Policies and guidelines supporting the sustainability of human milk donation to milk banks in Switzerland: a document analysis.

backgroundDonor milk from a human milk bank is recommended for vulnerable infants when the mother’s own milk is scarce. Globally, despite an increasing number of human milk banks, the demand for donor milk exceeds the supply, and access remains inequitable and insufficient. The objective of this document analysis was to investigate how global (universal), European, and national policies and guidelines support the sustainability of human milk donation in Switzerland.

methodsDatabase searches of Medline (via PubMed) and CINAHL were completed in June 2024. Eight documents were included: three guidelines, two position papers/consensus statements, two toolkits and one document with policy recommendations. The analysis was constructed around the micro (individual), meso (institutional) and macro (healthcare system and policies) level framework of structures and systems.

resultsGlobal and European documents offered general recommendations that can be flexibly adapted for each location. Global documents contained explicit recommendations related to sustainability for donations mainly at the macro and meso levels, whereas European documents recommendations related to factors influencing sustainability of human milk donation at all three levels. Swiss guidelines primarily addressed the meso level through specific recommendations adapted to the national context. Regarding sustainability and its three pillars, the majority of the identified recommendations focused on the social pillar. The economic pillar was moderately addressed, whereas the environmental pillar—encompassing issues such as milk wastage, contamination, pollution associated with single-used plastics and broader environmental impacts—was largely overlooked.

conclusionsThe sustainability of human milk donation is addressed inconsistently in current global, European and national guidelines on human milk banking. Some documents provide multiple explicit recommendations across different levels, while others refer to the sustainability of donation only implicitly. Future work and research should consider providing a coherent framework across policy, organisational and behavioural levels to enhance the sustainability of human milk donation.