Shannon K. Carter, Ph.D. & Beatriz Reyes-Foster, Ph.D.
Introduction
The mature trees in the neighborhood keep the Florida August sun from beating on Beatriz as she exits her car at the home of a woman we call Crystal.1 Crystal lives in an unassuming ranch-style house in an older neighborhood. Beatriz arrives at the front, sees the doorbell, hesitates. She knocks instead, and soon enough a four year old comes to the door. Crystal’s voice can be heard from inside the house, telling him to let her in. The reason Crystal doesn’t come to the door is evident as soon as Beatriz comes into the small living room: she is sitting on the couch, tandem-nursing her father’s two-week old foster child, Mia, and her own twelve-week-old daughter, Nancy. Mia was separated from her mother at birth and Crystal, convinced the already fragile infant needed all the help she could get, offered to nurse her. In addition to her own milk, she used a local Facebook mothering group to request milk for the new baby, obtaining additional milk from eight donors. Crystal’s father, who intended to adopt Mia, supported Crystal’s efforts to obtain milk for his foster daughter. When Crystal and Beatriz sat down for an interview in late August 2015, baby Mia had just been approved to receive milk through a local semi-formal milk sharing organization, Get Pumped (www.getpumpedonline.org).
While most caretakers encountered in our research are breastfeeding mothers who have encountered difficulties with feeding their own infants, or mothers who have a bountiful supply to give away, Crystal and Mia’s story illustrates one of the myriad ways breast milk sharing takes place in the U.S. Media portrayals of peer milk sharing portray milk sharing mothers as naïve, uninformed risk-takers willing to “play Russian Roulette” with their babies’ lives by defying explicit warnings from institutional authorities such as the US Food and Drug Administration (FDA) and the American Academy of Pediatrics (AAP) (Carter, Reyes-Foster & Rogers, 2014; Carter and Reyes-Foster 2015), yet the mothers we met over three years of research in Central Florida milk-sharing communities firmly reject this portrayal. White, educated, and socioeconomically privileged, our sample of milk-sharing mothers deploy this privilege to challenge patriarchal attempts to sow fear and suspicion of women’s bodies and exert control over their mothering choices. In this paper, we examine the ways in which mothers who participate in peer breast milk sharing describe their practices in relation to media representations. We argue that peer breast milk sharing can be viewed as a form of resistance to patriarchal images of women.
Background on Peer Milk Sharing
Peer milk sharing is the non-remunerated transfer of human milk from one caretaker to another for the purpose of feeding a child. This practice, which has existed in various forms throughout human history, appears to be growing in the US, largely due to the emergence of social media, which has made the largely hidden practice visible. Milk sharing sites Human Milk 4 Human Babies (HM4HB) and Eats on Feets (EoF) have hundreds of local pages facilitating tens of thousands of milk exchanges annually (Gribble, 2014). In addition, milk-sharing arrangements are frequently made through local online and offline social networks (Reyes-Foster, Carter & Hinojosa 2015). The 2010 appearance of the milk sharing networks HM4HB and EoF quickly resulted in statements from the FDA and later the AAP warning mothers against using breast milk acquired directly from others or the internet. In 2013 –and every year after—the New Jersey Legislature has attempted to pass a resolution to fund an awareness campaign about the “dangers of casual milk sharing” (NJ A-3702). Warnings were issued without any research indicating that peer breast milk sharing is unsafe, or published knowledge about how and why parents engage in the practice. In 2016, the American Academy of Nursing (AAN, 2016) released a statement that broke from this prohibitionist stance, stating that some parents will choose to use peer-shared milk, and recommending actions to ensure parents are properly educated in risk mitigation.
In the years since the emergence of these peer milk-sharing networks, social scientists have turned their attention to this practice. Research suggests parents who engage in peer milk sharing are predominantly white, educated, and socioeconomically privileged (Palmquist & Doehler, 2014; Reyes-Foster et al., 2015); some research has found a small but significant difference between the socioeconomic status (SES) of donor and recipient mothers (Palmquist & Doehler, 2014). Parents engage in some form of screening prior to giving or receiving human milk, and monetary exchange for milk is a rare and stigmatized activity (Gribble, 2014; Palmquist & Doehler, 2016; Reyes-Foster et al., 2015). Parents who engage in milk sharing mobilize their online and offline social networks to make exchange arrangements, and seldom take milk from complete strangers (Palmquist & Doehler, 2014; Reyes-Foster et al., 2015). Participants report generally positive food handling practices (Reyes-Foster, Carter & Hinojosa, 2017), and most babies who receive peer-shared milk are healthy term infants (Palmquist & Doehler, 2014). To date, it appears to be that no infant has become ill from consuming shared milk.
In parallel to social scientific work on peer milk sharing, some life scientists have also carried out research on commodified breast milk. Although milk selling appears to be highly stigmatized practice in the milk-sharing community, an informal milk market does exist, particularly in the form of the breast milk classifieds website Onlythebreast.com. A research team from Ohio State University led by epidemiologist Sarah Keim purchased breast milk via this website and conducted a series of analyses of the purchased milk. Analyses revealed that the samples, which had been purchased anonymously and shipped to an unrefrigerated PO box, where they sat for several days, contained high levels of potentially dangerous bacteria (Keim et. al., 2013) and some were contaminated with cow milk (Keim et. al., 2015). Although the study design did not reflect practice on the ground, these results quickly garnered media attention, including the cover of the Sunday New York Times, which used the headline “Breast Milk Donated or Sold Online is Often Tainted, Study Says” (Bakalar, 2013). Peer milk sharing and selling thus became conflated, despite repeated claims by social scientists that the two are distinct practices and that commodification negatively impacts safety (Stuebe, Gribble & Palmquist, 2014). This conflation was, unfortunately, encouraged in public statements made by the Ohio State University team researchers (Keim, 2015) and social scientists have been unsuccessful in decoupling the conflation of milk sharing and milk selling in public discourse.
Portrayals of Mothers Who Participate In Peer Milk Sharing
Media representations depict mothers who participate in milk sharing as violating core components of “good mothering.” Analyses (Carter et al. 2015; Carter and Reyes-Foster 2016) of the 20 highest circulating US newspapers revealed that mothers who received peer-donated milk were portrayed as well-intentioned, but naïve and uninformed. They were depicted as immoral mothers for violating the principles of “scientific mothering” (Apple, 2006), an idealized form of motherhood that requires mothers to seek and follow scientific guidance on childrearing, by failing to consult scientific experts regarding dangers of peer milk sharing. Mothers who donated breast milk were portrayed as morally suspect and untrustworthy, potentially giving tainted milk to unsuspecting recipients.
These images were juxtaposed with portrayals of mothers who donate and receive breast milk through breast milk banks as morally good mothers (Carter et al. 2015; Carter and Reyes-Foster 2016). Milk bank donors were portrayed as morally pure because they had undergone rigorous lifestyle and health screening, and their milk had been scientifically tested and identified as “clean.” Milk bank recipients were portrayed as collaborating with healthcare providers to make scientifically-based decisions, thereby conforming to the scientific mothering ideal. This juxtaposition demonstrates that it is not the transfer of breast milk that elicits negative evaluation, but rather the fact that, when shared among peers, the transfer takes place outside of institutional surveillance and control.
Negative media portrayals of mothers who participate in peer breast milk sharing draw upon broader patriarchal images of women. The female reproductive body and its corresponding fluids – menstrual blood, amniotic fluid, breast milk – are portrayed in western imagery as dirty and polluting (Schildrick, 1997; Ussher, 2006). Contradictory images reflect the “doublespeak” Hausman (2003) identifies, where breast milk is promoted as both “liquid gold” and a potentially dangerous vector of disease. Whether a mother’s milk is deemed healthy or not is often determined by her conformity to hegemonic mothering standards (Reich, 2010). At milk banks, milk from screened donors is constructed as dangerous until it has undergone institutional oversight and scientific processing, after which it becomes a life-giving substance akin to medicine (Carroll, 2014). The processes that transform breast milk from dangerous to healthy illuminate western views of women as untrustworthy, their reproductive bodies as pollutants, and the authority of institutional oversight.
Research Method
This research uses a mixed methods approach, culling data from an online survey, three years of ethnographic engagement in Central Florida milk-sharing communities, and 30 semi-structured interviews. We have been engaged with the Central Florida milk sharing community since fall 2013. Participation observation is a methodology commonly used among qualitative researchers. It requires that researchers become immersed in the daily life of the community she purports to study, a prolonged period of rapprochement that frequently results in the development of long-term relationships. Both study authors were mothers of nursing children during the time this research was conducted. This common interest facilitated rapport and ensured our acceptance into the community. Although our participant observation was carried out in person, many interactions with members of the community took place in online communities, specifically various local “mommy groups” on the social media network Facebook.
Using Qualtrics, we developed a 102-item, mixed-methods online survey containing quantifiable multiple-choice and Likert-scale questions as well as open-ended qualitative questions. We recruited participants through distribution of our survey link through Facebook in 18 private Central Florida breastfeeding, mothering, and milk-sharing groups, the Florida pages of EoF and HM4HB, our own personal pages and the pages of 20 professional contacts (lactation counselors, breastfeeding advocates, midwives and alternative medicine practitioners) who assisted with recruitment. Once the survey link was initially distributed, it was re-shared by other page members to their personal networks, making the exact number of times the link was shared difficult to trace.
When a potential participant gained entry into the online survey, they were presented with a prompt: “Milk sharing is the exchange of human milk including cross-feeding (also known as wet nursing) and exchanging expressed milk (including direct exchange, donation to a milk bank or organization like Get Pumped). A milk sharing participant is one who has given, received or facilitated milk sharing. Have you ever participated in milk sharing?” If the respondent answered “yes,” they could take the survey. The survey was distributed from April 2014 to September 2014 and took approximately 30 minutes to complete. Survey questions utilized in this manuscript examine the way in which mothers who participate in milk sharing describe their own practices in relation to media representations of milk sharing.
In addition to the online survey, we collected 30 in-depth, semi-structured interviews with milk-sharing caretakers in Central Florida who were engaged in milk sharing at the time of the interviews. Participants were recruited through online social networking and snowball sampling. Interviews were conducted between August and December 2015. Interviews were semi-structured, where the researcher generally followed an interview schedule, but allowed the interviews to flow in a conversational manner. The interview schedules contained questions about milk handling, milk sharing relationships, milk sharing practices, and personal convictions about breast milk vs. formula use, use of donor milk and its safety, and the commodification of breast milk. Participants chose their own pseudonyms. Interviews lasted 40 minutes to one hour. The interviews were audio recorded and transcribed verbatim.
We focused our analysis on four themes: milk sharing as aligned with scientific recommendations, peer milk donors as honest and trustworthy, peer-shared milk as safe and healthy, and institutional oversight as corrupt and untrustworthy. These themes emerged organically in our initial analysis in an open coding process based on Grounded Theory (Corbin and Strauss, 2015). Once themes were identified, we coded qualitative responses and interview transcripts for these themes, with an openness to identifying new themes that emerged. In this paper we focus on these initial four themes.
Findings
Milk-Sharing as Aligned with Scientific Recommendations
Although peer milk sharing violates FDA and AAP recommendations, participants aligned their milk-sharing practices with scientific recommendations. Participants relied on scientific evidence of the benefits of breast milk and its specific properties, including antibodies and nutrients, to validate their practices. A survey participant wrote, “The benefits of breastmilk in general have been widely scientifically proven and donor’s breastmilk carries many of the same benefits as the mother’s milk.” They also drew upon scientific knowledge in their critiques of infant formula, stating that formula was less healthy than donor breast milk due to artificial ingredients, chemicals, and genetically-modified organisms. A participant wrote, “Formula is a poor substitute for human breast milk. It is full of harmful chemicals, including known carcinogens like aluminum, and does not provide all of the nutrients, antibodies, and other benefits of human milk.” In these excerpts, participants draw upon scientific knowledge and medical recommendations to inform their milk sharing practices, contrasting media images of them as scientifically uninformed and naïve.
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Peer Milk Donors as Honest and Trustworthy
Many recipients in our study reported engaging in some screening practices before accepting milk from potential donors (Reyes-Foster et al., 2017), yet they also describe acting on trust. When asked if she screened donors, Olivia responded, “I didn’t. Only because like I was saying earlier that there’s this level of trust even though they were strangers, because they’re breastfeeding their own child.” Similarly, Anna explained, “I believe that a mom would not give milk to my baby if they didn’t think it was safe for their baby.” Similar sentiment was apparent throughout our survey. One participant wrote: “I perceive donor milk as less healthy than mother’s milk only because a recipient can’t know for sure what is in that milk vs. her own milk. But, from what I have seen, women are very honest about what they consume, how they treat their milk, and how they treat their bodies.” Participants also described breast milk donors as “generous,” “noble,” and as “angels on earth.” In contrast to media representations of breast milk donors as suspect and untrustworthy, our study participants view them as trustworthy, moral mothers.
Donors reciprocated this trust by expressing the trustworthiness of recipients. When asked if they had refused to give someone milk, nearly all participants said no and elaborated that they trusted that their recipients would not ask unless they needed it. When asked if she screened recipients, Trisha responded, “Not really. If they said they were in need, I just trusted that they were in need, for a baby, for the right reasons.” Some donors reported having “a feeling.” Sara explained:
I think you just kind of have a feeling. Like, obviously I wanted to give to moms who actually needed it, that weren’t trying to sell it or something like that. But I mean, you can hear it in a mom’s voice. She calls you, she’s crying, you hear her baby. I met them in parking lots, I’d see their, like, ten-day-old baby. Like, I mean, you just, I don’t know, you just kind of have a feeling.
These excerpts reveal emotion and mutual trust that underlies milk sharing relationships. Recipients trust that women who donate breast milk are honest and trustworthy to provide clean milk and donors trust that recipients are in need of breast milk to feed their babies.
Peer-Shared Breast Milk as Safe and Healthy
Survey participants were asked to evaluate the health and safety of mothers’ own milk, donated breast milk, and formula. Responses indicate that they rated mothers’ own milk as healthiest and safest, with donor milk a close second, and formula the most unhealthy and unsafe. In open-ended explanations, some acknowledged potential risks of donated milk, reinforcing the need for donors to be “trustworthy.” Participants wrote, “A donor’s milk is a great substitute if the donor is healthy and honest.” Others described donated milk as healthy, without qualification: “Donor milk is next best because it is still a living substance full of immunity and nutrition.” Participants’ narratives construct peer breast milk – a bodily fluid produced by women’s reproductive bodies – as a clean, safe, and healthy substance, contrasting with media representations of peer-shared milk as risky and cultural imagery of women’s reproductive bodies as polluting.
Institutional Oversight as Corrupt and Untrustworthy
Participants also expressed distrust in institutions that govern infant feeding, particularly the FDA. Many viewed the FDA statement against milk sharing as either a way for the agency to protect itself, or a collaboration with formula companies for financial gain. When asked perceptions of the statement, participants wrote, “I believe it is a liability issue and the FDA is protecting themselves,” and “Once again big business lobbies for what they want. No doubt formula companies are one of them!” Participants believed the agency’s opposition resulted from its inability to regulate peer-shared milk: “If they’re not making money off it or if they can’t ‘regulate’ it, then it’s no good…,” and “They want to control anything and wish everything was pasteurized, processed, and nutrients lost.” Some described the statement as “controlling” and “anti-woman.” In these narratives, participants challenge the validity of the FDA’s statement, arguing that it protects the agency, but does not reflect the interests of themselves or their babies. They oppose the oversight and control that they read in the statement and the corresponding mistrust in women and their reproductive bodies, contrasting media images that present banked milk as safe due to institutional processing and oversight and peer milk as unsafe based on its lack of regulation.
Participants expressed that the value of peer-shared milk relied on it being mother-to-mother and commerce-free. Participants distinguished breast milk sharing and selling, with most opposing selling. They explained that mothers who are monetarily incentivized may be less careful with the quality of their milk, and valued the idea that women were helping each other through milk sharing. Asked their perceptions of milk sharing, they wrote, “Support all mamas in providing the best nutrition for their babies. Mothers who donate are heroes to those searching,” “It is the most natural and appropriate act of sharing and love among mothers,” and “I like milk sharing if I get to meet the other party face-to-face and their baby. I think it does a lot of good in the world to share.” The mother-to-mother giving that participants value challenges dominant cultural values of individual responsibility and capitalist consumption. By giving breast milk, mothers are taking collective responsibility for infant feeding and challenging the idea that all consumable objects have a price tag.
Conclusion
This study examined the narratives of mothers who engage in peer breast milk sharing, highlighting the ways milk sharing can be viewed as a form of resistance. In contrast to media images, mothers constructed milk sharing in alignment with scientific recommendations that “breast is best,” viewing peer-shared milk as safe and healthy. They base their transactions on trust, with recipients trusting that donors are clean and honest and donors trusting that recipients are need milk to feed their babies. They challenge the perspective that institutional oversight is needed to ensure safety by accusing agencies of being corrupt and self-interested, and valuing the mother-to-mother nature of milk sharing among peers. In this sense, the mothers are resisting patriarchal images of women as morally suspect and untrustworthy and our reproductive bodies as dirty and polluting. They also challenge broad cultural values of individual responsibility for mothering by taking collective responsibility for feeding breast milk, and challenge institutional authority by circumventing established institutions including the FDA and the economy.
We suggest that these forms of resistance are made possible by our participants’ race and socioeconomic privilege. As women who are predominantly white, class-privileged, and college-educated, these mothers enact social privilege in several ways. First, they utilize their education to weigh contradictory scientific evidence and biomedical guidelines to draw their own evidence-based conclusions that support milk sharing. Second, they produce and express breast milk to give away without needing compensation for the time, effort, physical space and privacy required. Third, they engage in infant feeding practices that violate recommendations from major health organizations without fear of legal repercussion, even while utilizing public internet pages to do so. Thus, although peer milk sharing might challenge some patriarchal assumptions about women and their reproductive bodies, it also reproduces privileged motherhood.
Further, at the same time that peer milk sharing may be viewed as a form of resistance, there are many ways that it could also be viewed as conformity. Participants drew upon scientific evidence in their decisions to engage in peer milk sharing and to guide their screening, milk handling, and milk storage practices, thereby conforming to the scientific mothering (Apple, 1995) ideal. They often drew upon hegemonic models of motherhood, particularly “intensive mothering” (Hays, 1996), to determine that they could trust breast milk donors and recipients. They mobilized their socioeconomic privilege to produce a substance and give it away for free, driving to meet in public places or at each other’s homes. In these ways, they are conforming to and thereby reproducing dominant cultural images of what it means to be a “good mother.” It is this interplay between resistance and conformity, privilege and domination that we plan to explore in our future work.
Notes
- This and all other names are pseudonyms.
References
American Academy of Nursing. 2016. “Position Statement Regarding Use of Informally Shared Human Milk.” Nursing Outlook 64(1): 98-102.
Apple, Rima. 2006. Perfect Motherhood: Science and Childrearing in America. New Brunswick: Rutgers University Press.
Carroll, Katherine. 2014. “Body Dirt of Liquid Gold? How the ‘Safety’ of Donated Breastmilk is Constructed for Use in Neonatal Intensive Care.” Social Studies of Science 44(3): 466-485.
Carter, Shannon K., Beatriz Reyes-Foster and Tiffany L. Rogers. 2015. “Liquid Gold or Russian Roulette? Risk and Human Milk Sharing in the US News Media.” Health, Risk & Society 17(1): 30-45.
Carter, Shannon K. and Beatriz M. Reyes-Foster. 2016. “Pure Gold for Broken Bodies: Discursive Techniques Constructing Milk Banking and Peer Milk Sharing in U.S. News.” Symbolic Interaction 39(3): 353-373.
Corbin, Juliet, and Anselm Strauss. 2008. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. 3rd ed. London: Sage. Original edition, 1990.
Gribble, Karleen. 2014. “Perception and Management of Risk in Internet-Based Peer-to-Peer Milk-Sharing.” Early Child Development and Care 184(1): 84-98.
Hausman, Bernice L. 2003. Mother’s Milk: Breastfeeding Controversies in American Culture.
New York: Routledge.
Hays, Sharon. 1996. The Cultural Contradictions of Motherhood. New Haven: Yale University
Press.
Keim, Sarah. 2015.The dangers of the milk sharing economy. Project Syndicate, Aug 17.
http://www.project-syndicate.org/commentary/unsafe-human-milk-sharing-economy-by-
sarah-a–keim-2015-08
Keim, Sarah, Hogan, Joseph, McNamara, Kelly, Gudimetla, Vishnu, Dillon, Chelsea, Kwiek,
Jesse, and Sheila Geraghty. 2013. Microbial contamination of human milk purchased via
the Internet. Pediatrics 132: 5: e1227-e1235.
Keim, Sarah, Kulkarni, Manjusha, McNamara, Kelly, Geraghty, Sheila, Billock, Rachel,
Roneau, Rachel, Hogan, Joseph, and Kwiek, Jesse. 2015. Cow’s milk contamination of
human milk purchased via the Internet. Pediatrics 135: 5: e1157-e1162.
Reich, Jennifer A. 2010. “From Maternal Love to Toxic Exposure: State Interpretations of Breastfeeding Mothers in the Child Welfare System.” Pp. 163-174 in Giving Breastmilk: Body Ethics and Contemporary Breastfeeding Practices edited by Alison Bartlett and Rhonda Shaw. Bradford, Ontario: Demeter Press.
Reyes-Foster, Beatriz, Shannon Carter, and Melanie Hinojosa. 2015. “Milk Sharing in Practice: A Descriptive Analysis of Peer Breastmilk Sharing.” Breastfeeding Medicine 10(5): 263-269.
——-. 2017. “Human Milk Handling and Storage Practices Among Peer Milk-Sharing Mothers.” Journal of Human Lactation 33(1): 173-180.
Shildrick, Margrit. 1997. Leaky Bodies and Boundaries. London: Routledge.
Stuebe, Alison, Karleen Gribble and Aunchalee Palmquist. 2014. Differences between online
milk sales and peer-to-peer milk sharing. Pediatrics. (E-letter Reply to Keim et al.,
Microbial Contamination of Human Milk Purchased via the Internet).
- JourMS - 