Neonatal care

Protecting our most vulnerable patients beyond the NICU/nursery with the Access to Donor Milk Act

With the continued struggle to prevent preterm birth, our next line of defense is to ensure that the treatment preterm infants receive is of the highest standard and optimized for the best possible outcomes.


There is no denying that the medical community has made tremendous advances in the field of neonatal-perinatal care. However, one major barrier remains: the prevention of preterm births in the United States. A recent March of Dimes report card for premature births gave the U.S. a D+ grade with a preterm birth rate of 10.4%. While this is a 0.1% decrease since the 2021 rating, the 2021 rate was the highest for the nation in at least 10 years. Like many health outcomes, this too affects our Black and Brown families most, with Black families experiencing preterm birth at an elevated rate of 14.6%.

With the continued struggle to prevent preterm birth, our next line of defense is to ensure that the treatment these preterm infants receive is of the highest standard and optimized for the best possible outcomes regarding survivability and development. One of the most studied and accessible means of supporting this growth and development is through the promotion of an exclusive breast milk diet for all infants. In 2022, the American Academy of Pediatrics (AAP) revised its policy on infant feeding to support exclusive breastfeeding for the first six months of life, with continued provision of breast milk alongside food for up to two years or longer if able.

Introduced in the House and Senate in September, the Access to Donor Milk Act of 2023 will, if passed, amend the Child Nutrition Act to include access to donor milk, provide funding for donor milk banks to increase milk collection, storage and processing, and encourage HHS to establish standards for donor milk collection, storage and transfer.

Within the vulnerable NICU population, evidence has shown that the use of expressed milk is associated with improved outcomes, most notably a decrease in the frequently devastating diagnosis of necrotizing enterocolitis (NEC), which remains one of the leading causes of morbidity and mortality among the preterm neonate population.

Lack of paid parental leave is among reasons for decline

Despite these recommendations and well-established science documenting the advantages of an exclusive breast milk diet, the U.S. continues to struggle to support lactating parents and their children. According to the CDC 2022 Breastfeeding Report Card analyzing 2020 data, while we have improved initiation of milk with 83.1% and 61.6% of newborns receiving any breast milk or exclusive breast milk at birth respectively, these numbers rapidly decline to 58.2% and 25.4% by six months of age and only 37.6% of infants reportedly receive any breast milk by age one.

More importantly for this upcoming legislation, by six months of life over 37% of infants have been fed supplemental formula. This decline is driven by many factors—lack of standardized paid parental leave, lack of community support for lactating parents and unsafe or unsanitary environments for pumping for parents who must return to work, among others—some of which were addressed with the passage of the PUMP Act of 2023 and many more.

In recent years, a number of states and the District of Columbia have passed legislation to provide coverage for pasteurized donor milk for infants who would medically benefit from this treatment following discharge from the hospital; however, it was not until 2023 that the Federal legislature has begun to take notice of the dire need to help to eliminate the disparities in accessing this treatment on a national level.

These bills are especially important for those on WIC

On Sept. 14, both the House of Representatives and the Senate introduced the Access to Donor Milk Act of 2023. These bicameral, bipartisan bills attempt to address the ongoing health care needs of our nation’s youngest and most vulnerable citizens. H.R. 5486, introduced by Rep. Chrissy Houlahan (D-Pa.) alongside Reps. Stephanie I. Bice (R-Okla.), Maria Elvira Salazar (R-Fla.), Nancy Mace (R-SC) and Debbie Lesko (R-Ariz.), currently enjoys strong bipartisan support, while S. 2819, introduced by Sens. Tammy Duckworth (D-Ill.) and Marco Rubio (R-Fla.), has yet to gain much traction in the Senate.

Both bills aim to amend Section 17 of the Child Nutrition Act of 1966 (42 USC 1786), under which the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) was established, to make the following provisions regarding access to pasteurized human donor milk:

  • Include access to donor milk within the language of the act when discussing support for the costs for breastfeeding parents under the WIC Program.
  • Define “milk banks” as non-profit organizations focused on collecting, testing, pasteurizing and distributing donor milk under the standards as established by the FDA.
  • Appropriate $3,000,000 for the 2024 fiscal year, with continued funds to be determined in following years, to allow for the Secretary of Health and Human Services (HHS) to establish grants for eligible donor milk banks in order to:
    • Raise awareness of and provide resources educating about the needs for donor milk, especially in high-risk infants.
    • Provide financial support for donor milk collection, storage, pasteurization, transfer and processing, as well as for acquiring increased staff and supplies to carry out these actions.
  • Places accountability on HHS to establish national standards surrounding the collection, preparation, storage, pasteurization and mobilization of donor milk and its byproducts, such as milk-derived caloric fortifiers, as well as setting benchmarks for appropriate screening of donors.

Additionally, by placing the focus of this legislation on the families covered by WIC, these bills speak directly to the inequity of not only preterm birth rates and maternal/infant outcomes in our nation, but also stand to serve as a bridge to providing the best possible nutrition to the infants at highest risk of complications following discharge. Importantly, the language of this bill focuses on at-risk infants (former premature infants, those with history of abdominal surgery or feeding intolerance) to ensure that while making this life-saving product more accessible outside of the hospital walls, protections will be in place to ensure that supply remains available for these infants upon birth while admitted to the NICU.

There are currently 32 milk banks under the umbrella of the Human Milk Banking Association of North America (HMBANA) located throughout the United States and Canada. These nonprofit centers set the standard for milk collection, pasteurization and allocation. These grants can help to fortify existing milk banks and establish additional banks to aid in maintaining supply. 

What you can do to help

As mentioned above, both bills have been introduced rather recently and need your help in gaining the attention and traction they deserve in their respective houses of Congress. It takes only minutes to contact your representative and senators by going to the AOA Osteopathic Advocacy Action Center and using our Letter of Support to send your message to Capitol Hill. There is a good chance that either you or someone you know has been affected by complications of premature birth. Let your or their stories be heard as you support the passing this much-needed legislation.

Editor’s note: The views expressed in this article are the author’s own and do not necessarily represent the views of The DO or the AOA.

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