Elisheva raises excellent questions in her post about donor milk as
"treatment" vs. nutrition, and whether this is a "real world vs. ideal
world" issue when it comes right down to the nitty-gritty.

My thinking is that it's both; that the issue is one of priorities and (like
everything else, it seems) a matter of supply & demand. OR, more exactly,
demand and supply. So we *know*, beyond a doubt, that all babies should get
human milk - if not their own mama's, then WHO #3 or #4 (from a single
donor, or pooled). But not everybody knows that, or ranks it of sufficient
importance, so that sufficient demand is not created to make the supply
available. I'm pretty sure that if the universal need for human milk were
taken absolutely seriously, there wouldn't be a shortage of supply - we know
that the stuff is created bountifully, and it's not all that big a deal to
share it. But it's a lot like regular old direct nursing - the demand must
be there to bring in the supply.

So, until a child's need for human milk is taken as seriously as its need to
breathe or sleep, and until artificial foods are seen as an absolute last
resort, it will continue to be the *donor milk* that is viewed as the
extreme measure. As long as the perception is that artificial milk is an
acceptable and OK substitute, there will not be the consumer (INCLUDING
physician/medical personnel) demand that will bring a sufficient supply of
donor milk for any baby not getting its mother's own into being. And it's a
catch-22, because as long as that's the perception (as it is now, for the
most part), that will remain in some ways the truth - it's simpler and
cheaper to pick up artificial milk and load it into the bottle than it is to
obtain donor breastmilk. Imagine if the reverse were true: if donor human
milk were as simple and inexpensive as formula is now, and formula were
scorned and required medical intervention and a lot of rigamarole & money to
obtain!

So, until that happy day when WE Rule the Earth, or at least until
enlightenment on this matter becomes more widespread, it's down to
priorities; the sick babies with well-informed doctors, and the ones whose
parents are educated and determined and assertive enough AND WEALTHY ENOUGH
to afford donor milk will be the ones who get it. Everyone else is stuck
with the de fault choices (of which commercially available formula is
probably the best).

As my dear little son said when he was not yet 2 years old and watched a
bird pulling up a worm to eat, "Sad but true, life is tough." (But, to bring
an encouraging tone to this otherwise gloomy observation, now that he's a
grownup he finds life neither sad nor tough! Growth brings light!)

Cathy Bargar RN IBCLC IThaca NY

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