Taking milk from strangers

People often ask me what I do. When I say that I’m a medical anthropologist and I study breast milk sharing, the usual reaction is confusion and more questions.

What is milk sharing? Why am I studying it?  What is medical anthropology? Isn’t anthropology about bones and artifacts?

I think what I do is fascinating. Maybe you will, too, after you read this!

Share what? That’s so weird

In the spring of 2011, I was in the final stretch of my second pregnancy, doing what many 21st century mothers do – scouring the web. If it had to do with pregnancy, birth, babies, parenting, motherhood, or career, I was Googling it. On this particular morning, I stumbled across a Washington Post story by Rachel Saslow, Mother’s share breast milk via Internet groups despite FDA’s concerns. I was intrigued. I couldn’t get it out of my mind.

This was a tale of two mothers, Suzanne and Amanda, who met online and struck up a relationship around breast milk. Like so many women in the U.S. who initiate breastfeeding, Suzanne had tried to breastfeed, but did not make enough milk to meet her baby’s needs. She wept the first time she fed her baby formula. Then, a lactation consultant told her about Eats on Feets and Human Milk 4 Human Babies.  These were milk sharing sites that helped mothers like Amanda, who had a surplus of breast milk find babies to give it to, without a fee, as a gift.

I was familiar with allonursing, Islamic milk kinship, and various forms of paid wet nursing through the ages. (btw, I love what Katie Hinde over at Mammals Suck has to say about all this, here and here).

But, I had certainly never heard of Internet breast milk sharing before reading this article. And before her LC mentioned it, neither had Suzanne, who according to the Washington Post story, thought “it was the weirdest thing” she had heard of.

But….why?

A few basic questions about this story really caught my attention. Why was the FDA freaking out? How were parents dealing with the risks involved in feeding their babies unscreened, unpasteurized breast milk from a stranger they met on the Internet? Why did some women have so much trouble making enough milk, but others had so much milk (like hundreds and hundreds of ounces) that they were giving it away, for free?

I could easily wrap my head around the idea that mothers had trouble breastfeeding. I wasn’t breastfed. When I was born in the 1970s, my mother had trouble getting me to latch. New to the U.S. and not yet fluent in English, it was hard for her to communicate with the doctors about her breastfeeding concerns. Soon she became painfully engorged. Rather than helping her breastfeed successfully, her doctor gave her some kind of shot to relieve the engorgement by drying up her milk.

Most of my friends formula fed their babies, and those who chose to breastfeed only did so for a few months, and not without a fair share of drama.

I breastfed my daughter for nearly a year, exclusively for the first 6 months, but I constantly worried about whether she was getting enough and certainly never had any milk to spare. The fact that these “milky mamas” were producing gallons of milk to give away was frankly a little mind blowing.

You mean people don’t follow doctors’ orders?

I was also fascinated by the various ways in which parents had to negotiate the risks of milk sharing. The FDA statement that discourages mothers from sharing their unpasteurized milk with other babies has to do with the potential for disease transmission, exposure to pharmaceuticals and other drugs, or bacterial contamination when milk is not stored and handled carefully.

Medical anthropologists spend a lot of time trying to understand differences in what public health officials recommend and what people actually do.

Milk sharing seems to be one of those situations where health authorities are saying one thing, but their messages, for a variety of reasons, are being reinterpreted or kind of dismissed altogether. I wanted to know what those reasons were and what parents were doing to make sense of the risk in their everyday milk sharing practices.

Saslow’s WP story touches on the social pressure on mothers to breastfeed. The growing scientific evidence for the benefits of breast milk seems to make the idea of formula feeding especially difficult for today’s parents. But, I found myself wondering whether it was really that simple. Were parents being somehow implicitly bullied into milk sharing, even if it meant putting their child at risk for HIV or exposure to chemicals and illicit drugs rather than formula feed?  Honestly, this explanation didn’t quite add up.

Need. More. Information.

To help me gain insight, I logged onto Eats on Feets and Human Milk 4 Human Babies for the first time. Everyday, I devoted time to reading posts, hoping to better understand what milk sharing was all about.

The sites became my jumping off point to gather more information. After reading a bunch of posts I would surf the web and academic literature on topics that were, at the time, very foreign to me: insufficient glandular tissue (IGT), tongue tie, food allergies, early formula supplementation, the effects of pre-term birth on breastfeeding, unsupportive breastfeeding practices. It was on these sites that I encountered things like Domperidone-providing pharmacies in Vanuatu, power pumping, BFAR (breastfeeding after reduction), SNS (supplemental nursing systems), and nipple shield for the first time.

I learned about the Human Milk Banking Association of North America (HMBANA) and differences between milk banking, milk sharing, and milk selling.

I began to catch a glimpse into the politics of human milk, especially in the ways that women described milk sharing as a feminist act of resistance against capitalist, patriarchal domination, medical surveillance, and oppression of their bodies and personal decisions about what to do with their milk. (In case you’ve been hiding under a rock, women aren’t really keen to have other people tell them what to do with their bodies, including what they do with their breast milk or how they feed their babies.)

I also began to see growing antagonism against milk sharing by some vocal milk banking advocates.

I read about mothers who did everything humanly possible to try and breastfeed but still couldn’t produce enough milk. I read about the babies who became sick after being fed formula and parents who were either not eligible to receive banked donor milk or could not afford it. I read about babies with two moms, two dads, trans* parents, foster parents, adoptive parents, and grandparents who were looking for milk. I read about mothers who decided to pump their milk for donation after their babies had passed away and surrogate mothers who wanted to pump their milk for other babies after giving birth to a “surrobabe.” I read about donors who, like Amanda, had previously been on the receiving end of milk with one baby, but had been able to donate milk following a subsequent pregnancy, and vice versa.

And guess what?

This narrative that Internet milk sharing was only about parents randomly taking milk from dangerous, diseased strangers did not seem to capture what was happening on the ground. It actually looked way more complex, and rich, and interesting than this.

Attention! The train has left the station 

As my understanding of Internet milk sharing grew, so did the numbers of people who were joining these sites. Local community pages began popping up in every state across the U.S., with national pages emerging for countries around the globe. In May 2011 the HM4HB site had about 3,000 members.

Today over 56,000 people follow HM4HB alone. Thousands more follow the hundreds of other sites devoted to milk sharing.

The controversies surrounding milk sharing have intensified over time as well. A quick Google search yields all kinds of editorials, both praising and condemning “peer-to-peer” milk sharing activities and other types of profit-making markets for human milk. But, most of what has been written about milk sharing is little more than speculation.

Here’s the question I kept coming back to: if milk sharing is so risky, then why are so many parents continuing to do something that health authorities were telling them is super dangerous, possibly deadly, for their babies? I am guessing that the vast majority of parents in the U.S. really care about their babies and would do anything to keep them from harm.

Clearly there is a disconnect here that deserves attention. Clearly, we need a better understanding of the social context of milk sharing risk and risk reduction strategies people use.

Others, like blogger Jodine Chase at Human Milk News, agree:

“It would be much more valuable for researchers to explore how families who seek human milk for their children actually behave.”

Australian breastfeeding researcher and advocate Karleen Gribble has led the charge with her open-ended email survey, so that milk sharing donors and recipients could add their voice to the controversies and shed light on some of these questions.

Time for a research proposal!

The more I learned about milk sharing, the more questions I had. Like, how does unpasteurized shared milk affect an infant’s health? What about when that baby is fed by dozens of donors? What does it feel like to donate milk to another baby, or breastfeed someone else’s baby? What is it like to feed your baby someone else’s milk? Do babies respond (behaviorally, physiologically, immunologically) to someone else’s milk differently than to their own mother’s milk?

What do husbands, wives, grandparents, family, friends, and health professionals have to say about milk sharing? Are health care providers involved in these decisions, and if so, what do they say or do? What happens when a long-term milk sharing relationship ends, because the donor decides to wean or doesn’t have more milk to give? Does milk sharing inspire mothers to breastfeed longer? What can we learn from families who milk share to enhance the efforts of non-profit milk banking?

Like Dr. Gribble, I wanted to design a really solid study, but one that employed the tools that anthropologists use: participant observation, interviews, and field notes. I knew I wanted to do something that was ethnographic; this meant doing a study of milk sharing “on the ground” by spending time with people who are milk sharing, talking to them, observing them, learning from them.

I also began to think about the many ways an ethnographic study of milk sharing might shape how anthropologists value studies of breastfeeding within the discipline.

It turns out that milk sharing touches upon many themes that are at the heart of anthropology: cooperation, kinship, human health and development, technological innovation and sociality, sex and gender, identity, and the ways in which things (like breast milk) come to have shared meaning and value.

The lowdown on my milk sharing project

The research design of this milk sharing project is pretty straightforward. Basically, after spending over two years following milk sharing sites and doing a systematic content analysis of online posts, I designed a comprehensive online survey. The survey gave me a way to recruit participants for telephone interviews.

Online surveys and telephone interviews are relatively cheap and easy to do. But ethnographic research – the kind I wanted to do at least – required some money, mostly for travel and such.

With some internal research funding from Elon university and a Wenner-Gren Foundation post-PhD grant (THANK YOU!!!!), I am now in the middle of a multi-sited ethnographic study of milk sharing across the U.S. I basically hang out and talk story as a way to understand what milk sharing looks like on the ground.

I’ve interviewed donors, recipients, family, friends, health care providers, and basically anyone who has an opinion about milk sharing or a milk sharing story to share with me. I’ve observed donors express and prepare milk for donation. I have looked on as recipients feed donor milk  to their babies. I’ve gone along to milk pick ups, drop offs, and observe conversations between donors and recipients. I’ve spent time at social events and have seen all kinds of impromptu shared breastfeeding and conversations about milk sharing.

I am amazed and humbled by what these participants have shared with me. They have welcomed me into their homes, often during difficult and chaotic circumstances, which usually involve unpredictable schedules, tiny babies, and intense sleep deprivation. They have taught me so much, and I have much to learn.

Tip of the proverbial iceberg

Usually when I say I study milk sharing, I get the raised eyebrows. But, in certain circles, people pull me aside to tell a story of a friend, sister, mother, aunty, grandmother, or wife who breastfed someone else’s baby, gave milk to someone, or got milk from someone – all without the help of the Internet I might add.

Milk sharing has deep social (and some might argue biological) roots. It’s not going to just go away because health authorities caution against it. It is part of our past, our present, and most likely our future. What is happening online is just scratching the surface.