Last month Virgie Townsend wrote an editorial for the Washington Post on her experience as a breast milk donor. In her piece Ms. Townsend shares how her milk came in faster and fuller than she expected. After running out of room in her freezer she decided to look into donating. In her piece, Ms. Townsend described donating 107 ounces of breast milk to a human milk bank in Massachusetts and shared details of the month-long screening process she went through to become a certified donor. She also discussed the rigorous screening and pasteurization process that her milk will go through before making its way to neonatal intensive care units across the Northeast United States.

Ms. Townsend’s hard work is commendable. The labor that goes into pumping breast milk can be hard to articulate to those who haven’t done so themselves, but it should be noted that it requires grit, patience, time, and energy. As a fellow breast milk donor, I appreciated Ms. Townsend shining light on the process of donating milk – I was also very disappointed to see her dismiss peer-to-peer milk sharing as dangerous without exploring the peer-to-peer process or digging into why exactly most mothers who receive donated breast milk do so through peer-to-peer networks. With over 90 percent of milk being shared in the U.S. being shared through informal channels, it seems worthy of exploration.

Like Ms. Townsend, I view donating breast milk as an act of community service and take great pride in the fact that I’m able to help women in my community feed their babies. Unlike Ms. Townsend, however, when I began to accumulate more milk than my son could ever drink and looked into my options for donating I decided that peer-to-peer milk sharing was the most ethical and effective way I could use my milk.

To date, I’ve donated 5,060 ounces of milk, all pumped within the last seven months, to babies in my community. Those ounces were hard won and I’m proud to have supplied nearly 40 gallons of milk, over 1000 meals, to eight babies (besides my own) who live within a few miles of my home. When I began to donate milk, I spent my pumping time digging into research on how, when, and why women share their milk.

While milk sharing may seem to be a novel practice in our modern, city dwelling lives, it’s been around since the beginning of time. Prior to the advent of formula, wet nursing or milk sharing was simply how babies survived if a mother passed away during childbirth or if she did not independently produce enough milk for her baby. Wet nursing in America certainly has a racist, dirty history, but along with the forced wet nursing of slaves, there have always been women who chose to nurse other women’s babies when their mothers could not.

While milk sharing was prevalent in the U.S. in the late 1800s, wet nursing and milk sharing decreased in frequency with the rise of commercial formula and other convenience feeding practices of the early 1900s. The first public health push for breastfeeding began in the 1920s when physicians began to note that babies who were fed cow’s milk and homemade formulas often suffered from dangerous bought of diarrhea that babies who received breast milk did not. As industry progressed and commercial formula companies began to enter the market, breastfeeding rates continued to fall. By 1971 only 24 percent of babies ever received any breast milk at all. In the late 70s women’s-centered health and a better understanding of how breast milk improves infant health led to a renewed push for breastfeeding that has moved breastfeeding’s rates upward (with periodic rises and falls) to where we are today. In 2011 79.2 percent of all babies were breastfeed and nearly half were still breastfeeding at six months.

As breastfeeding rates have continued to rise, and the serious, positive, long-term impacts of breastfeeding have begun to solidify in the collective conscious of moms in the U.S., their desire to ensure their babies have access to breast milk, even if it’s not their own, has increased.

In 1919 the first human milk bank in the United States opened in Boston. Over the next several decades, as societal trends of breastfeeding waned and waxed, various small scale milk banks popped up and then disappeared. In 1985 the Human Milk Banking Association of America was founded with the goal of establishing health and safety standards for all American Milk Banks. There are currently 24 human milk banks in operation in the United States.

These milk banks solicit donations from across the country and, after screening, pasteurizing, and combining milk into protein packed meals, provide it to premature babies for whom formula can pose a dangerous risk.

While the milk banks in operation across the U.S. provide an important services, America on the whole is way behind the curve when it comes to institutionalized milk sharing. While other nations (most notably, Brazil) have developed responsive, complex milk sharing systems that can be easily accessed by both donors and recipients, moms in America who wish to donate their milk have only two choices: to go through an arduous process of becoming a milk donor for a certified milk bans – and then freezing, packing and shipping her milk on a regular schedule – or finding another mom online who needs milk and meeting her in a parking lot somewhere to pass along their liquid gold.

While the lack of options to donating moms is frustrating, it’s far more stressful and difficult to be a mom in need of breast milk. Certified milk banks in the United States only provide milk to babies who are currently hospitalized – and charge a hefty fee (typically around $4 per ounce) for their services. To fill this major gap, several prominent milk sharing communities such as Eats on Feets and Human Milk 4 Human Babies and have come to play an important role in peer-to-peer milk sharing. Today, most mothers who receive donated breast milk (over 90 percent) receive it not through a milk bank, but though a peer-to-peer network.

When I talked with the mothers of the babies I’ve donated to, their reasons for soliciting breast milk donations varied: One mother was parenting a child she adopted at birth who was born prematurely and with drugs in his system. Formula was dangerous for his immature gut and, as he grew, he seemed to thrive on donated milk. Another mother had exclusively breastfed her two older children, but when her twins arrived she found that she simply could not produce the amount of milk they required. My milk provided the two bottles per day that each needed to meet their growth milestones.

Another mother had experienced a traumatic cesarean section and was disappointed that her milk barely came in at all – when she tried to supplement with formula her baby’s tummy tightened and she wailed with gas pains all day and night. She tried every brand of formula in the store and even special ordered a gentle formula from across the ocean, but after trial and error she found that the only thing that soothed her and allowed her to eat pain free was donated breast milk. There was also a mom who was having surgery and needed just 60 ounces to get her baby through the period of time she needed to dispose of her milk due to her medication, and another who was headed to her sisters bachelorette party and would be unable to ship back the 30 ounces her little would need while she was gone.

Each of these women and the countless others who must turn to peer-to-peer milk donors due to a lack of milk sharing infrastructure in the U.S. place an enormous amount of trust in on another. Unlike milk that goes through a certified milk bank, their donors are not screened for disease, drugs, or alcohol use, and the milk that they feed their babies is not pasteurized or tested in any way. While Ms. Townsend worried greatly about the potential risk of a baby getting sick from donor milk, and mentioned the AAP recommendation to only use milk shared through a milk bank, the simple fact is that until women have ready access to breast milk though a milk bank, they will continue place their trust in their fellow mothers to procure milk for their babies.

Instead of condemning peer-to-peer sharing as unsafe, we should work towards reforming the culture of breast milk and milk sharing in the United Stated to ensure that, first and foremost, all women who want to breastfeed are supported to do so and, second, that all women who desire donor breast milk are able to access it in a safe, reliable manner.