Before there were milk banks, there were mothers helping mothers. Wet nursing — the practice of one woman breastfeeding another’s baby — has existed for centuries and laid the groundwork for today’s human milk sharing and donation systems. But while wet nursing was often informal, class-based, or transactional, modern milk banking is grounded in public health, safety, and equity. Understanding the history of milk banking helps us appreciate how far we’ve come — and how lactation professionals can help shape the future.

From Wet Nursing to Milk Banking

Human milk sharing has always existed in some form. For most of human history, wet nursing — the practice of one woman breastfeeding another’s baby — was the most reliable solution when a mother could not feed her own child. In ancient societies, wet nurses were often employed by wealthy families, while in lower-income communities, the practice was more informal and rooted in communal survival. Wet nursing was also common in cases of maternal death, illness, or social barriers to breastfeeding (Fildes, 1988).

As infant mortality rates were high and breastfeeding was crucial for survival, wet nurses played a vital public health role long before medical systems were formalized. However, the practice was deeply shaped by class, race, and power dynamics — especially during colonial and slavery periods when enslaved or impoverished women were often forced or economically pressured to serve as wet nurses for others’ children, sometimes at the expense of their own (Fildes, 1988).

By the 19th century, with the rise of germ theory and early pediatrics, wet nursing began to decline, and doctors increasingly sought more controlled alternatives. These included early attempts at artificial feeding, which were often inadequate and dangerous. This gap — between the need for human milk and the inability to provide it safely without the mother present — gave rise to milk banking as a concept.

In the early 20th century, forward-thinking physicians and nurses began exploring ways to collect, store, and distribute breast milk outside of the mother-infant dyad, particularly for premature or sick babies in hospital settings (Jones, 2003). These efforts laid the foundation for the first formal milk banks.

The first documented human milk bank was established in 1909 at the Kaiser Franz Josef Hospital in Vienna, Austria, where donor milk was used to nourish premature and orphaned infants at high risk of mortality. Just a few years later, the Boston Floating Hospital for Children opened the first U.S. milk bank, integrating donor milk into its innovative pediatric care (Jones, 2003). Both institutions prioritized human milk as a medical intervention, not just nutrition, and implemented early screening and hygienic practices well ahead of their time. Their success laid the foundation for modern milk banking by demonstrating that donor milk could be safely collected, processed, and used to improve infant survival—especially among the most vulnerable.

Growth and Early Safety Measures

Following the success of early milk banks in Vienna and Boston in the early 20th century, the concept of organized milk banking began to spread across Europe, North America, and parts of Latin America. As neonatal care advanced and more premature babies survived birth, clinicians recognized the critical role of breast milk in improving outcomes—particularly in preventing infections and feeding complications. Hospitals began to formalize the process of collecting, storing, and feeding donor human milk to sick or low-birth-weight infants.

By the 1930s through the 1970s, milk banking had become increasingly common in pediatric hospitals and maternity wards. These institutions recognized that the survival of preterm and ill infants often depended on access to human milk when their own mothers were unable to produce enough. In this era, milk was typically donated by postpartum women who had abundant supply, often recruited from within the hospital or local community.

Despite the relatively rudimentary technology of the time, early milk banks employed remarkably thoughtful safety measures. Donors were typically screened with basic health questionnaires, and some hospitals began implementing serological testing for infectious diseases as early as the 1910s—a notable precursor to the comprehensive blood testing used today (Jones, 2003; Arnold, 1992). Milk was often boiled or heated to reduce bacterial load, though pasteurization protocols varied by institution. Collection equipment was sterilized using hospital-grade techniques, and donor milk was stored in glass containers under refrigeration or freezing when available (Arnold, 1992).

Hospitals also began developing policies around the labeling, tracking, and documentation of donor milk to reduce the risk of mix-ups. While these early protocols lacked the sophistication of modern systems, they reflected a growing awareness that donor milk—like blood—required careful handling and a standardized chain of custody.

During this time, the clinical benefits of donor milk were increasingly documented. Physicians observed that breastfed preterm infants had fewer cases of diarrhea, respiratory illness, and failure to thrive compared to those fed early cow’s milk–based formulas. These clinical observations helped cement donor milk as a standard part of neonatal care in many institutions.

By the 1970s, milk banking had reached a peak in the United States and Canada, with over 50 active milk banks operating independently, often within hospital-based settings (Updegrove, 2013). Most were small and served only local or regional populations. Still, they played a crucial role in the survival of thousands of infants each year.

However, despite this growth, the lack of standardized national protocols remained a challenge. Each milk bank operated with its own guidelines for donor eligibility, milk handling, and safety testing. This patchwork approach would eventually leave the system vulnerable when new public health threats emerged—most notably, HIV/AIDS in the 1980s.

Crisis and Closure: The HIV/AIDS Era

In the early 1980s, as the medical community began to understand that HIV could be transmitted via human body fluids, including breast milk, serious concerns emerged about the safety of donor milk. At the time, there were no standardized national protocols in place for donor screening, blood testing, or pasteurization methods across milk banks. Each operated independently, and the absence of unified safety measures made it difficult to assure the public — or healthcare providers — that donor milk was safe from transmission of HIV or other pathogens (Arnold, 1993).

The response was swift: most milk banks closed. Within a few years, the number of active milk banks in North America dropped from over 50 to fewer than 10 (Arnold, 1993; Updegrove, 2013). This mass closure represented a significant loss in infant nutrition infrastructure at a time when neonatology was advancing rapidly. For the first time in decades, many hospitals were left without access to donor milk, and formula became the default alternative — despite its known risks, particularly for preterm infants.

This public health crisis was also a turning point. It became clear that milk banking could only survive long-term if rigorous safety standards were implemented and upheld. The HIV/AIDS epidemic, while devastating, exposed critical gaps in the milk banking system and galvanized a movement to rebuild milk banking around science-based, standardized, and transparent safety practices.

The Birth of HMBANA

In response, a group of these professionals came together in 1985 to establish what would become the Human Milk Banking Association of North America (HMBANA). The organization was formally incorporated in 1986 with a clear mission: to develop, implement, and uphold rigorous safety and operational standards for nonprofit donor milk banks across the United States and Canada (Jones, 2003; Arnold & Asquith, 1991).

At its inception, HMBANA filled a critical vacuum in leadership. There was no federal regulation of milk banks at the time, and commercial interest in donor milk was minimal. HMBANA stepped into this space with a public health–driven model, emphasizing nonprofit, altruistic donation and medically justified use of pasteurized donor human milk (PDHM). The organization began by creating detailed guidelines for every step of the milk banking process, including:

• Medical screening and blood testing of donors for infectious diseases

• Safe collection, storage, and transport of donor milk

• Use of Holder pasteurization (62.5°C for 30 minutes) to eliminate pathogens

• Post-pasteurization bacterial culturing to confirm safety

• Nutritional analysis and strict labeling, tracking, and documentation protocols

These protocols were based on the best available science and modeled in part after blood banking systems and food safety regulations. They became the gold standard for nonprofit milk banks in North America.

Importantly, HMBANA also emphasized that donated milk should never be commodified. To this day, HMBANA-accredited milk banks do not compensate donors, maintaining an ethical commitment to altruism and safety. Instead of profit, HMBANA’s framework centers on infant health equity—ensuring that PDHM is available first and foremost to the most medically fragile infants, especially those in NICUs.

Over time, HMBANA developed relationships with hospitals, physicians, public health departments, and researchers to promote awareness of donor milk and expand milk banking access. The association also began accrediting milk banks that adhered to its guidelines, creating a network of trusted, standardized nonprofit banks.

Thanks to HMBANA’s leadership, milk banking has seen a dramatic resurgence since the early 2000s. From fewer than ten milk banks in the late 1980s, the network has grown to more than 30 HMBANA-accredited milk banks operating today across the U.S. and Canada (HMBANA, 2024). Their consistent standards have restored confidence in donor milk safety, paving the way for widespread use in NICUs and beyond.

In many ways, HMBANA has done for human milk what blood banks did for transfusions: transformed a life-saving human product into a safe, regulated, and ethically governed medical intervention.

Rebuilding and Growing the Network

Since the early 2000s, milk banking has seen a significant resurgence. Advances in donor screening, pasteurization technology, and clinical research have restored confidence in the safety and efficacy of donor human milk. NICUs across the U.S. and Canada began incorporating pasteurized donor human milk (PDHM) into feeding protocols for very low birth weight infants — helping to prevent necrotizing enterocolitis (NEC) and improve outcomes.

As of 2024, there are over 30 HMBANA-accredited nonprofit milk banks in North America (HMBANA, 2024). Many operate in partnership with hospitals, academic institutions, and community milk depots. Some milk banks now serve outpatient infants as well, offering PDHM for babies with complex medical needs, feeding challenges, or maternal lactation difficulties.

Globally, milk banking has expanded even further. More than 600 milk banks now operate in over 60 countries — including national systems in countries like Brazil, India, and South Africa (WHO, 2023). The story of milk banking is no longer just about saving the smallest babies in intensive care units; it’s about scaling a lifesaving intervention with equity and cultural sensitivity.

Looking Ahead

The history of milk banking reflects an ongoing balance between urgency, safety, and trust. From its early beginnings in Vienna to its rebirth through HMBANA, milk banking has always existed to fill a critical gap — helping babies who need human milk when their mothers’ milk is unavailable.

As lactation professionals, we are part of that legacy. Whether we refer families to milk banks, educate parents about donor milk, or support donation efforts in our communities, we are helping to advance a century-old mission to ensure every baby has access to human milk.

Coming up in Part 2: We’ll take a closer look at how milk banking works today — from donor screening and milk processing to the clinical use and safety of PDHM. We’ll also explore what the research says about outcomes and why pasteurized donor milk is often the best option when mother’s milk isn’t available.

References

Arnold, L. D. (1992). Human milk storage and preservation in the early 1900s. International Review of Modern Surgery, 42, 161–165.

Arnold, L. D. (1993). HIV and breastmilk: What it means for milk banks. Journal of Human Lactation, 9(1), 9–11.

Arnold, L. D., & Asquith, M. T. (1991). The evolution of services in modern human milk banking. Journal of Human Lactation, 7(3), 93–98.

Cohen., M., & Ryan, H. (2019). From Human Dairies to Milk Riders: A Visual History of Milk Banking in New York City, 1918-2018. Frontiers, 40(3), 139-170. 

Davis, A. (2020). Other mothers’ milk: From wet nursing to human milk banking in England, 1900–1950. Women’s History Review, 29(3), 416–434.

Fildes, V. (1988). Wet nursing: A history from antiquity to the present. Blackwell.

HMBANA. (2023). Guidelines for the establishment and operation of a donor human milk bank. https://www.hmbana.org/

HMBANA. (2024). Find a milk bank. https://www.hmbana.org/find-a-milk-bank.html

Jones, F. (2003). History of North American donor milk banking: One hundred years of progress. Journal of Human Lactation, 19(3), 313–318. https://doi.org/10.1177/0890334403255857

Updegrove, K. (2013). Nonprofit human milk banking in the United States. Journal of Midwifery & Women’s Health, 58(5), 469–474.

World Health Organization. (2023). Infant and young child feeding: Human milk banking. https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding