Preterm birth
Human milk supply shortage
Low rate of milk donation
Compensated donors
Human milk pricing variability
Small-scale milk banking service providers
Poorly developed human milk distribution networks
Complicated contracting process
Health illiteracy regarding benefits of human milk
High rate of childbirth outside any kind of health care facility
Lack of visibility into supply and demand
Weak regulatory enforcement capabilities
Human milk donation is unregulated
Unregulated market risks patient safety
Unqualified and unlicensed practitioners
Human milk collection, storage and distribution has poor quality control
Human milk poses biosafety and biosecurity risks to public health
lack of safe collection, handling and distribution, as with human blood supply and tissue banks
Human milk donors are not appropriately screened
Donated human milk is not appropriately screened
Human milk is not handled safely during collection, storage and distribution
Breakdown of cold chain when storing, transporting and handling human milk
widespread tampering and adulteration within healthcare supply-chains
Adulteration of donated human milk
Contamination of donated human milk with pathogens, toxins and drugs
environments of weak trust
administrative corruption
rampant fraud and abuse in clinical settings
health systems plagued by repeated public scandals
vulnerable to disruption : communications networks; supply-chain disruption
increasing risk of disruption : social instability, natural disaster
risk of weakened governance : assessment and evaluation; decision-making, planning, policy-making
management systems disruption : monitoring and control; program, project management; services systems management; change management