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Pure Gold for Broken Bodies: Discursive

Techniques Constructing Milk Banking and


Peer Milk Sharing in U.S. News
Shannon K. Carter
University of Central Florida

Beatriz M. Reyes-Foster
University of Central Florida

Technological advances provide increased ability to transfer human


tissues—blood, organs, milk—from one body to another. This article
analyzes mechanisms of reality construction in U.S. news to construct
shared human breast milk. Articles used typifications and human
interest stories to convey participants as victims, lay heroes, and vil-
lains. Milk banking was portrayed as institutionally integrated through
associations, expert testimonies, and formalized procedures, making
banked milk “pure gold.” Peer sharing was portrayed as institutionally
opposed through institutional warnings, expert testimonies, informal
procedures, and hypothetical atrocities, making peer milk “fool’s gold.”
Findings suggest that “biovalue” of human milk is interconnected with
institutional processing.
Keywords: milk sharing, breastfeeding, U.S. news, discourse analysis,
biovalue

INTRODUCTION
Western societies in the twenty first century have access to technologies that allow
human beings to use human blood, tissues, embryos, and stem lines in new and
unprecedented ways (Swanson 2014; Waldby 2002a, 2002b, 2006). Recent techno-
logical advances have also enabled circulation and use of another bodily product:
human milk. While there is a burgeoning sociological literature examining circula-
tion and use of human materials for research and medical treatment (Busby 2006;
Busby, Kent, and Farrell 2014; Carsten 2011; Waldby 2006), social scientific studies
of the uses and movement of expressed human milk are in an incipient, if promising,

Direct all correspondence to Shannon K. Carter, University of Central Florida, Department of Soci-
ology, 4000 Central Florida Blvd., Orlando, FL 32816, USA; e-mail: skcarter@ucf.edu.

Symbolic Interaction, (2016), p. n/a, ISSN: 0195-6086 print/1533-8665 online.


© 2016 Society for the Study of Symbolic Interaction. All rights reserved.
DOI: 10.1002/SYMB.233
2 Symbolic Interaction 2016

stage (Carroll 2014; Palmquist and Doehler 2014; Reyes-Foster, Carter, and Hino-
josa 2015; Thorley 2008, 2009, 2012). One particular use and movement of expressed
human milk is peer milk sharing, the practice of one mother freely donating her
milk to a baby who is not her own without going through an intermediary institution
such as a human milk bank. In this article, we use the portrayal of peer breast milk
sharing in U.S. media to illustrate linguistic mechanisms used to construct differences
between the transfer of human fluids and tissues through biomedical institutions and
the free and unregulated exchange of an easily retrievable and storable bodily fluid.
Sharing human breast milk is a common and ancient practice. However, advances
in milk expression technologies, including invention of the electric breast “pump,”
has made breast milk expression and storage easier than ever before. In contem-
porary Western societies, peer milk sharing most commonly occurs by exchanging
expressed milk, with cross-feeding (breastfeeding a baby other than one’s own)
prevalent but less common (Reyes-Foster et al. 2015; Thorley 2009). Although
research is limited, it appears that much peer milk sharing takes place within social
circles; however, donors report exchanging milk with strangers at a much higher rate
than do recipients (Reyes-Foster et al. 2015). Creation of websites and Facebook
groups in 2010 that facilitate milk sharing online generated public interest in this
practice (Akre et al. 2011). Public and professional interpretations of the exchange
of human milk in the context of peer milk sharing and milk banking are vastly
different. Several health practitioners have published commentary that opposes
peer sharing, construing it as a significant risk to infants akin to “playing Russian
roulette with your baby” (Feibel 2013). In contrast, milk banking is constructed as
“safe” and “healthy,” providing a life-saving substance to needy infants (Carroll
2014). A study of U.S. newspaper articles found similar portrayals, where banked
human milk was portrayed as a healthy, life-saving substance and peer milk was
portrayed as dangerous and risky (Carter, Reyes-Foster and Rogers 2015).
The purpose of the current study is to identify the mechanisms of reality construc-
tion used in U.S. newspaper articles to construct milk banking as safe and peer milk
sharing as risky. Rather than focusing on constructions themselves, this examina-
tion focuses on the social processes through which particular constructions of reality
are constituted (Gubrium and Holstein 1997; Holstein and Miller 1993). We draw
on ethnomethodological and social constructionist principles that view social reali-
ties as ongoing accomplishments produced through artful actions and interactions of
individuals in everyday life (Berger and Luckmann 1966; Garfinkel 1967; Gubrium
and Holstein 1997). From this perspective, newspaper journalists constitute reality
in their rhetorical representations of it. Examining how constructions of reality are
produced is important because they reflect how phenomena are presented to the
public, potentially impacting perceptions (Heritage et al. 1988). Seale, Cavers and
Dixon-Woods (2006) argue that although biomedical experts have been widely iden-
tified in social science research as constructing body parts in ways that objectify and
commodify them, the significant role of the media has been largely overlooked. They
state “mass media play a significant role in filtering and shaping the reporting of
Milk Sharing in U.S. News 3

science, health and medicine” (37). We focus on news media rather than publications
targeting expectant parents because of their broader reach and greater potential for
impacting public opinion.

SHARING BREAST MILK, BANKING BLOOD


Although the extent of peer milk sharing in the United States is unknown, recent
studies estimate “thousands of individuals across the United States” (Perrin et al.
2014:132) and “tens of thousands” (Gribble 2013:85) worldwide have used the inter-
net to facilitate breast milk exchange. Despite emphasis on internet-based sharing,
milk sharing in the United States involves exchange through online and offline social
networks and, similar to other biological “gifts” (Waldby 2002b), may cultivate
friendship and community (Martino and Spatz 2014; Reyes-Foster et al. 2015). Peer
milk recipients are predominantly white, college-educated, and class-privileged
mothers who are committed to breastfeeding but experience breastfeeding difficul-
ties and use peer milk to supplement (Palmquist and Doehler 2014; Reyes-Foster
et al. 2015). Recipients take measures to manage risks, such as screening donors and
obtaining medical records, and they perceive peer-shared milk as safer and healthier
than formula (Gribble 2014a). Some donors prefer peer sharing to help members of
their own communities whereas others morally oppose milk banking (Gribble 2013).
Most peer milk is exchanged for free and in person (Gribble 2014b; Reyes-Foster
et al. 2015; Steube, Gribble and Palmquist 2014).
Peer milk sharing takes place in a broader social context of opposition toward the
practice. After creation of milk sharing websites, U.S. Food and Drug Administration
(US FDA) (2010) released a statement that “recommends against feeding your baby
breast milk acquired directly from individuals or through the internet” and opposi-
tion was published in medical news articles and commentary (Geraghty et al. 2011;
Nelson 2012; Vogel 2011). A study found high levels of bacteria in breast milk pur-
chased online (Keim et al. 2013), providing scientific evidence to support opposition,
even though the methods used to collect milk tested in the study—anonymously,
through economic purchase, and delivered via mail —do not represent common
practice (Reyes-Foster et al. 2015; Steube et al. 2014).
Although US FDA (2010) and American Academy of Pediatrics (AAP 2012)
endorse banked milk for premature infants when mother’s own milk is not available,
banked milk has not always been perceived as safe. Concerns over HIV transmission
through breast milk lead to the closure of many milk banks in the 1980s (Jones
2003). With the ability to test for HIV, interest in human milk banking revived
and nonprofit milk banks in the United States and Canada formed the Human
Milk Banking Association of North America (HMBANA) (Miracle et al. 2011).
HMBANA is a nonprofit organization that established guidelines for screening,
processing, and distributing human milk for affiliated milk banks to follow (Upde-
grove 2013); milk banks are not regulated by the FDA (US FDA 2010). There are
currently 16 HMBANA-affiliated milk banks in United States and Canada, which
4 Symbolic Interaction 2016

reserve processed milk for the neediest infants, such as those born premature and in
neonatal intensive care units (NICUs) (Updegrove 2013).
One can identify significant similarities between the banking and donation of
human milk and the donation and use of blood, sperm and human tissue. Like blood,
sperm, and human tissue, banked milk is seen as simultaneously precious—given
generously for a socially sanctioned purpose such as medical application or the
advancement of science—and dangerous, requiring extensive processing and test-
ing before it can be safely given to a recipient. However, there are also ways
in which human milk donation should be understood as distinct. To begin with,
unlike blood and tissue donation, it is possible to circumvent biotechnological
processing through direct peer-to-peer milk sharing. Swanson’s work (Swanson
2009, 2014) suggests that while blood and sperm drove the transformation of bod-
ily fluid donations from therapeutic intervention to “banked” currency, human
milk has had a less determined trajectory marked by ebbs and flows that coincide
with the historical de-valuing of human milk following the emergence of readily
available infant formula. Mothers’ milk stations from the 1940s gave way to milk
“banks” operating informally out of women’s kitchens in the 1960s and 70s—“milk
banks were organized more like swaps of outgrown toys and baby clothes, passed
along by those who had a surplus to those in need without thought of reimburse-
ment” (Swanson 2009:754). It was only with its subsequent re-valuing as “liquid
gold” in the late twentieth and early twenty-first centuries that milk banking has
taken its current, institutionalized appearance in the United States in the form of
the HMBANA.
In their analysis of blood donation in the United Kingdom, Busby, Kent, and
Farrell (2014) build on Waldby’s notion of “tissue economies” and “biovalue”
to argue that current technological advances in the harvesting and uses of blood
and tissues have created significant ethical conundrums as narratives of dona-
tion continue to hinge on “altruism” as the use of donated blood, tissues, and
other bodily products—including breast milk—becomes increasingly profitable.
Biovalue “refers to the yield of vitality produced by the biotechnical reformula-
tion of living processes” (Waldby 2002b:310). In other words, as human products
become increasingly usable for research and medical applications, they acquire
new forms of value. In referring to blood, Busby, Kent, and Farrell identify
new and emergent forms of biovalue in blood as it is processed, reformulated,
and divided.
An interesting parallel could be made to banked breast milk, as the process of
collecting, testing, and pasteurizing the milk also results in forms of biovalue, mak-
ing banked milk expensive, difficult to obtain, and scarce. As corporations such as
Medolac begin using human milk to produce “enhanced” products for premature
infants to sell to hospitals for a profit, one can expect the emergence of new forms
of biovalue. Unlike tissues, embryos, and blood, however, women who donate and
receive milk have the ability to opt out of engaging in this process. The fact that moth-
ers continue to participate in the free exchange of human milk, often deliberately
Milk Sharing in U.S. News 5

eschewing milk bank donation, suggests that human milk donation may differ from
tissue and blood donation in significant and meaningful ways.

SOCIAL CONSTRUCTIONS OF BREAST MILK


Social science research shows that how human breast milk is socially constructed
varies by sociohistorical context (Gottlieb 2004; Scheper-Hughes 1985). In contem-
porary U.S. society, breast milk is fetishized as “liquid gold,” believed to provide
nutritional and immunological benefits unparalleled by infant formula. AAP (2012)
recommends exclusive breastfeeding for the first 6 months of life, followed by con-
tinued breastfeeding through at least the first year. The extent to which mothers
follow these guidelines is connected to their perceived morality as “good mothers”
(Knaak 2010; Murphy 1999; Wall 2001). Despite a rather consistent message that
breastfeeding is superior to infant formula, Hausman (2003) points out that there is
“doublespeak” regarding breastfeeding in the United States: breast milk is portrayed
as a potential “risk” to infant health through the spread of infectious diseases, harm-
ful drugs and environmental contaminants. Mothers in the United States who are
HIV positive are instructed to not breastfeed, and those who do could be accused of
criminal neglect (Hausman 2011; Van Esterik 2010). In the criminal justice system,
perceptions of the purity or contamination of a mother’s milk depends on broader
evaluations of her fitness as a mother (Reich 2010). Thus, as Bartlett and Shaw state,
“breast milk in culture and politics is never neutral, always contested” (Bartlett and
Shaw 2010:2).
Social science scholarship shows that breast milk in the context of peer milk shar-
ing and milk banking is also socially constructed. Carroll (2014) identified three forms
of labor used to construct banked donor breast milk as safe for consumption by frag-
ile infants. Milk donors engage in “reproductive labor” by adhering to guidelines for
pumping and storing their milk; milk bank staff members engage in “material labor”
to transforms the milk through bacterial testing and pasteurization from an unknown,
potentially risky fluid into a known, tested and safe product; and physicians engage
in “immaterial labor” to “reposition breastmilk as akin to a medicine” (2014:479).
With regard to peer milk sharing, there are currently no published studies that test
the safety of milk exchanged among peers and there are no known reports of babies
getting sick from peer milk. Consequently, Shaw (2004) argues opposition to peer
milk sharing reflects cultural expectations of body boundedness, or what she calls
the “yuk factor.”
The ways in which breast milk is socially constructed are significant because it
impacts practice. Whether breast milk is discarded or fetishized depends on the con-
struction of its utility. Similarly, whether excess breast milk is donated to a bank,
shared among peers or discarded depends on how it is constructed. In this article,
we examine the mechanisms used to construct banked and peer breast milk. Our
research asks: How are the constructions of banked breast milk as safe and peer
breast milk as dangerous achieved in U.S. news articles? That is, what mechanisms
6 Symbolic Interaction 2016

of reality construction are used to achieve a definition of breast milk as safe in one
context and risky in another?

RESEARCH METHOD
We collected all news articles related to milk sharing and/or milk banking published
between January 1, 2010 and December 31, 2014 in the top 20 highest circulating U.S.
newspapers. We used this timeframe because peer milk sharing had gained media
attention by that time as a result of the creation of milk sharing websites. We used
the Pew Research Center’s (2013) State of the Media Report to identify the highest
circulating newspapers. We used LexisNexis Academic database to locate all articles
published in these newspapers that related to milk sharing. The search terms we used
were milk share, milk sharing, milk bank, Eats on Feets, and Human Milk 4 Human
Babies. We used the same search terms on each newspaper’s website (when archives
were available) to assure that we identified all relevant articles. The sample consisted
of 34 articles.
We have analyzed the articles in two different ways. The first analysis (Carter
et al. 2015) used Feminist Critical Discourse Analysis (Lazar 2005, 2007) to examine
the constructions of breast milk, receiving parents, donors and recipients in the
contexts of milk banking and peer milk sharing. The original analysis identified
what was constructed in the articles, focusing on the symbolic definitions attributed
to each of the four subjects in the two milk sharing contexts. The current analysis
focuses on the more ethnomethodological question of how those constructions are
produced (Garfinkel 1967). We focus on what Gubrium and Holstein call the “artful
side of interpretive practice” (Gubrium and Holstein 1997:123) to identify the
meaning-making devices used to achieve these constructions. The analysis consisted
of general and focused coding (Charmaz 2000) to first identify the techniques of
reality construction and then examine the nuanced similarities and differences
within each technique.

FINDINGS
Our findings show similarities and differences in the mechanisms used to con-
struct milk banking and peer milk sharing. Overall, we find use of typifications
and human interest stories to construct a particular “type” of person involved in
both forms of milk sharing. We observe different discursive techniques in por-
trayals of the institutional side of these forms of milk sharing. Milk banks are
portrayed as receiving institutional support from the U.S. government and med-
ical establishment, which is reinforced through expert testimony and formalized
procedures. In contrast, peer milk sharing is portrayed as receiving warning from
various institutions, and is reinforced through expert testimonies that focus on
hypothetical risks.
Milk Sharing in U.S. News 7

INDIVIDUALS INVOLVED IN MILK SHARING


In a comprehensive review, Seale (2003) argues media health reports characterize
people through oppositional characters to facilitate portrayals of risk. In the case
of milk sharing, we identify the characters of “victims” and “lay heroes.” Although
victims are not always necessary, when used they are typically children due to their
heightened vulnerability (Seale 2003). “Lay heroes” are (often female) non-experts
who conquer some life-threatening situation without medical intervention (Seale
2003). These characterizations are achieved in the current data through two main
mechanisms: typification and human interest stories. Typification reduces objects
into categories of relevant characteristics by associating a set of general traits with
a particular phenomenon (Schutz 1970). Gubrium and Holstein (1997:138) argue
that although typification is a “mundane form of explanation,” it has political
consequences because reduction into categories necessarily carries an evaluation
and recommended action. Human interest stories are media reports focusing on
an individual previously unknown by media audiences and experiencing some
extraordinary circumstance (Fine and White 2002; Hughes [1940] 1981).
Babies who receive donor breast milk are portrayed as victims of illness, through
no fault of their own, using typifications and human interest stories. Articles refer to
“sick and premature babies,” and “babies in intensive care.” They use human interest
stories to highlight one case, often utilizing death metaphors to portray the scenarios
as life-threatening.

Heinisch wasn’t producing enough breast milk for Liam, and formula made him
horribly sick. At 4 months, he weighed a skeletal eight pounds. (Philadelphia
Inquirer, December 7, 2010)

Describing the baby as “skeletal” portrays the child on the border between life
and death, a tactic used to elicit anxieties about human mortality and the potential
tragic loss of an innocent life (Seale 2003).
Typifications and human interest stories are also used to image parents of recipient
babies as individuals whose bodies absolutely cannot produce milk such as gay men,
adoptive mothers or biological mothers with complicated medical histories.

“Parents who have adopted, for instance, or have had mastectomies—or who
simply do not produce enough milk—often rely on donated or purchased breast
milk” (New York Times, October 21, 2013).

Human interest stories use extreme cases to portray biological mothers as victims
of their own (dysfunctional) bodies.

A 40-year-old cancer survivor is collecting breast milk from dozens of her Brook-
lyn neighbors to help feed her 3-week-old son. Eva van Dok Pinkley can’t nurse
Oliver herself because of a double mastectomy. … [She] has endured multiple
miscarriages and two rounds of failed fertility treatments. (Daily News, July 28,
2011)
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This human interest story images poor reproductive health and an extremely bro-
ken body—one that is not only unable to lactate, but was barely able to reproduce
at all.
This image is reinforced with personal testimonies.

[Lynn’s] anguish [over not producing enough milk] was compounded by a his-
tory of miscarriages. “Now I was ‘failing’ to produce enough milk for him to even
live,” she recalled. “To say I was bawling my eyes out was an understatement.”
(Philadelphia Inquirer, December 7, 2010)

Human interest stories reinforce descriptions of the “type” of parent who receives
donor milk as one who could not possibly produce breast milk. Biological mothers
are presented as women who are victims of their own extremely broken bodies, suf-
fering multiple physical ailments and histories of reproductive failure. Their inability
to lactate is just one more way their bodies have failed.
In contrast, typifications and human interest stories present donors as “lay
heroes” (Seale 2003); they are perfect mothers with perfect maternal bodies.
Donors are typified as women whose bodies naturally produce abundant milk
that they donate for a righteous cause. Articles describe donors as “mothers who
simply produce more than their babies need.” This image is reinforced by human
interest stories.

In one of life’s curious twists, her slight figure proved to be a mighty dairy, pro-
ducing high-fat milk at a high volume. (Star Tribune, April 17, 2010)

To complement their perfect maternal bodies, typifications and human interest


stories portray donors as perfect mothers by describing them as “kind-hearted,” and
“generous.”

Since November, Wilma Ruth Torres, of Fremont, has donated more than 1,000
ounces of her breast milk to Mothers’ Milk Bank. Pumping is time consuming, she
said, but well worth it knowing the milk is going to help sick babies. “That’s why
I do it,” said Torres, who has an excess of milk from nursing her 9-month-old son,
Samuel. “You can be a blood donor your whole life, but this is something special
you can do for a short time.” (San Jose Mercury News, March 29, 2011)

Typifications and human interest stories portray donors as lay heroes who res-
cue victim babies and their parents. Their bodies naturally produce abundant milk
and they are motivated to sacrifice time and energy to express it—an activity they
admit is less than enjoyable—for the intrinsic reward of knowing they have given a
highly coveted gift to a baby in need. Consistent with the intensive mothering ide-
ology (Hays 1996), donors surpass the hegemonic expectation of prioritizing their
own babies’ needs by sacrificing their own desires for other, unrelated babies. This
image of milk donors as “good mothers” parallels media portrayals of organ donors
as “good people” (Morgan et al. 2007).
Milk Sharing in U.S. News 9

MILK BANKING AS AN INSTITUTIONALLY-INTEGRATED PRACTICE


While the same techniques are used to construct individuals involved in milk sharing
through milk banking and peer networks, different techniques are used in reference
to relevant institutions in the two contexts. Milk banking is constructed as a formal-
ized system highly integrated with major U.S. institutions, particularly biomedicine
and government. It is constructed as an institutionally integrated practice through
institutional associations, expert testimonies, and formalized procedures.

Institutional Associations
Milk banking is constructed as a legitimate practice through portrayals of milk
banking as an institutionalized process interconnected with U.S. medical organi-
zations and government, even if no such official connection exists. For example,
increased demand for banked human milk is portrayed as resulting from medical
and government advocacy regarding health benefits of breastfeeding. Increasing
breastfeeding rates is a stated goal of the Healthy People 2020 Objectives and the
Surgeon General’s Call to Action to Support Breastfeeding (U.S. Department of
Health and Human Services 2011a, 2011b).
Milk bank managers say federal, state and local health authorities are more
aggressively promoting breast milk than in the past, prompting the demand from
mothers who can’t provide enough for their own children. (USA Today, April 7,
2010)

Associating demand for banked milk with institutional statements legitimizes milk
banking by portraying affiliation between milk banks and established institutions.
Portrayals of collaboration between milk banks and hospitals also legitimize milk
banking.
Neonatal intensive care units insist on breast milk for the smallest babies because
it drastically improves their prospects. (New York Times, February 12, 2013)

Focus on hospitals rather than practitioners reinforces association of milk banks


with formal institutions. Articles state that some health insurances will pay for
banked milk and some hospitals recruit milk donors, furthering the image of milk
banks as highly integrated within the medical establishment.
Articles present U.S. government as supporting milk banking particularly through
the FDA. Although some articles acknowledge that FDA does not regulate milk
banks (US FDA 2010), others nevertheless portray an affiliation between the two.
The nonprofit bank is state licensed and the first to receive endorsement from the
Food and Drug Administration. (San Jose Mercury News, March 29, 2011)

Overall, the articles present an image of institutional integration and collabora-


tion, achieved by associating milk banking with the formal institutions of U.S. gov-
ernment and biomedicine.
10 Symbolic Interaction 2016

Expert Testimonies
Institutional support for milk banking is reinforced through expert testimonies.
Experts are referenced generally as “experts,” or “public health experts” or through
job positions such as “doctors,” “physicians,” and “neonatologists.” Others are
established through detailed reporting of their job titles, institutional affiliations,
and years’ experience, such as “a neonatologist in Austin, Tex., one of several experts
who in 2010 urged the Food and Drug Administration to step in and start regulating
human milk banks,” and “assistant director of nursing for maternal child services
at Flushing Hospital, has been in the health care business for 30 years.” Using lists
and numbers are media tactics that reinforce the facticity of the report (Seale et al.
2006). In this context, listing the experts’ qualifications and quantifying their years’
experience increases apparent facticity and adds to the legitimacy of the expert’s
testimony.
Expert testimonies reinforce the articles’ messages and associate it with estab-
lished organizations.

“[Pasteurization] will kill all viruses and almost all bacteria” without destroying
the beneficial components of breast milk, said Thomas Hale, a clinical pharmacol-
ogist at the Texas Tech University School of Medicine. … “Milk bank donors can’t
take any drugs or smoke or drink,” Hale said. (Philadelphia Inquirer, December
7, 2010)

Experts reinforce the procedures involved in milk banking and the philosophy of
the practice. By relying on experts who work within the healthcare industry, expert
testimonies also reinforce the image of institutionalized support from the biomedical
establishment.

Formalized Procedures
Articles reinforce the image of milk banks as formal institutions by focusing on for-
malized procedures. According to the articles, successful milk bank donors undergo
blood and DNA testing for infectious diseases and require pediatrician testimony
that their child is exclusively breastfed and healthy. Screening is “rigorous,” with
many potential donors not meeting requirements.

Donors are put through rigorous screenings. They must be nonsmokers in good
health whose blood tests are negative for herpes, HIV and syphilis. (San Jose Mer-
cury News, March 29, 2011)

Donors are trained in milk-handling and often provided specific containers for
donations.

Once the donor is approved, the milk bank will send her special containers into
which she pumps excess milk. That milk is then frozen for delivery to the milk
bank. (USA Today, April 7, 2010)
Milk Sharing in U.S. News 11

Donated milk is tested by milk banks while it undergoes processing.

All milk shipped from milk banks is pasteurized, which kills skin and gastroin-
testinal bacteria, as well as many viruses, including those that cause colds. (New
York Times, October 21, 2013)

Distribution of processed milk is also described as following formalized proce-


dures. Milk is dispensed primarily to hospitals and distributed to infants who have
physician prescription.
Milk banks are constructed as morally righteous because they partake in these
rigorous procedures voluntarily.

Thirteen banks in the United States and Canada follow voluntary guidelines set
up by the Human Milk Banking Association of North America, which require
that donors and donations be screened, and that milk be pasteurized. (New York
Times, October 21, 2013)

Milk banking is portrayed as a rigorous, standardized, institutional process guided


by a strict set of formally established rules. It involves oversight of donors and pro-
cessing to assure that milk is purified before distribution. The portrayed outcome of
this formalized operation is a substance guaranteed to be “clean” through rigorous
screening, testing and processing. Referring to the formalized procedures as “volun-
tary” suggests a level of volunteerism on the part of the milk banks, associating them
with moral righteousness.

PRODUCT OF MILK BANKING: PURE GOLD


The product of milk banking is portrayed as a highly valued, pure commodity. Breast
milk is generally commodified in its reference as “liquid gold”; however, banked milk
is further commodified because it is sold in a highly regulated market. Numbers are
used in media reports to increase facticity of the stories and amplify the magnitude
of a phenomenon (Seale et al. 2006). Articles in the current study use numbers to
report the high cost of banked milk in dollars per ounce and to quantify breast milk
by its volume.

Neonatologists call breast milk “liquid gold” because of the immunity it provides
newborns. It’s expensive too. The milk bank sells breast milk for $3.50 per ounce
to hospitals around the country. (Denver Post, January 12, 2010)

The Mothers’ Milk Bank of San Jose, one of 10 banks accredited by the Human
Milk Banking Association of North America, distributed 420,000 ounces of breast
milk last year, a 25 percent increase from the previous year, Executive Director
Pauline Sakamoto said. (San Jose Mercury News, March 29, 2011)

Banked breast milk is further commodified in its portrayal as subject to economic


laws of supply and demand.
12 Symbolic Interaction 2016

With a growing number of doctors saying breast milk is the best food for babies,
especially hospitalized preemies struggling to gain weight, the demand for milk
donations is increasing. (USA Today, April 7, 2010)

Banked milk is portrayed as a commodity not because the milk itself is valuable;
as the next section will illustrate, milk extracted directly from women’s bodies is
viewed with suspicion. Nor is it commodified based on the labor involved by the
women who produce it; articles emphasize that mothers are not paid for their milk
donations. Instead, the value of the milk lies in the oversight, testing and procedures
enacted upon it inside the milk banks. The articles emphasize that most banks are
nonprofit organizations, and money they receive from selling processed milk pays
only for operating the bank.

The milk bank sells breast milk for $3.50 per ounce to hospitals around the coun-
try. Thanks to grant funding, the nonprofit bank usually breaks even. The bank
also gives a portion of its milk away free. (Philadelphia Inquirer, December 7,
2010)

One article refers to payment for milk as a “handling fee.”

Hospitals pay a handling fee of $3 to $5 an ounce for the donated milk collected
by the milk banks, which they test, pasteurize and freeze until it’s needed. (USA
Today, April 7, 2010)

Articles construct banked milk as a commodity in limited supply that is expen-


sive, measurable in ounces, and subject to economic laws of supply and demand. The
money required to purchase banked milk is not to compensate for the milk itself
or the labor power to produce it, but instead is to compensate for the purification
process that occurred at the milk bank: screening, collecting, testing, processing, and
dispensing. It is the process that transforms the milk from a suspect substance into
a purified form: “pure gold.” The process itself is what gives economic value to the
resulting substance.

PEER MILK SHARING AS AN INSTITUTIONALLY-OPPOSED PRACTICE


In contrast to portrayals of milk banking as an institutionally integrated practice,
peer milk sharing is portrayed as an institutionally opposed practice. This is achieved
through institutional warnings, expert testimonies, hypothetical atrocities, and infor-
mal procedures.

Institutional Warnings and Expert Testimonies


U.S. government is cited as warning against peer milk sharing, most commonly
through US FDA’s (2010) official statement.
Milk Sharing in U.S. News 13

Last fall, the FDA released a statement that recommended “against feeding your
baby breast milk acquired directly from individuals or through the Internet”
because unscreened donor milk could allow the transmission of HIV, chemical
contaminants, some illegal drugs and some prescription drugs. (Washington Post,
April 12, 2011)

This warning is reinforced by reporting similar statements by equivalent institu-


tions in France and Canada (Gribble and Hausman 2012).
Expert testimonies from representatives of the biomedical establishment rein-
force the image of unanimous institutional opposition.

But some physicians and public health experts fear that in their quest to provide
infants with the benefits of breast milk, new parents may inadvertently be expos-
ing their babies to potential harm. (New York Times, February 12, 2013)

Some articles report that breastfeeding advocates and specialists recommend


against peer milk sharing, further legitimizing warnings.

Still, health professionals and other nursing advocates, including La Leche League
International, caution against casual milk sharing because of potential risks to the
baby, such as infection, bottle contamination, and the reality that some viruses
and diseases are asymptomatic, said Diana Mahar, a pediatrician at Kaiser Per-
manente Pinole and a breast-feeding spokeswoman for the American Academy
of Pediatrics. (San Jose Mercury News, March 29, 2011)

Through institutional warnings and expert testimonies, the articles present an


image of unanimous agreement among relevant institutions and organizations
against peer milk sharing.

Hypothetical Atrocities
“Atrocity stories” (Stimson and Webb 1975) are dramatic accounts of events that
take place between two parties, typically of unequal status, that cast the storyteller as
a hero who has been wronged by the other. Atrocity stories are told by patients about
doctors’ wrongdoings (Stimson and Webb) or among professionals about illegitimate
actions of clients and patients (Dingwall 1977). In the case of breast milk sharing,
there are no reported cases of a baby getting sick from breast milk acquired through
peers. In light of the lack of atrocity stories to recite, articles report what we call
“hypothetical atrocities”—negative events that could possibly happen in the future,
but have not been documented to date. In hypothetical atrocities presented in the
articles, “risks” are presented as possibilities, chances, and potential, with emphasis
on the unknown.

“The study makes you worry,” said Dr. Richard A. Polin, the director of neona-
tology and perinatology at Columbia University, who was not involved in the
research. “This is a potential cause of disease. Even with a relative, it’s probably
not a good idea to share.” (New York Times, October 21, 2013)
14 Symbolic Interaction 2016

One expert suggests that peer recipients may not even be obtaining breast milk:

Dr. Keim said there is no way for a consumer to be certain what she is getting from
an online source. “We looked at everything a buyer could know herself – temper-
ature, the condition of the containers, how long it took to ship, what sellers were
saying in their ads – and only the time in transit had any effect on contamination.
Buyers have no way of knowing even what they’re getting – it could be cow’s milk
or formula.” (New York Times, October 21, 2013)

This sentiment is supported in an opinion piece published by Keim (2015) titled


“The Dangers of the Milk-Sharing Economy.”
Articles portray peer milk sharing as risky practice through hypothetical atroci-
ties, where the recipient infant could be victimized through transmission of harm-
ful and even deadly pathogens. Two characters become villains—individuals who
threaten others’ health (Seale 2003)—responsible for the hypothetical atrocities:
mothers who donate milk through peer networks and parents who feed their babies
peer-shared milk. In contrast to the perfect mothers with perfect bodies described
as “typical” donors and discussed in human interest stories, peer milk sharing is con-
strued as problematic due to the potential that one will acquire milk from a “bad”
mother—one who subjects her body to harmful substances thereby tainting her milk,
or who purposefully contaminates milk for monetary gain. The parent who feeds
their baby this potentially deadly milk is an unknowing villain guided by emotion
and naiveté (Carter et al. 2015).

Informal Procedures and the Internet


A primary concern presented by experts who caution against peer milk sharing is
the source through which milk exchanges are facilitated: the internet. The internet is
portrayed as an unregulated, disembodied space where milk is exchanged in absence
of humans. Articles present warnings against obtaining milk through internet sources
as if the milk exchange itself takes place in cyberspace.

The FDA’s statement encouraged women to consider milk banks instead of turn-
ing to the Internet. (The Washington Post, April 12, 2011)

Statements portray the internet as an agentic body itself that operates with-
out people behind it, furthering the image that obtaining milk via the internet is
dangerous.

PRODUCT OF PEER MILK: FOOL’S GOLD


The dominant portrayal of the product of peer milk sharing is an unidentified, poten-
tially harmful substance exchanged in an “underground” market.

A cottage industry has sprung up facilitating the sale and donation of human
breast milk on the Internet, but a study published Monday in the journal Pediatrics
Milk Sharing in U.S. News 15

confirms the concerns of health professionals over this unregulated marketplace.


(New York Times, October 21, 2013)

Portrayals of milk exchange through an “underground market” emphasize lack


of regulation and oversight in both its production and sale. This construction
of milk obtained through peer networks—especially via internet or monetary
exchange—can be likened to “fool’s gold”: a substance that appears valuable on the
surface but may actually be a synthetic substitute void of any valuable qualities. This
product is created through questionable actions of women accessed via internet who
either consumed potentially harmful substances themselves, thereby tainting their
milk, or purposefully manipulated milk for monetary gain. It is a potential threat to
infant health.

DISCUSSION
This article analyzed the mechanisms of reality construction used in U.S. newspaper
articles to construct human breast milk in the contexts of milk banking and peer milk
sharing. We found that typifications and human interest stories are used to construct
the individuals involved in milk sharing in both contexts. Babies were generally typed
as innocent victims who are extremely sick and desperately in need of donor breast
milk. Parents of recipient babies were typed either as individuals for whom lacta-
tions would be unlikely—such as gay men or adoptive mothers—or as biological
mothers with multiple medical complications. Typifications provided a general idea
of the kind of person who would engage in milk sharing as a recipient or donor and
human interest stories provided an extreme example to reinforce the typification. In
the case of breast milk donors and recipients, donors were typified as perfect moth-
ers with perfect maternal bodies and recipient mothers were typified as women with
extremely broken bodies.
Scholars have argued that human interest stories moralize social issues by portray-
ing them in individualistic terms, which locates responsibility within the individuals
who are impacted by them (Henderson et al. 2009; Saguy and Almeling 2008).
Classifying recipient mothers as a particular “type” of woman through typifications
and human interest stories portrays the scenario of a mother who wishes to breast-
feed her infant but experiences difficulty doing so as an uncommon case, resulting
from an anomalous reproductive health history. Research on mothers who engage
in peer milk sharing shows that recipient mothers are typically women who are
breastfeeding, but are unable to produce enough milk to breastfeed exclusively
(Palmquist and Doehler 2014; Reyes-Foster et al. 2015). The inaccurate media por-
trayal, achieved through typifications and human interest stories, diverts attention
from broader structural factors that inhibit U.S. mothers’ ability to breastfeed such
as lack of access to adequate breastfeeding services, disruptive hospital practices,
workplace policies and cultural opposition to public breastfeeding. It suggests that
these women have failed as mothers since their reproductive bodies are deemed
16 Symbolic Interaction 2016

inadequate (Apple 2006), and does not promote social policy changes since breast-
feeding problems—like other health problems such as obesity (Saguy and Almeling
2008)—are portrayed as individualized issues.
Our analysis also found that articles used different and similar techniques to con-
struct the processes of milk banking and milk sharing in ways that mirror the pro-
cesses of institutionalization and legitimization of the banking of other bodily fluids
and tissues (Busby 2006; Busby and Martin 2006). Consistent with blood and tissue
banking (Busby and Martin 2006), milk banking was constructed as an institution-
ally integrated practice through institutional associations, expert testimonies, and
formalized procedures that render inherently risky milk safe in the same way that
the processing and testing of donated blood renders blood safe while maintaining the
risky status of donor bodies (Carsten 2011). Banked milk is similar to donated blood
and tissue in that institutional processing imbues it with biovalue (Waldby 2002b),
rendering into “liquid gold.” However, in contrast to blood and tissue, which can-
not easily be exchanged informally, it is possible to easily circumvent institutional
processing through peer donation. Institutional associations, which were reinforced
by expert testimonies, portrayed milk banks as fully integrated and accepted by U.S.
government and medical institutions, in contrast to peer milk sharing.
This portrayal masks the reality that most U.S. milk banks operate without
government oversight (US FDA 2010) and there is evidence that some healthcare
providers have conflicting views about the use of pasteurized donor milk. A study of
healthcare workers in NICUs in Australia found that although the majority reported
that donated breast milk is preferable over formula, a lower proportion believed that
setting up a human milk bank was justifiable (Lam, Kecskes and Abdel-Latif 2012).
There are also medical reports that raise questions about the safety of milk banking,
such as an infection outbreak in a French NICU due to a contaminated milk bank
pasteurizer and bottle warmer (Gras-Le Guen et al. 2003) and findings that pre-term
infants fed human donor milk obtain less protein and therefore slower growth com-
pared to infants fed mothers’ own milk (Arslanoglu, Moro and Ziegler 2009).
Currently about one-third of United States advanced care neonatal units provide
human milk to most infants (Perrine and Scanlon 2013). Despite lack of unanimous
support for milk banking among healthcare providers and lack of United States
government oversight of milk banks, articles portrayed milk banking as a system
that is highly integrated with these established institutions by portraying associations
between them and using expert testimonies to reinforce these associations. These
techniques legitimized milk banking and, in juxtaposition, delegitimized peer milk
sharing.
Peer milk sharing was constructed as an institutionally opposed practice through
institutional warnings, expert testimonies, hypothetical atrocities, and informal
procedures. Institutional warnings and expert testimonies collectively presented an
image of unanimous opposition toward peer milk sharing by the United States gov-
ernment and medical institutions. Scholars argue that such portrayals facilitate the
government of individuals in liberal societies by promoting self-regulation (Foucault
Milk Sharing in U.S. News 17

1991; Rose 1992). In the case of infant feeding, Murphy (2003) argues that mothers
are constrained through a series of “quiet coercions” that define breastfeeding as
healthy and formula feeding as “risky.” In the newspaper articles examined here,
experts defined peer milk sharing as even riskier than formula. Murphy states,
“Where risk is defined within and through expert scientific discourses, mothers who
engage in ‘risky’ feeding practices are faced with the challenge of maintaining their
identities as ‘good mothers’” (Murphy 2003:456). Thus, the morality of mothers who
receive peer milk is challenged on two fronts: first for not producing breast milk
of their own to feed their babies and second for choosing to feed their babies peer
breast milk instead of formula.
The potential “risk” of peer milk sharing is further reinforced by hypothetical
atrocities, where a possible future negative event that has not actually happened is
narrated. Scholars posit that atrocity stories typically follow a formula, where the
teller is a hero who was wronged by a villain who made some sort of illegitimate claim
of superiority (Dingwall 1977; Stimson and Webb 1975). In the current study, moth-
ers who receive peer milk are cast as villains in hypothetical atrocities for putting
their babies at risk. Atrocities are hypothetical because there are no documented
cases of illness resulting from peer milk sharing, making actual atrocity stories an
unavailable narrative device. In this narrative context, experts fabricate hypotheti-
cal stories about what might happen at some future point in time. Dingwall (1977)
argues that atrocity stories are particularly useful when the legitimacy of one’s profes-
sion is challenged, as they can facilitate reinstatement of the professional hierarchy.
Peer milk sharing arguably challenges institutionalized medicine as mothers disobey
formal recommendations against peer milk sharing and circumvent medically sanc-
tioned forms of infant feeding. Therefore, the hypothetical atrocity allows experts to
reclaim their status as experts and legitimize their profession by portraying peer milk
sharing as a practice that puts infants at risk.
Through these techniques, breast milk sharing and the mothers who do it are con-
structed as morally questionable at the same time that the authority of apparently
official institutions is reified. Through typifications, human interest stories, and hypo-
thetical atrocities, U.S. newspapers portray the broken bodies of recipient mothers,
the safety of milk banks, and the danger of peer milk sharing. Despite the fact that
closer inspection reveals that peer breast milk sharing is in reality a complex practice
and that apparently official milk banks are in fact not as regulated as they appear to
be, these social processes create powerful symbols that, because they are assumed to
represent reality, come to construct it.

ACKNOWLEDGMENTS
The authors would like to thank Tiffany Rogers for assistance with data collection
and the anonymous reviewers and Dr. Robert Dingwall for their constructive com-
ments on an earlier draft of this manuscript.
18 Symbolic Interaction 2016

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ABOUT THE CONTRIBUTOR(S)


Shannon K. Carter, PhD is Associate Professor of Sociology at the University of Central Florida.
Her current research focuses on mothering and infant feeding, with projects examining African
American mothers’ breastfeeding experiences, faculty mothers’ experiences balancing work and
infant feeding, and peer breast milk sharing among mothers in Central Florida. Her publications
in this research area are in Health, Risk & Society, Breastfeeding Medicine, Sociology of Race &
Ethnicity, and Journal of Family Issues.

Beatriz M. Reyes-Foster, PhD is an Assistant Professor of Anthropology at the University of Central


Florida. A medical anthropologist, she has conducted research on mental illness and mental health-
care in Mexico and is currently pursuing research on infant feeding in Central Florida. Her work
has appeared in journals such as Breastfeeding Medicine, Health, Risk & Society, Critical Discourse
Studies, and Religion and Violence.