Facilitators and Barriers to Utilizing Donated Human Milk from a Peer: A Liberation Health Social Work Approach

Background and Purpose: Peer-to-peer human milk (HM) sharing, whereby lactating women benevolently donate their breastmilk to a peer, is a common practice and is increasing via online and offline social networks (Gribble, 2014; Palmquist & Doehler, 2016). Peer-to-peer HM sharing may be a preferred choice for parents who have a strong desire to provide their child with HM, but who are unable to produce it themselves (Gribble, 2014; Perrin, Goodell, Allen, & Fogelman, 2014). While HM has been unequivocally established as the ideal food source for infants, much stigma and controversy surrounds the practice. This study sought to examine recipient mothers’ experiences of obtaining HM from a donor. Research questions guiding this inquiry were (a) What challenges do recipient mothers experience in peer-to-peer HM sharing? (b) What supports do recipient mothers identify in peer-to-peer HM sharing?

Methods: A phenomenological approach—focused on understanding the individuals’ lived experience of a particular event, happening, or circumstance (Creswell, 2013) was used to elucidate mothers’ experiences of peer-to-peer HM sharing. Additionally, we utilized the liberation health social work model (Belkin Martinez and Fleck-Henderson, 2014) as a structure for examining participants’ experiences in context of the social, cultural, and political environment. Researchers conducted in-depth interviews with mothers (N=20) in the United States (US) and Canada who were recipients of peer-to-peer HM sharing. Participants were recruited using flyers shared by Human Milk 4 Human Babies—an online Facebook community that maintains spaces for interested families to connect and share HM. Interviews were audio-recorded, transcribed verbatim, and uploaded into NVivo Pro 11 for analysis. Using principles of grounded theory in data analysis, researchers independently reviewed transcripts and completed open, axial, and selective coding. The authors discussed conflicts in theme identification until agreement was reached.

Results: Participants were all female, and ranged from 21 to 41 years of age (M = 32.2); 16 were biological and four were adoptive parents. Participants were from 14 different states in the US and two were from Vancouver, British Columbia. Household income ranged from $30,000 to $300,000 (M = $105,846) US dollars. Most were married and college educated. Participants’ stories highlighted personal, cultural, and institutional factors affecting peer-to-peer HM sharing. Challenges to peer-to-peer HM sharing were (a) substantial effort required to secure HM; (b) institutional barriers; (c) milk bank specific barriers; and (d) lack of societal awareness and acceptance of HM sharing. Facilitators included (a) informed decision-making and transparency; and (b) support from healthcare professionals. 

Conclusion(s): Despite risks and numerous barriers, participants continued to pursue peer-to-peer HM sharing. Informed by a liberation health framework, healthcare professionals—rather than universally discouraging HM sharing between peers—should facilitate open dialogue with parents about its pros, cons, and screening recommendations to promote safety and mitigate risk. Although we recruited from a social media page with global reach, there was little diversity in participants’ race, nationality, ethnicity, and socioeconomic status. Future research should more purposefully pursue the unique experiences of women of color, transgender individuals, gay couples, and low-income individuals who participate in peer-to-peer HM sharing.