage. Enrolled mothers will be trained on how to use electric breast pumps, and enrolled in an evidence- and community-informed educational program developed by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Each woman will also receive her own personal breast pump kit, including a manual piston pump that can be used during power cuts. Once or twice a day, women will come to the factory clinic and pump milk directly into a pre-sterilized glass bottle. The milk will be pasteurized and made available for collection by mothers/caregivers to take home and fed to the infant the following day.
Almost a year ago, Grand Challenges Canada (funded by the Government of Canada) supported us with a seed grant under the Stars in Global Health program to develop our outside-the-box approach to increase breast milk feeding among the offspring of garment factory workers. Our idea started as a class project in Dr. Yu Ling Cheng’s ‘Global Health Challenges’ course at the University of Toronto. Now, it is being spearheaded by icddr,b and extensively supported by Medela Australia. We are in the process of determining the upper limit for safe storage of pasteurized breast milk at ‘Bangladeshi’ room temperature (warmer than in other parts of the world), as well as characterizing the type and amount of bacteria, spores, fungi and yeast that proliferate in pasteurized and unpasteurized breast milk over time. This will ensure that the pasteurized milk is absolutely safe for consumption by the infants. Preliminary tests on heavily contaminated raw cows’ milk have proven the efficacy of the pasteurization device. Samples with initial bacterial counts too high to quantify were safe for human consumption after one pasteurization cycle.
Progress on the project has been slower than we anticipated. In the wake of the 2013 Rana Plaza garment factory collapse, safe and healthy workplace programs were trumpeted, but we quickly discovered that many workplaces are still inherently ‘mother-unfriendly’. Notably, mothers commonly lie to prospective employers about their post partum status: having young children is a liability and hurts their employment prospects. It’s hard to have a program for working mothers when no one wants to admit to being a working mother. Finally, we were able to partner with a local garment factory in Dhaka. Next month, the first participants will be enrolled and we will begin data collection.
I have no illusions about the months ahead: we will certainly encounter problems we haven’t yet anticipated. There is a lot of work to be done and project roll out will at times be difficult. But I am also excited. We have been able to work with experts all over the world who share our passion for improving the health of some of Bangladesh’s most vulnerable women and children. We have been granted an opportunity to change lives. The results and impact of this innovative project that support women to combine breastfeeding and work will reach far beyond World Breastfeeding Week.
For more information about this project, visit the project page: Mothers’ milk pasteurization for Bangladesh garment workers.