Dear all:

Let me make it clear.  I think my posts may have led to the perception (at least from what I read into Jacqui's post) that I am like the overenthusiastic IBCLC who yells at a mother whose baby really is starving for giving some formula. When in fact, I'm really criticizing the marketing of the formula, not the mother who used it.  Just like I would educate that mother that the formula she was given in the hospital is NOT free -- it costs the mothers who end up using formula for the duration a lot of extra money because they are paying for those promotional samples and marketing, I will try to explain more about why I am particularly unhappy about deceptive marketing when it comes to ANY type of international development project.  Deceptive marketing hurts all international projects.  It makes donors wary, it leads to what we call  opportunity costs -- when energy that could be spent on an effective intervention is wasted on something that is ineffective or even sometimes harmful.  And this leaves those who want to donate confused and doubtful that their donations are used appropriately.

Let me also make it clear that I am a big fan of small local projects.  I would love to see more small donor milk banks and direct milk sharing succeed in developing sustainable and safe models.  And it is only through experimenting and trying out ideas, some of which will work and some of which won't that you get there.

When I worked as Director of Nutritional Programs (a title that I changed to Nutritional Advisor because that more appropriately describes the role) at Helen Keller International -- I worked with five programs in Asia, three programs in Africa and one program in Mexico.  Technically, however, the program in Niger was a regional office that reached all of West Africa.  Helen Keller International was not a direct service delivery project.  It provided technical assistance to facilitate the initiation and sustainability of programs implemented by both governmental and nongovernmental organizations.  I had to keep track of budgets, so I know the good, the bad, and the ugly when it comes to how projects are marketed and how money is used and misused.  And I know how hard it is to interest some donors in building sustainable projects.  The United States Agency for International Development (USAID) usually gave three-year grants.  This meant a project was barely off the ground.  If you managed to get an extension, you might get closer to a sustainable project, but I'd say it takes more like 10 years to get there.  From my experience, I have a soft spot for the small local projects.  Our Bangladesh office pulled together a huge group of local nongovernmental organizations for a gardening program that reached millions.  The local organizations all had different management styles and niches, but they pulled together to create a web of gardening initiatives that empowered women, increased income, and improved nutritional status.  At the same time, there is a role for the short term being coupled with the long term approach.  And sometimes it is harder to "market" the long term approach.  On the surface, the costs of initiating a gardening program make it seem like you are reaching fewer people than a vitamin A capsule program where you can reach millions for pennies a person.  Yet, this doesn't take into account that once a woman starts a family garden, she will reap the benefits of that for far longer.  And I would say that this mimics what Jacqui talks about doing with premies. 

Now when it comes to the bad and the ugly, there are varying degrees.  Nonprofit organizations need donations.  Sometimes the "marketing" of their requests slide a bit into gray areas.  For instance, Les Amis de Pere Damien worked where I was a Peace Corps volunteer.  They work on leprosy and on tuberculosis. You could "market" donating to get rid of leprosy because of how squeamish people are about leprosy.  Meanwhile, tuberculosis kills far more people and ate a bigger portion of their budget.  This gets trickier when you have grants.  USAID grants stipulate that the funds they give are to be used only to that project.  I know for a fact that some organizations will shift money from one fund to another and this is considered illegal.  Rarely, if ever, is any organization taken to task for this.  

In terms of the parallel here, I find that Prolacta and IMBP tend to emphasize HIV and orphaned babies.  We tend to react to HIV or the actual disease AIDS viscerally.  HIV and AIDS cause deep fear -- like cancer in the 1950s.  Since the emphasis had been more on HIV and orphaned babies, I did my calculations for what it would take to feed one of those babies all the way through their period of needing mother's milk.  And I did not do these calculations based on how Milk Matters uses their milk, I did this because of how Prolacta tends to market the collection of milk of which 75% is going to their for profit endeavors.  

The IMBP website states "For every ounce that remained in the U.S., Prolacta PROVIDED (note the past tense) at least $1 to IBMP" (http://www.breastmilkproject.org/op_prolacta.php) and that 267,682 ounces have been donated to babies in Africa.  By my calculations this means that Prolacta should have given $803,046 for the build up of local milk banks.  This is not something that local milk banks should have to ask for.  This is what the IMBP website states HAS happened.   

IMBP has stated that they have awarded $184,000 for health care initiatives in Africa (http://www.breastmilkproject.org/wwd_hcd.php) or 23% of what Prolacta provided to build up local milk banks.  

This includes $22,448 to Milk Matters  (http://www.breastmilkproject.org/hiw_faq.php?section=4) for “milk bank operations and development”, $12,843.23 to iThembu Lethu, South Africa for collection and processing of donor breastmilk, and $5,100 to Beryl Thyer Memorial Africa Trust for hospital equipment for a local breast milk bank) – or 5% of the total money that they stated would be dedicated to build up local milk banks.  The rest of the money was for water projects, health care clinics and care of orphans.

My question really was whether or not local milk banks are actually receiving what appears to have been promised on the website?   This is what they are marketing as having already happened to potential donors.

Furthermore, the section on sustainability [http://www.breastmilkproject.org/hiw_sustainability.php] is not a model.  It is a projected budget.  Having had to write a huge number of grants that included a sustainability section for USAID, a simple graph would not pass muster.  I want to know more specifically how they have been helping local milk banks.  What training, what supplies, what assistance to market to potential LOCAL donors directly.

I, personally, would much rather direct parents to send their money directly to local projects such as Milk Matters.

Sincerely,

Susan Burger, MHS, PhD, IBCLC

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