It's high noon on the dusty edge of Phnom Penh's Stung Meanchey waste dump. Cheksrey Toy, a thin 19-year-old, steps into the small patch of shade beneath her stilted home, lifts her T-shirt, and begins to feed her infant son.
The sprawling dump site once served as the capital's largest trash receptacle and a visceral symbol of its poverty, a place where those of meager means came by the thousands to pick the public's rubbish for recyclables to sell. The work began to dry up when the dump closed officially in 2009. Many of those who used to frequent the site have now found other trades, or other trash heaps.
Toy has turned to selling her excess breast milk to Ambrosia Labs, a company that claims to be the first to import human milk to the United States. Six months ago, she says, recruiters came to her NGO-run housing community seeking mothers who had recently given birth, carrying breast pumps with them. "I wanted the money, and I didn't have any money," she says. Now, she earns between $5 and $10 per day at a clinic just a short motorcycle trip from her home. (Cambodia's average national income hovers at around just $3 per day.)
The clinic occupies a three-story shop house in a neighborhood dotted with aid organizations built to support the poor communities around the defunct dump. It is marked only by a blue sign, which reads kun meada—"mother's value" in Khmer.
Ambrosia usually employs around 20 mothers, says American co-founder Bronzson Woods. He and business partner Ryan Newell started the company in July 2015, tapping into a network Woods had built while serving as a Mormon missionary in Cambodia a few years earlier. But Woods devised the idea for a breast milk business while he was back in the US; his sister-in-law had given birth to twins, and couldn't produce enough milk to feed them. Woods discovered that demand for human milk was high, but supply was pinched. Breast milk is only available commercially through milk banks or on a growing online market, which remains unregulated.
American women aren't incentivized to donate their milk, Woods says. "That's where we thought we could kind of fit in," he explains. He also references the country's high rates of breastfeeding: "Cambodia's in a sort of developmental sweet spot, right?"
I wanted the money, and I didn't have any money.
Before coming to Ambrosia, women must exclusively breastfeed their children for six months, the World Health Organization recommendation. But as soon as they pass that mark and undergo a health check and screening for diseases—per American milk-bank regulations, which Woods says for now are stricter than those of the Food and Drug Administration—they can get to work.
The women receive around 64 cents for each ounce of their breast milk, and usually pump around 12 ounces per day. (By comparison, the milk bank Mother's Milk Cooperative, which supplies for-profit Medolac Laboratories, pays its American "donors" $1 per ounce.) The breast milk is then frozen, sent to a facility in Utah where it is pasteurized, and shipped all over the US; states in the South are a hot market, Newell mentions. On Ambrosia's website, the milk is sold for up to $4 per ounce.
Inside the Phnom Penh clinic, the mothers sit at small plastic tables lined with bottles and breast pumps. They take on morning and afternoon shifts, and chat throughout the day. Children's cries echo down the staircase, and those old enough to walk dart in and out of the room. Like Toy, many of the women who sell their milk at the clinic were working odd jobs before: trash picking, vegetable picking, sewing. Mao Chanthouen, 34, sits next to a friend from her neighborhood—located near the dump—who recruited her. "I'm quite happy," she says. "I can donate breast milk to other children, and get payments for it"—earning nearly as much in one day as she could previously earn in one week as a seamstress.
Cambodia, as Woods mentioned, is a good fit for the company's model. The country has one of the highest rates of breastfeeding in Southeast Asia: Sixty-five percent of infants are exclusively breastfed for the first six months. But in the cities, mothers usually don't breastfeed for much longer, and those who give birth in Phnom Penh hospitals find themselves subject to forceful formula marketing, often immediately after delivery.
Woods says that incentivizing milk pumping encourages women to keep breastfeeding, in addition to providing them with a steady income. "It's a win-win," he says.
But local women's rights experts see the small-scale breast milk sales as existing on shaky ethical ground—not unlike the commercial surrogacy industry in Cambodia, one of the last countries in the region where the practice still operates with little regulation. "It treats the women as a tool for producing things for other people who have more opportunity," says Ros Sopheap, the director of NGO Gender and Development for Cambodia (GDC). "Even if the women do it voluntarily, there is financial pressure."
Woods insists that the business model is not exploitative—"To come to Cambodia... it's not about paying women less. It's about attracting more supply at a similar price," he says. Sopheap disagrees, arguing that Ambrosia Labs intentionally targets poor women who lack other job options and act only out of short-term financial interest. "Women do not have a chance to analyze things further. They need money," she adds. "Why don't they go to the women who have good finances and education?"
It treats the women as a tool for producing things for other people who have more opportunity.
The ethics of a business model that commodifies motherhood aren't so simple, says Sharmila Rudrappa, a sociologist who has studied the global surrogacy industry. "Calling this sort of company unethical is not thinking through the larger structures that have created these conditions," she says.
Rudrappa acknowledges that physical and cultural distance can assuage even principled buyers' anxieties, especially in the case of breast milk. "A company like Ambrosia would have trouble in the US," she says, pointing to a 2014 Medolac campaign to increase breastfeeding among low-income mothers in Detroit that was scrapped after drawing local criticism. ("It reeks of exploitation," an organizer told the Detroit News at the time.)
So far, Ambrosia Labs has employed 50 Cambodian mothers in total, and the contracts tend to last around six months. Meanwhile, Woods and Newell's business is looking to expand, pending approval from Cambodia's Ministry of Health. The pair have already received calls from those interested in replicating the model elsewhere in Southeast Asia and as far away as Eastern Europe.
For a business without much precedent, Rudrappa says protecting the mothers should be a first step. "I don't think the problem is that these kinds of milk banks become standard—it is what kind of standards have been established internationally to protect these women and their children." She rattles off a few: good nutrition for mothers and children, quality gynecological care, safe housing.
Chanthouen's daughter is already 20 months old, with round cheeks and wide eyes. Throughout the pumping session, she rolls a marble around the clinic's tile floor. But suddenly, she begins to cry. She stands and begins to suck at her mother's free side, creating an odd sort of symmetry. Chanthouen wants another child but is not sure if she can afford it. She may not be able to extend her contract at Ambrosia for much longer.
When the milk dries up, so too will the work—again.