Research Anthology: Raw Milk

Key points

  • Raw milk consumption is linked to a number of foodborne illnesses that can result in serious complications and death.
  • The federal government regulates interstate milk sales, but states control the sales within their own state.
  • Raw milk sales are trending upward in some states.
Pitcher pouring milk into a glass on a table.

Public health concerns about raw milk consumption

Raw milk, or unpasteurized milk, is a public health concern.A Studies have shown an association between the legal sale of unpasteurized dairy products and a higher incidence of related disease outbreaks.B Recent increases in raw milk availability have public health experts researching the risks and potential disease outbreaks that can result from its consumption.

Consuming raw milk is linked to a significant number of foodborne illnesses, some of which can result in serious complications and death.C A variety of pathogens cause these illnesses, including:

  • Escherichia coli.
  • Campylobacter jejuni.
  • Salmonella
  • Listeria monocytogenes.
  • Brucella abortus.D

Exposures to Brucella strain RB51 are of recent concern. It is both difficult to diagnose and resistant to the first-line antibiotic used to treat brucellosis.E

Pasteurization protects public health

Milk pasteurization, a heating process that destroys pathogens,F protects public health. In 1947, Michigan was the first state to require milk pasteurization.G Since then, both the federal government and the states have played important roles in governing milk safety. Under authority granted by the Commerce Clause of the US Constitution,H the federal government regulates the interstate sale of raw milk.

In 1987, the Food and Drug Administration (FDA) mandated pasteurization of all milk or milk products (with the exception of some cheeses) for sale or distribution in interstate commerce.I The FDA also regulates milk through its branding regulation. This requires pasteurizing anything labeled as "milk" sold in interstate commerce.

Reason raw milk is still available

While the federal government has authority to regulate interstate milk sales, individual states control the intrastate sale of dairy products. Many states have adopted the Grade "A" Pasteurized Milk Ordinance, a model law by the US Department of Health and Human Services. It prohibits the retail sale of unpasteurized milk.J Some states allow the distribution or sale of raw milk within their state in one or more of the following locations:

  • Retail locations
  • Individual farms
  • Farmers' markets
  • Cow or herd shares, an arrangement under which an individual owns part of a cow or herd and is entitled to the milk produced.K

Raw milk demand increasing‎

In recent years, consumer demand has resulted in expanded legal access to raw milk in several states. Increased legalization of the intrastate sale of raw milk is expected to increase the disease burden associated with the consumption of raw milk.L

Legal resources

The following resources describe federal laws on the interstate sale and distribution of raw milk.

  • 21 C.F.R. § 131.110 (2019)
    • Federal regulation for the standardization of milk and cream in interstate commerce, defining "milk" as "the lacteal secretion" from cows.
    • Requires that milk be pasteurized and contain certain percentages of milk solids and milkfat.

The following resources summarize state laws on the intrastate sale and distribution of raw milk.

  • Map of State Laws Related to the Sale of Raw Milk, Public Health Law Program, Centers for Disease Control and Prevention (2019)
    • Presents a map of state laws governing the sale of unpasteurized milk to consumers as of 2019.
    • Indicates changes to state laws expanding or restricting access to unpasteurized milk from 2012 through 2018.
  • Legal Status of the Sale of Raw Milk and Outbreaks Linked to Raw Milk, by State, 2013–2018, Centers for Disease Control and Prevention
    • Provides a map of the 50 states coded by type of state raw milk law and number of outbreaks, a resource of CDC's Raw Milk website.
  • State Milk Laws, National Conference of State Legislatures (2016)
    • Categorizes state raw milk laws based on legality of sale or distribution for different sites or modes (e.g., retail stores, on the farm, through cow share programs).
    • Links to an undated state-by-state summary of raw milk laws.
  • 2011 Raw Milk Survey, National Association of State Departments of Agriculture (NASDA) (2011)
    • Summarizes data collected by NASDA on the regulation and sale of raw milk in 50 participating states.

The following articles give historical background and policy analyses of raw milk laws, including legal challenges to and theories of recovery under those laws.

  • The dangerous right to food choice, Wiseman SR. Seattle University Law Review 2015;38:1299–315.
    • Discusses the argument that the right to choose the food one eats, even if the government deems a food unsafe, is a fundamental right under the Constitution.
  • The legal anatomy of product bans to protect the public's health, (Subscription required; link to abstract provided.), Hodge JG & Scanlon M. Annals of Health Law 2014;23:20–41.
    • Analyzes government product bans to protect consumer safety and devises a framework of essential elements to support passage (and prevent reversal) of product bans intended to protect the public's health.
    • Mentions raw milk among examples of bans on consumable products.
  • Raw milk in court: implications for public health policy and practice, David SD. Public Health Reports 2012;127(6):598–601.
    • Explains federal laws governing the sale of raw milk and reviews two federal cases involving raw milk (i.e., Farm-to-Consumer Legal Defense Fund v. Sebelius (action challenging constitutionality of federal interstate ban), US v. Allger (action by FDA against Pennsylvania farmer engaged in interstate sale and cow share program).
  • Deja moo: Is the return to public sale of raw milk udder nonsense?, Adams DC, Olexa MT, Owens TL, et al. Drake Journal of Agricultural Law 2008;13(2):305–46.
    • Provides a detailed examination of raw milk and the laws governing it.
    • Discusses legal theories for recovery of damages by persons sickened by raw milk (e.g., negligence, products liability, breach of warranty).
  • A legal history of raw milk in the United States, Weisbecker A. Journal of Environmental Health 2007;69(8):62–3.
    • Provides a brief history of the development of local, state, and federal laws governing the sale of raw milk from the early 1900s to 2006.
    • Focuses on FDA activity leading up to the FDA 1987 prohibition of the interstate sale of raw milk.

Public health resources

CDC defines a foodborne disease outbreak as “an incident in which two or more persons experience a similar illness after ingestion of a common food, and epidemiologic analysis implicates the food as the source of the illness.”M The resources below describe some of the outbreaks associated with raw milk reported from 2010 to present.

The resources below discuss both emerging concerns and well-established risks associated with drinking raw milk, focusing primarily on risks posed by raw dairy in the United States. Articles assessing comparative risks and benefits are also included under this heading.

Advocates for raw milk emphasize benefits of drinking raw milk related to nutrition, allergies, and lactose intolerance.N While there is some evidence connecting raw milk to the "farm effect"—an association between children growing up on farms and reduced allergies—evidence of other benefits is lacking.O Furthermore, the scientific literature in this area routinely acknowledges that even if raw milk plays a role in, for example, preventing allergies, the risk of serious infection far outweighs possible benefits.P The following resources address potential benefits of raw milk consumption.

Raw milk consumers themselves occasionally have been the subject of studies to determine their characteristics and motivations. The following articles present the results of some raw milk consumer studies.

  • Survey to determine why people drink raw milk, Mullin GE, Belkoff SM. Global Advances in Health & Medicine 2014;3(6):19–24.
    • Examines the health-related motivations of individuals for consuming raw milk, testing a hypothesis that preference for raw milk would be related to lactose maldigestion.
  • Characteristics of consumers of unpasteurized milk in the United States (Subscription required; linked to abstract provided), Buzby JC, Gould LH, Kendall ME, et al. Journal of Consumer Affairs 2013; 47(1):153–66.
    • Analyzes sociodemographic data from FoodNet Population Surveys (1998–1999, 2002–2003, and 2006–2007) to identify characteristics of raw milk consumers.
  • Profile of raw milk consumers in California, Headrick ML, Timbo B, Klontz KC, et al. Public Health Reports 1997;112:418–22.
    • Describes patterns of raw milk consumption in California, where the sale of raw milk is legal.
    • Examines demographics of respondents who drank raw milk, and the prevalence of raw milk consumption in California in 1994.

Raw milk websites

  • Raw Milk
    • Information from CDC for consumers and researchers, with links to outbreak studies, resources and publications, questions and answers, infographics, and videos of individuals who describe their experiences with foodborne illness from raw milk.
  • Food Safety and Raw Milk
    • Explains the role of the FDA in regulating raw milk and provides information for consumers and links to internal and external sites about raw milk.

Position statements of national organizations

In addition to US government agencies, such as the FDA and CDC, the following national organizations have issued formal statements about the hazards of drinking raw milk and the need for pasteurization:

  • Raw Milk Policy, American Veterinary Medical Association; undated (accessed June 2019)

Acknowledgements and disclaimers

Lisa Landsman, JD, MPH, Cherokee Nation Assurance (CNA) contractor and program analyst for the Public Health Law Program (PHLP) within the CDC National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce developed this anthology. The author thanks Dawn Pepin, JD, MPH, and Rachel Hulkower, JD, MSPH, CNA, contractors with PHLP, for their editorial assistance.

Research for this anthology was on the consumption of fluid, unpasteurized cow's milk primarily in the United States using Westlaw and PubMed databases between February and May 2019.

For technical assistance with this anthology, please contact phlawprogram@cdc.gov. PHLP provides technical assistance and public health law resources to advance the use of law as a public health tool. PHLP cannot provide legal advice on any issue and cannot represent any individual or entity in any matter. PHLP recommends seeking the advice of an attorney or other qualified professional with questions regarding the application of law to a specific circumstance.

The findings and conclusions of this summary are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

  1. See, e.g., Centers for Disease Control and Prevention. Raw Milk [website]. Last updated June 8, 2017. Available at www.cdc.gov/foodsafety/rawmilk/raw-milk-index.html.
  2. Langer AJ, Ayers T, Grass J, et al. Nonpasteurized dairy products, disease outbreaks, and state laws—United States, 1993–2006. Emerging Infectious Diseases 2012;18(3):385–90.
  3. Oliver SP, Boor KJ, Murphy SC, et al. Food safety hazards associated with consumption of raw milk. Foodborne Pathogens and Disease 2009;6:793–806.
  4. Langer, supra note 2.
  5. Centers for Disease Control and Prevention. Exposures to Drug-Resistant Brucellosis Linked to Raw Milk (Food Safety Alert) [website]. February 8, 2019. Available at www.cdc.gov/brucellosis/exposure/drug-resistant-brucellosis-linked-raw-milk.html.
  6. Lejeune JT, Rajala-Schultz PJ. Unpasteurized milk: a continued public health threat. Clinical Infectious Diseases 2009;48(1):93–100.
  7. Boor KJ, Wiedmann M, Murphy S, et al. A 100-year review: microbiology and safety of milk handling. Journal of Dairy Science 2017;100:9933–51.
  8. US Const. art. I, § 8, cl. 3.
  9. Requirements Affecting Raw Milk for Human Consumption in Interstate Commerce, 52 Fed. Reg. 29509-02 (August 10, 1987) (codified at 21 C.F.R. § 1240.61).
  10. US Department of Health and Human Services, Public Health Service, Food and Drug Administration. Grade "A" Pasteurized Milk Ordinance (2017 Revision). Available at www.fda.gov/media/114169/download.
  11. See, e.g., Mungai EA, Behravesh CB, Gould L. Increased outbreaks associated with nonpasteurized milk, United States, 2007–2012. Emerging Infectious Diseases 2015;21(1):119–22; Adams DC, Olexa MT, Owens TL, et al. Deja moo: is the return to public sale of raw milk udder nonsense? Drake Journal of Agricultural Law 2008;13:305–46.
  12. Costard S, Espejo L, Groenendaal H, et al. Outbreak-related disease burden associated with consumption of unpasteurized cow's milk and cheese, United States, 2009–2014. Emerging Infectious Diseases 2017;23(6):957–64.
  13. Centers for Disease Control and Prevention. Foodborne Disease Outbreak 2011 Case Definition [website]. Accessed July 27, 2022. Available at https://ndc.services.cdc.gov/case-definitions/foodborne-disease-outbreak-2011/.
  14. Lucey, JA. Raw milk consumption: risks and benefits. Nutrition and Food Science 2015;50(4):189–93.
  15. MacDonald LE, Brett J, Kelton D, et al. A systematic review and meta-analysis of the effects of pasteurization on milk vitamins, and evidence for raw milk consumption and other health-related outcomes. Journal of Food Protection 2011;74(11):1814–32.
  16. Davis JK, Li CX, Nachman KE. A literature review of the risks and benefits of consuming raw and pasteurized cow's milk. Johns Hopkins Bloomberg School of Public Health, Center for a Livable Future, 2014 report. Available at www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-for-a-livable-future/research/clf_publications/pub_rep_desc/Literature-Review-Risks-Benefits-Consuming-Raw-Pasteurized-Cow-Milk.html.
  • 21 C.F.R. § 131.110 (2019). See also 21 USC § 331(a) (2019) (prohibiting introduction into interstate commerce of any adulterated or misbranded food).