Protecting human milk as a life-saving medical intervention

For School of Health Sciences Senior Lecturer Dr Ying Jin, that gap is more than a statistical oversight - it is a structural blind spot in the health system. Her new national project sets out to answer a deceptively simple question: before we try to improve human milk and breastfeeding outcomes for vulnerable infants, do we actually understand the systems designed to support them?

As part of this initiative, Dr Jin was awarded funding from the Palmerston North Medical Research Fund, which enabled internationally recognised nurse scientist and global leader in human milk and lactation research Professor Diane L. Spatz to travel to New Zealand as a collaborator and mentor for the project. Her expertise in neonatal nursing, human milk science, and health system implementation strengthens the project’s international relevance while building local research capacity. Dr Spatz’s 10 step model to promote and protect human milk and breastfeeding for vulnerable infants has been implemented in low, middle and high income countries globally.

Over the past three years, Dr Jin has worked alongside clinicians, lactation consultants and human milk bank staff, supporting postpartum women, their pēpi and whānau. In doing so, she observed significant variation between hospitals in terms of the availability of International Board Certified Lactation Consultants and how often and what times of day they see patients; the education and training of NICU nurses and other staff related to human milk; the availability of donor milk and which infants have access to donor milk during the hospitalisation period, and overall variances in clinical practices related to the use of human milk and breastfeeding.

What has been missing is a national map of those differences.

“We are actually very good at collecting breastfeeding rates for healthy babies. We know how many babies are exclusively breastfed at discharge. What we don’t have is systematic national mapping of lactation support and human milk feeding practices for hospitalised infants,” Dr Jin says.

Breastfeeding is often framed as a personal decision, but in a NICU where babies may be extremely premature or critically unwell, the reality is far more complex.

Establishing and maintaining lactation in a NICU environment depends heavily on structure. Are hospital-grade breast pumps available? Is there protected time and space for skin-to-skin contact? Are staff trained and consistent in their advice? Is donor milk accessible when needed? Are specialist lactation consultants embedded within the unit?

For vulnerable infants, human milk is not simply nourishment. It is widely recognised as a life-saving medical intervention, associated with reduced complications and improved health outcomes.

Dr Jin believes the timing of this project is critical. New Zealand’s neonatal population is more complex than ever. Advances in care mean more very-preterm babies are surviving, often with prolonged hospital stays. At the same time, the health workforce is under pressure, and equity in maternal and infant care is under intense national scrutiny.

Policy discussions are taking place in this environment but without a clear baseline understanding of current human milk rates at discharge from NICUs nationwide.

“If we do not understand the system, we risk making decisions in the dark.”

“We might introduce policies that hospitals do not have the staffing to implement, allocate funding without understanding where the real gaps are, and misinterpret outcome data without understanding the structural context.”

In the absence of system-level information, even well-intentioned reforms can fall short or widen existing inequities.

By mapping policies, resources and clinical practices nationwide, the project aims to create the first comprehensive baseline of NICU human milk rates and breastfeeding infrastructure in Aotearoa. That baseline can inform targeted quality improvement initiatives, workforce planning and future equity-focused interventions specific to intensive neonatal care.

“This project is catalytic. It will ensure measurable system change.”

Upcoming Public Lecture

Internationally acclaimed expert Diane L. Spatz, PhD, RN-BC, FAWHONN, FAAN will be sharing her evidence-based global model to protect human milk, improve care and advance equitable outcomes across Aotearoa New Zealand at a public lecture at 12noon, on Wednesday 4 March. An event open to both health professionals and the wider community.