Thirty years ago, poor Brazilian women were paid for their breast milk, leaving their children at risk of malnourishment. Equipment at the few milk collection centres was so costly it limited the country's ability to expand the program's reach.
That has changed dramatically, thanks in part to Joao Arigio Guerrade Almeida, a chemist who has turned the Brazilian Milk Bank Network into a model studied by other countries and credited with helping slash infant mortality by two thirds.
"Brazil is really the world leader in milk bank development," said Dr Lisa Hammer, a University of Michigan pediatrician who was part of a team visiting the Rio de Janeiro-based network last week.
Relatively unusual in much of the world, donating breast milk is common in Brazil, where the network of banks works in much the same way as blood banks, testing, sorting and storing milk used mostly to feed premature infants in neo-natal units.
When a mother is unable to breast feed her baby, due to illness, drug addiction or other problems, the network steps in to offer free milk. Last year, it collected milk from some 150,000 women to nourish about 155,000 babies.
Reaching such success was not easy. Almeida recalled the trouble he saw on his first visit to a Rio milk bank in 1985, at the tail end of the country's two-decade-long military dictatorship.
"What I saw frightened me," he said. The system relied on "donations" from destitute mothers who often sold so much breast milk they were left without enough for their own infants.
Almeida lobbied for a ban on the sale of breast milk and sought alternatives to expensive imported equipment. High-end pasteurising machines that cost USD 25,000 were swapped for USD 1,500 Brazilian-made machines used in food-testing laboratories. Jars made for mayonnaise or instant coffee were sterilised to store milk for freezing, replacing imported beaker tubes that had accounted for a whopping 89 per cent of operating costs at Brazilian milk banks.
"We found ways of adapting the system to the reality of a developing country without compromising the quality and safety of the milk," said Almeida, 57. "We also shifted the focus from the child to the mother, making her into the protagonist."
Brazilian women increasingly are choosing to nurse, with the Health Ministry estimating more than half of mothers now breast feed exclusively for their children's first six months of life. In the United States, that rate is 16.4 per cent, according to the Centres for Disease Control, even though breast feeding is widely seen as the best source of nutrition for infants.
The network, with its 214 bank locations, is a rare success story in Brazil's strained public health system. It has helped set up similar programs in more than 15 Latin American and African nations, as well as in Spain and Portugal. The team visiting from the University of Michigan last week sought tips on setting up a bank at the university's hospital in Ann Arbor.
