We Can Double The Production Of Human Milk By 2025

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Has The Tipping Point Arrived In The Long Global Struggle To Advance Breastfeeding Rates?

Dan Garbez and Dr. Stella Dao, inventors of the Freemie breast pump system, meet Malcolm Gladwell, author of The Tipping Point

New Breast Pump Technology Aimed At Productivity Is Transformative

My wife and I recently had the opportunity to hear Malcolm Gladwell give a talk to her medical group. Mr. Gladwell is the celebrated New Yorker writer, author of The Tipping Point: How Little Things Can Make a Big Difference, David and Goliath, and many other best-selling books. Certainly near the top of his long list of accomplishments, Gladwell is famous for popularizing the idea of a "tipping point" as a way to understand how and why some ideas, innovations or behaviors catch fire at some critical stage, and ultimately cause fundamental and widespread change.

In the book and at some of his public appearances, Gladwell shares many real world stories that highlight the role of innovation as one factor that can contribute to dramatic social change. But not every great innovation catches on. A great idea may languish for years in obscurity, subjected to periodic tinkering, or, on the other end of the spectrum, an idea may be the focus of relentless, resource-intensive development efforts.

Sadly, many truly great ideas never make it past the former stage. But some lucky ones do break through. And sometimes this breakthrough is the result of a minor, incremental improvement, or even some unrelated or coincidental change in some external factor that causes the idea to catch on. But if it does catch on, it can spread - to paraphrase Gladwell - like a virus. Transformative ideas can spread and infect the landscape to the point that, over time, people can't even imagine what things were like before...

My wife and I founded a company several years ago to bring our invention, the Freemie breast pump system, to market.

It all began when Stella gave birth to our twins prematurely in January, 2004. Little Kim and Joe weighed in at just over 3 pounds each. My wife, a physician who was planning to return to work in a busy emergency department after maternity leave, was faced with the prospect of being dependent on a breast pump for the next year. She sized up what was needed at that time to manage pumping with the available equipment. She quickly realized it simply wasn't going to be possible to do her job, take care of vulnerable patients in the ER and take care of our equally vulnerable preemies at home.

Using a traditional breast pump required her to frontally undress. So privacy was necessary. The equipment required her to hold the milk receptacles over each breast. This, combined with the fact that seclusion was required, interrupted her ability to do almost any task associated with her job. She was trying to produce enough milk for twins, and had to be able to stop working and go seclude herself somewhere for as much as 30 minutes, or more, every 2-4 hours.

It didn't matter that the law said her employer had to give her breaks to pump. It didn't matter that she could order the staff not to bother her and to guard her privacy while she pumped. The requirements of this regimen weren’t merely impractical. It would have been unsafe. She was responsible for the lives of patients.

But giving up on breastfeeding was also categorically never an option: "I'm not going to bring home germs from the ER without also bringing home breast milk with its protective antibodies for our babies too." In those first weeks, with our kids in the neonatal intensive care unit (NICU), she was obsessed with this dilemma. It was driving her crazy.

At some point while she was cursing the pumping routine during one of those middle of the night feeding sessions (she was frequently pumping while I took turns feeding one baby at a time) she realized that women’s work does not end when they give birth. Their work increases. Pumping in particular was a lot of work, and unnecessarily so. Mothers everywhere needed a breast pump that was easier to use. It needed to be more versatile so they could use it whenever they needed, wherever they needed, so they could maintain their milk supply. In the middle of that night, it was as clear as day to Stella; moms needed to be able to pump with their clothes on and hands free.
It was easy to agree with her at 3:00 a.m., because I was living with this struggle too. I confess, I didn't remember I had promised to help make a prototype the next morning. But over the next few weeks she beat it into my head that I had to help her make it a reality, or - she made clear - I would never hear the end of it. So I got on board.

Specifically, what she envisioned was a milk collection system that she could just slip into her bra, under her shirt, that could connect to an efficient hospital quality breast pump, so that she could continue working in a rather public environment and avoid extended interruptions to her work while milk was collecting. In computer parlance, this whole process needed to work in the "background" of her life to reduce the time dedicated solely to pumping.

Being a refugee from Vietnam as well as a physician, she had the vision to understand the global problem from the beginning. Together, we thought, "We have to make it easier and cheaper to provide breast milk than to buy formula anywhere in the world!"

As those weeks and months became a blur, the desire to understand the process and the economic impact of providing milk to our twins was a big part of the all-consuming adjustment to parenthood. I closely watched my wife pump. I paid attention to the whole process. She taught me the biology as we evaluated the mechanics together. I observed how much labor went into it. I took note of the impact on my time and productivity. It required quite a bit of work on my part to help make time for her to pump. And we discussed and researched these issues all the while. The entrepreneurial exercise was exhilarating! It was clear the economics of the solution we envisioned were a no-brainer.

The Global Challenge

As expensive as formula is, the real cost to pump breast milk is much higher for most women using the traditional pump systems. Too much time is sacrificed, and productivity is lost at home and work. The drawbacks of the traditional system are so well known as an onerous drain on productivity that women who can afford to simply take extended maternity leave in order to nurse longer. They know it will be impractical or impossible to try to pump once they get back to work. The cost in lost wages for these women is staggering. But millions of women must work, and sacrifice tremendously for what little maternity time they do take. The statistics don't lie; most of these women simply have to stop breastfeeding.

Basic economics explains why baby formula is a mammoth, multi-billion dollar global industry. In too many cases, the immediate cost to the mother of formula, while extremely high, is much cheaper than the alternative cost to her in lost wages.

From the beginning we were cognizant that time is money. We can save moms time by providing them greater flexibility to manage pumping. If they can use their time more efficiently, they will be more productive.

The cost in time spent dealing with and worrying about the complex logistics of pumping is high. Women need to negotiate extra breaks with employers and coworkers each day, then interrupt work to make the trek to a private space. If we eliminate this logistical nightmare, this will make the production of breast milk more affordable. Moms will make more money if they don't have to restrict work schedules or take unpaid breaks. Their employers and coworkers will be happier too, as they will be less impacted. They will have more time with their families if they aren't staying late at work to get caught up. Their babies will be healthier, and they'll be able to breastfeed longer. Women instinctively want to do the best they possibly can for their babies, and if they can provide more milk longer without serious financial sacrifice, the vast majority will.

Looking out into the future, we dreamed that we might one day get really good at delivering this solution. We started to believe we might be able to reduce the actual cost to produce breast milk below the cost of formula. If we could make that possibility a reality, breast milk will take market share from formula without even having to make the case for better health! (That's not a tough sell, but the reality is simple dollars and cents are frequently more powerful persuaders.) Straightforward market-driven economics would take over at that point, and higher breastfeeding rates would become irreversible. I felt this in my core, and it has been one of the driving forces of our commitment and focus ever since. As a child of Silicon Valley, it's in my DNA to know if you have to compete with an entrenched alternative like the massive baby formula industry, the best way to do it is to offer a "better, cheaper, faster" solution. That is how transformative change occurs. We know which milk product is "better." We just had to focus on the "faster" and "cheaper" parts.

The formula industry's infrastructure, production costs and distribution models are as mature and as efficient as they can be. But formula is still made in big industrial factories with complex supply chains, requiring resource intensive logistics to get to market. The cost per calorie, by the time it gets to the baby, is incredibly high. In contrast, the breast milk "industry" should have many natural advantages. Mom makes it on the spot, very close to the point of consumption. Most of the materials she needs are reusable. The cost of her caloric inputs is exponentially less expensive than the finished product that is the baby formula alternative.

Unfortunately, the infrastructure, technology and culture that has evolved to support the production of human milk is still stuck in the early 20th century. We think it quite odd, perhaps Sisyphean, that the primary efforts to modernize this system have focused on trying to get the rest of society to believe that women need to be excused, confined and isolated in order to pump milk, and that companies need to dedicate a permanent support infrastructure for what is frequently a temporary need, and adopt expensive policies to administer to this need.

We think moms need to be unleashed to be more productive. Moms need to be liberated!

The Opportunity

There is a great opportunity to empower moms to improve the efficiencies of their daily lives by giving them a real choice as they figure out how to nourish their babies and take care of their families. We can radically reduce the cost of human milk by transforming the production process and reducing the level of resources necessary to support it. We know the demand is strong. If the tools make it possible for moms to produce breast milk without having to ask others for concessions, or require others to subsidize their efforts, this reduces the direct costs to the moms also. Concessions are a negotiation, and there is usually a price. If the tools can make it easier for moms to produce more breast milk than to earn the wages needed to buy formula, that is what they will do. Give moms complete power over the process, and infant nutrition and health will experience a true renaissance. A golden age for the liquid gold could be upon us.

That was the original vision. Of course, we were under no illusions about the obstacles we faced. Failure was the most likely prospect. But if we just got a little lucky, we could easily make a measurable global contribution to maternal and infant health. Even if we could make a 5% difference, our idea could contribute to saving thousands of lives every year by reducing infant mortality.

The Game Plan

People now ask what compelled us to take this on ourselves, rather than just selling that first invention to the highest bidder. The answer is simple. We feared that it would become an expensive niche product. That would not deliver on the true promise we envisioned. That would be failure.

We knew the idea would be seen as disruptive and potentially threatening to established interests. So we mapped out a complex strategy to gain market acceptance and allies, and to position ourselves to work with and partner with as many breast pump companies as we could. The way we see it, we are all engaged in the same work. The formula industry is the real competition, and our side has been losing.

Before the invention even had a name (we eventually came up with "Freemie," since it is hands free, and inspired by our preemies) we decided to work to make our technology compatible with as many pumps as we could. By adapting our invention to existing manufacturers' pumps already out in the market, we could make those pumps more productive and useful to the moms that have them. (Think of it as a modern, 21st century user interface for the essential milk extraction machine. It is like putting the Windows operating system on a computer that was running DOS. Exponentially more people can figure out how to make use of it.)

If a mom has another company's traditional pump, the odds are very high - if she is going to be successful - that she needs to pump with her shirt on, and be hands free so she can do something else or be around others while she's pumping. On a technical level this challenge to make it cross-compatible with so many different machines would involve not only difficult and expensive research and development, but a risky marketing strategy that faced serious and potentially insurmountable obstacles. But if we got traction, we could drive meaningful change one customer at a time, and it would spread. Again, we reasoned at the time, if we could make just a 5% difference we would be a huge success, and set a wonderful example for our children about the power of thinking big.

This mission has been an all-consuming passion for our family for more than a decade now. It has drawn in many more mercurial individuals with world-class talents to work with us. We've been joined in partnerships in the last year by terrific entrepreneurial companies from around the world who are equally committed to our vision and our passion. Really, in many ways, it is very humbling.


So Gladwell’s talk inspired me over the last few weeks to take time to reflect on where we are in our mission, as we frequently wondered in the early years where our tipping point might be as we strived for that 5%. These days our many close friends and observers who have been cheering us on all these years have been telling us that we have passed our personal tipping point. By some measures, that is hard to dispute.

But I am finally comfortable making the argument publicly that our personal story up to this point is really just the introduction to the larger global story that is about to tip. It is not about us anymore. This idea has taken on a life of its own. It is already playing a meaningful role in thousands of precious new lives. It is unstoppable because this is one virus moms everywhere are painfully aware needs to spread. Here's the situation:

The global breastfeeding movement has spent billions of dollars of public funds and charitable donations over the last several decades promoting and subsidizing breastfeeding as the optimal form of infant nutrition. Everyone now knows the science is in, and the health benefits are clear. But after all this money has been spent and the efforts continue, the World Health Organization estimates that only 38% of children globally are breastfed exclusively for the recommended six months. Furthermore, they estimate that suboptimal breastfeeding contributes to 800,000 infant deaths each year. That is 800,000 babies that could be saved by more breastfeeding!

Many activists and policymakers fear that breastfeeding rates have peaked, that breastfeeding is continually faced with new challenges that set back these efforts, and that gains made from efforts focused in one area are offset by losses in other areas. Some activists despair that they are always fighting an uphill battle, and only see hope in more governmental interventions and subsidies.

Don't get me wrong. Money has been well spent. Education, awareness and the commitment to advance breastfeeding are at an all time high. As we see it, now that the necessary tools of production are at hand, the stage is set for supply to finally catch up to demand. Increasing supply will be driven more and more by market forces rather than by government mandates in the developed world. Global charitable organizations are doing tremendous work to help the world's poorest. We will work hard to see these new tools become available where there is need.

Our idea is becoming the spark that we envisioned. We're transforming the process of human milk production by reducing the need for archaic and costly support infrastructures. We will seek to work with every actor who shares the common goal to improve infant nutrition and reduce mortality. I am confident the global production of breast milk will double in the next decade, as breastfeeding mothers will be able to produce more at lower costs to themselves.

This change will happen faster than anyone might expect, because - until now - we haven't had time to toot our own horn. We've been too busy. But our customers are sharing with us just how transformative our first little innovation has proven to be, and here's what we know:

For perspective, understand that the traditional breast pump system fails or seriously underperforms for about 90% of US women who need to return to work after having a baby. That is depressing. But this is an easily observable truth because a large body of data shows that probably 90% of US women returning to work fail to breastfeed as long as they should. As I've discussed, you can blame these failures on a variety of external factors, from a lack of support from family, coworkers and employers, to competition from formula, to various societal pressures. But how about looking at the tool that women are using, and asking whether this tool is getting the job done in the environments where it needs to be used? Why does this tool require a whole support infrastructure to work, often paid for by others? If the tool only works adequately for about 10% of the women who need it for this critical job, whereas the rest fail at that job (rendering useless that support infrastructure that somebody is paying for) then it's time for a new tool.

The contrast between the dismal results of the traditional breast pump and the success of our system is stark. We are getting the strong sense from users of our system that we are heading toward flipping the numbers. We anticipate a future where 90% of women will succeed in meeting their goals by utilizing our systems. We will continue to work to make our systems even easier and more flexible to use, available to more women in more places, with more options.

Perhaps as importantly, Freemie moms are telling us the increased versatility, freedom and productivity is having positive impacts on their finances, their families, coworkers and employers. These innovations will add millions of hours of productivity to the global economy every day. That means we all stand to benefit from increases in health and wealth.

The next steps for us are already in motion. R&D is ongoing at a feverish pace. We are continuing to expand globally through a variety of partnerships and initiatives. The global challenges to improve breastfeeding rates are manifested in very different ways in different cultures. But aside from the obvious disparities in resources, the key obstacles that millions of women worldwide face are related in fundamental ways to the universal challenges of time and place. We can mitigate those challenges. With the right tools available to moms, we see infant nutrition irreversibly tipping toward breastfeeding everywhere. We're also painfully aware that, in spite of how hard we and others are working, there are nearly a million babies that none of us will reach this year.

When Gladwell first published The Tipping Point social media wasn't the force it is today, and the term, "going viral" was not well known. We have done almost no advertising, and yet many thousands of individuals, activists and entrepreneurs have been spreading the news of our idea. Moms are helping each other! This success is leading to relationships with fabulous companies, influential individuals, NGO's and others who are helping us deliver this solution ever further around the globe. A decade from now, I am certain new moms won't recognize today's traditional breast pump system. But we need to go even faster, because there are millions more babies coming in the days, months and years ahead whose moms will be faced with desperate choices. We need to offer them a better choice. The new paradigm in breast milk production needs to go viral. With a little luck, maybe we'll get Donald Trump tweeting about how much he enjoys being around women using Freemie breast pumps...

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Dan Garbez
Dao Health
+1 (916) 339-7388
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Freemie - A Hands-Free, Concealable Breast Milk Collection System
since: 05/2010
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