Guiding the implementation of a future National Milk Bank Service

The purpose of the extension phase of my UKRI FLF is to understand the implementation of human milk bank services in the UK. Prior to the start of my FLF, milk bank services in the UK were generally small under-resourced services, with debate amongst neonatologists about whether they were necessary at all.

Since then, the work published during my FLF and from others globally have highlighted the breadth of public health impacts that access to donor human milk can have on both the individual level, in terms of support for maternal mental health and ameliorating adverse infant outcomes of supplemental feeding, and at the societal level with regards to support for breastfeeding and broader perceptions of human milk. This year, the WHO has launched a Guideline Development Group aiming to establish minimum standards globally for the operation of human milk banks, and there is an increasing clinical awareness that donor milk should be available as a supplement for infants where maternal milk is unavailable, including term as well as preterm infants.

Greater focus on the sector has also arisen as a consequence of the 2022 formula shortages where vulnerable infants were left without safe feeding options. Human milk banks in the USA had to quadruple output to meet the needs of hospital services. There is currently no emergency planning for such circumstances in the UK context, but a high likelihood of similar supply shortages developing in the near future.

The main aim of my FLF was to create evidence that could inform the creation of a National Milk Bank Service, with equitable opportunity to donate and receive donor milk. The need for such a service has largely been established, but there are a number of risks of inappropriate service implementation. These include safety risks, lack of equity, commercialisation, disruption to service provision, and failure to support maternal breastfeeding where possible.

Phase 2 of my FLF will therefore build on the foundations laid in the first phase of my UKRI FLF, complementing the work achieved so far, and establishing a cohesive programme of broad implementation research. The proposed programme will build on the network of diverse stakeholders and academic expertise brought together within the first phase of my UKRI FLF to address these gaps before milk banking services are further scaled in the UK, working across four workstreams:

1) the research team will make an assessment of donor milk acceptability using paradigms established recently on complex public health interventions by Sekhon et al., using a variety of methods that include surveys, semi-structured interviews and workshops with key stakeholders, and focus groups;

2) working with health economist, Dr Hema Mistry, a robust assessment of cost-effectiveness and costings will be conduct to facilitate future service planning;

3) the integration of a novel donor portal, facilitating the recruitment, communication and support of milk donors, developed during the first phase of my fellowship will be integrated into the Li-Lac milk bank tracking system and evaluated for efficacy in improving donor experience and volume donated against audited data from 2020-2022;

4) building on preliminary workshops that bring together emergency planners with milk banking and paediatrics experts, work will continue to co-design emergency response and service continuity plans, entrench risk management throughout UK milk banking, and establish the utility of freeze-dried milk as a method of building resilience in the sector.

This work will have broad ranging impacts on the intractable area of increasing breastfeeding rates, both in the UK and globally. After a recent presentation WHO European Region webinar on human milk banking, the Chair concluded that, "the case for milk banking had been made - now the focus should be on implementation." My team are in a unique position to meet this challenge.