Ensuring All Infants Have Access to Human Milk: A Systematic Approach for Establishing Sustainable and Integrated Human Milk Banking Programs

Background Human milk is a pillar for infant survival, and when mother's own milk is unavailable or insufficient for low‐birth, preterm infants donor human milk processed and screened by a human milk bank (HMB) is the next best option; yet guidance for the introduction of HMBs as a critical component within breastfeeding promotion programming is especially limited for low and middle income countries. Objective To ensure sustainability by systematically strengthening systems for establishing HMB programs as an integrated approach so all infants have access to quality and safe human milk. Methods We developed a systematic approach for the introduction of integrated human milk banking globally, specifically in low and middle income settings. The first step involves establishing ownership through conducting formative assessments, establishing learning exchange opportunities with other HMB programs globally, hosting stakeholder meetings, and developing country‐specific strategy and guidance integrated into maternal and newborn care practices. The second step involves operationalizing an adapted system through a pilot introduction of an integrated HMB with quality control systems, and breastfeeding promotion and communications activities, all tailored for the local context. The third step involves evaluation of impact and cost of the implemented model for informing future implementation at scale. At each of these steps, engagement of local policy makers is essential for ensuring ownership and effective adoption into the health system. Results By building local technical capacity, operationalizing HMBs locally, and evaluating systems, local ownership is ensured for the prioritization of human milk for all infants. This methodology for strengthening HMB systems has been implemented in South Africa, and is ongoing in India, Vietnam, and Kenya. In each setting local governments have demonstrated ownership, working to adopt HMBs into the health system. Conclusions Where the burden of preterm and low‐birthweight are most prevalent, as is the case in low and middle‐income countries, integrated HMB systems, supported by the government, are essential for ensuring that all infants receive human milk. Further guidance and tools adaptable to setting‐specific needs is needed for implementation, integration, and regulation, and ultimate scale‐up of HMB programs globally to ensure that all infants have access to life‐saving human milk. Support or Funding Information The Bill and Melinda Gates Foundation financially supported the human milk banking implementation work in South Africa and India. Department for International Development, United Kingdom, through the County Innovation Challenge Fund, is financially supporting the human milk banking work in Kenya. The Margaret A. Cargill Foundation is financially supporting the human milk banking work in Vietnam and India.