title: Sharing human milk in Australia: challenging regulatory regimes for infant feeding
Creators: name: Salmon, Libby
Publisher: name: The Australian National University
Year: 2023

description: Sharing human milk is an infant feeding practice with a long history in wet-nursing. From the early 20th century, wet-nursing was replaced by commercial milk formulas and, in some countries, by human milk banks, which provided pasteurized human milk under medical supervision to medically fragile infants. More recently, technological developments in breast pumps and the internet have enabled expressed milk to be shared without medical supervision and the emergence of markets for milk and novel milk products. Milk banking and informal milk sharing raise deep legal and social questions about safety, ethics and women's reproductive rights but remain obscure, at the margins of public health nutrition policy. This thesis examines how the regulation of milk sharing affects breastfeeding. The research used Australia as a case study at a critical time in the governance of two rapidly developing milk sharing sectors, from 2010 to 2022, following the establishment of milk banking, the advent of social media pages to share milk and international trade in human milk. These developments occurred under specific political and economic conditions: Australia was a Western liberal democracy with a welfare state, universal public health system and paid parental leave, but weak policies to protect and support breastfeeding. Progress in breastfeeding policy had stalled, in the face of unprecedented pressure from the commercial power of milk formula companies, while the self-regulation of milk banking enabled consolidation in this sector. This complex three-way competition, between breastfeeding, commercial milk formulas and shared milk, ignited media reports of milk banks saving premature infants and 'black markets' in milk, that pitted mothers against health authorities and babies against body builders. Drawing on regulatory theory and its broad conceptualization as the 'steering of events,' a multidisciplinary approach was used to investigate the regulation of diverse milk sharing practices through the state and 'beyond the state,' by government and civil society actors. The research approach combined a conceptual model of 'nodal governance' with a model of actor behaviour, based on actor awareness, motivations, pathways and rewards. These models linked micro- and macro-levels of governance, centred on women's embodied experiences of milk production, and reaching to the globalized biopolitics of infant feeding, leaving open to investigation how structure and individual agency shaped the flow of milk in society. Empirical analyses were undertaken to investigate regulatory mechanisms at these different levels of governance. An examination of how institutions framed milk sharing focused on the legal structures that applied to milk sharing in a document analysis of relevant laws and policies from government and non-government organizations. The conditions under which milk sharing occurred in health and community settings were examined through key informant interviews of four actor groups: mothers who shared milk, milk banks, health professionals and policy makers, with 95 participants. Data was collected from 2016-2019. The results showed that across the regulatory regime for human milk, discontinuities in legal frameworks and actor knowledge, objectives, courses of action and feedback signals created regulatory incoherence. This incoherence was distilled to three regulatory themes: contested sources of legitimacy, multiple lines of resistance and conflicting objects of regulation. Targeting these themes will help refocus regulation from milk as a product to milk sharing that supports breastfeeding processes. These findings highlight that policy alone is unlikely to address the power imbalances in infant feeding. New, localized governance structures are required that protect milk sharing as part of women's vibrant breastfeeding systems, and empower mothers, rather than serve commercial or medical interests in milk.