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This review examines anthropological contributions over the past decade to the biocultural processes and practices of lactation via the analytical pillars of colonialism, racial capitalism, and medicalization. The nexus of these three processes has been foundational to the profound disruption and decline of breastfeeding in the mid-twentieth century and is still impacting ongoing efforts to restore and facilitate breastfeeding. Anthropologists have helped expose and challenge biocapitalist, medicalized conceptualizations of lactation that undermine breastfeeding often even when they claim to support it. Moreover, they have highlighted how ethnocentric cultural ideologies shape biomedical categories of "normal" infant feeding and lactation and have demonstrated the variability of these processes and practices. While these efforts have yielded important interventions into anthropology and a range of other disciplines, significant work remains to integrate efforts across the subfields and to challenge racist, oppressive systems that continue to shape both the study and the practice of lactation. [ABSTRACT FROM AUTHOR]

Expressed human milk can be donated or sold through a variety of channels, including human milk banks, corporations or individuals, or peer‐to‐peer milk sharing. There is a paucity of research regarding the nutrient and bioactive profiles of expressed human milk exchanged through commerce‐free scenarios, including peer‐to‐peer milk sharing. The study objective was to evaluate the macronutrient, antimicrobial protein, and bacteria composition in expressed human milk acquired via commerce‐free arrangements. Expressed human milk samples were collected from the following commerce‐free scenarios: milk expressed for a mother's or parent's own infant (MOM; N = 30); unpasteurized milk donated to a non‐profit milk bank (BANKED; N = 30); milk expressed for peer‐to‐peer milk sharing (SHARED; N = 31); and health professional‐facilitated milk sharing where donors are serologically screened and milk is dispensed raw (SCREENED; N = 30). Analyses were conducted for total protein, lactose, percent fat and water, lysozyme activity, immunoglobulin A (IgA) activity, total aerobic bacteria, coliform, and Staphylococcus aureus. No bacterial growth was observed in 52/121 samples, and 15/121 had growth greater than 5.0 log colony‐forming units/mL. There was no evidence of differences by groups (p > .05) in lactose, fat, water, lysozyme activity, sIgA activity, aerobic bacteria, coliforms, and S. aureus. Mean protein values (95% confidence interval) were 1.5 g/dL (1.4, 1.6) for BANKED, 1.4 g/dL (1.3, 1.5) for MOM, 1.6 g/dL (1.5, 1.7) for SCREENED, and 1.5 g/dL (1.4, 1.6) for SHARED, which was not significantly different (p = .081). This research contributes to growing literature on the risks and benefits of uncompensated, peer‐to‐peer milk sharing. [ABSTRACT FROM AUTHOR]

Breastfeeding is critical to maternal and infant health. Psychosocial factors are associated with lactation outcomes, and perinatal mood disorders (PMDs) are often linked with breastfeeding difficulties and early, unexpected weaning. Parents may utilize human milk sharing to ensure their infant receives human milk when breastfeeding requires supplementation or is not possible, but this practice carries health risks and is often stigmatized. Milk sharing recipient mothers may be particularly vulnerable to PMDs associated with breastfeeding difficulties. The study objective was to explore factors associated with emotional responses to a parent's decision to feed their infant with shared human milk. An online cross‐sectional survey of 205 milk sharing recipients was analysed with linear regression. Controlling for participants' education and breastfeeding difficulties, higher perceived social stigma was associated with more negative emotional responses (p < .01). Receiving strong spousal/partner support for milk sharing (p < .001) and screening donors regarding the health of their nursling(s) (p < .05) were associated with more positive emotional responses. Social stigmatization of milk sharing may negatively influence emotional responses among recipient mothers. Based on these results, it can be recommended that health professionals screen breastfeeding mothers with lactation difficulties for emotional distress that may lead to PMDs and provide evidence‐based information about milk sharing in a nonstigmatizing way. Health professionals may support informed decision‐making for infant feeding practices, including human milk sharing, by providing information on milk sharing risks and risk mitigation, developing evidence‐based practices and guidelines that facilitate safe milk sharing, and directing families to available resources for psychosocial support. [ABSTRACT FROM AUTHOR]

Recent public health breastfeeding promotion efforts have galvanized media debates about breastfeeding in wealthy, Euro-American settings. A growing body of research demonstrates that while breastfeeding is increasingly viewed as important for health, mothers continue to face significant structural and cultural barriers. Concerns have been raised about the moralizing aspects of breastfeeding promotion and its detrimental effects on those who do not breastfeed. Far less, however, is known about the moral experiences of those who pursue breastfeeding. This study draws together research on breastmilk sharing (2012–2016) and nighttime breastfeeding from the U.S. (2006–2009), and long-term breastfeeding from the U.K. (2008–2009) from three ethnographic projects to address this gap. Comparative analysis of these cases reveals that while breastfeeding is considered ideal infant nutrition, aspects of its practice continue to evoke physical and moral danger, even when these practices are implemented to facilitate breastfeeding. Breastmilk sharing to maintain exclusive breastmilk feeding, nighttime breastfeeding and bedsharing to facilitate breastfeeding, and breastfeeding beyond the accepted duration are considered unnecessary, unhealthy, harmful or even deadly. The sexual connotations of breastfeeding enhance the morally threatening qualities of these practices. The cessation of these “problematic” breastfeeding practices and their replacement with formula-feeding or other foods is viewed as a way to restore the normative social and moral order. Mothers manage the stigmatization of these breastfeeding practices through secrecy and avoidance of health professionals and others who might judge them, often leading to social isolation. Our findings highlight the divide between perceptions of the ideal of breastfeeding and its actual practice and point to the contested moral status of breastfeeding in the U.S. and the U.K. Further comparative ethnographic research is needed to illuminate the lived social and moral experiences of breastfeeding, and inform initiatives to normalize and support its practice without stigmatizing parents who do not breastfeed. [ABSTRACT FROM AUTHOR]

Women in the U.S. face significant structural constraints in attempting to breastfeed as recommended in the first six months of their child's life. Internet-facilitated human milk sharing is an emergent response to breastfeeding challenges. Little is known about the demographic characteristics of milk sharing donors and recipients and the ways structural factors circumscribe the biocultural context of lactation in milk sharing practices. Data regarding demographic characteristics, reproductive history, lactation history, and levels of social support and health care provider support for breastfeeding were collected via an online survey September 2013–March 2014. Statistical tests were executed to ascertain whether significant differences exist between donors and recipients. A total of 867 respondents (661 donors, 206 recipients) met the eligibility criteria for the study. Respondents were U.S. residents and primarily White, middle-class, well educated, and employed women. Both donors and recipients reported higher than the national average for household income, maternal educational attainment, breastfeeding exclusivity 0–6 months, and breastfeeding duration. Differences in lactation sufficiency and breastfeeding outcomes between donors and recipients were associated with both structural and biocultural factors. Donors reported significantly higher income, education, and support for breastfeeding from spouse/partner, other family, employers, and pediatricians. Donors also reported significantly higher rates of full term birth for child of most recent lactation. This study provides a foundation for understanding how milk sharing reflects a broader political economy of breastfeeding in the U.S. [ABSTRACT FROM AUTHOR]

The widespread use of breast pumps in the United States is a recent phenomenon that is reshaping how individuals understand and perceive lactation. In the 1990s, adequacy of milk supply was primarily measured indirectly by infant weight gain and/or diapers; now >95% of all lactating persons in the United States use breast pumps and are seeing their milk regularly. How seeing milk impacts the perception of lactation sufficiency is an important area of research. Research aim/question : To understand personal and intersubjective influences of seeing expressed human milk on perceptions of milk supply among participants who express milk for their infants. We surveyed 805 lactating participants from the United States about their pumping practices using an online survey. Participants described pumping practices, milk output, and beliefs. They were then randomized to view one of three photographs of expressed milk (<2 oz, 4 oz, >6oz) and asked to imagine they had just pumped that amount and provide a written response; this created 4 exposure groups (2 increase and 2 decrease) and a control group (no difference). Participants randomized to a higher volume reported more positive feelings and used the terms "good", "great", and "accomplished" to describe emotional responses to output. Participants randomized to lower milk volumes reported more feelings of "bad" or "depressed." A subset of participants reported feeling "annoyed" about small volumes of milk. Participants in this study were very conscious of the volume of milk pumped each session; both increases and decreases were associated with emotional responses that could contribute to decisions about pumping practices, perceived milk supply, and lactation duration. • Milk expression is not a value neutral experience for lactating individuals. • When shown images of pumped milk, individuals misjudged the amount compared to their typical volume. • Individuals viewing larger amounts of milk than typically pumped reported embodied experiences. • Individuals viewing smaller amounts of milk than typically pumped reported both negative and practical responses. • Perceptions of milk supply can no longer assume milk supply is invisible but is highly visual. [ABSTRACT FROM AUTHOR]