“Someone's generosity has formed a bond between us”: Interpersonal relationships in Internet‐facilitated peer‐to‐peer milk sharing

Abstract

Internet‐facilitated peer‐to‐peer milk sharing enables the giving and receiving of human milk between individuals previously unknown to one another. However, the process of milk sharing allows for milk sharing partners to develop relationships with one another. The development of relationships between 41 milk recipients and 97 milk donors in Internet‐facilitated peer‐to‐peer milk sharing was explored via a questionnaire. Thirty‐seven recipient respondents and 55 donor respondents placed some level of importance on developing a relationship with their milk sharing partner. Thirty‐four recipient respondents and 48 donor respondents had developed a relationship with at least one milk sharing partner, from acquaintanceship to close friendship. Respondents also described milk kinship relationships. Friendships were commonly noted as a positive repercussion of milk sharing. Milk sharing stigma was the only commonly reported negative repercussion of milk sharing. Peer‐to‐peer milk recipients and donors are forced by circumstance and encouraged by the process of milk sharing and by their similarity to one another to trust each another, which acts as a catalyst to friendship development. Peer‐to‐peer milk sharing is a type of cooperative mothering wherein milk recipients are assisted in parenting their children via the gift of milk. However, reciprocity is evident as milk donors benefit from good feelings from helping another mother and child, pleasure through seeing the recipient infant grow, and often friendship with their milk recipient. Although Internet‐facilitated peer‐to‐peer milk sharing is instigated by the impersonal medium of the Interweb, each milk sharing connection has the potential to become a real relationship.

Key messages.

• Recipients and donors commonly place importance on relationships with milk sharing partners and develop friendships.

• Relationships develop because giving and receiving milk is personal; milk is highly valued; donation is viewed as a gift; the process of milk sharing requires that partners trust each other; and recipients and donors share similarities in life circumstances and are at a life stage when they are seeking friendship.

• Peer‐to‐peer milk sharing is a modern form of cooperative mothering wherein reciprocity is evidenced as donors experience good feelings from helping, pleasure from seeing the infant grow on their milk, and the benefits of friendship.

1. INTRODUCTION

Internet‐facilitated peer‐to‐peer milk sharing is controversial. Two major areas of concern have been highlighted: that such milk sharing arrangements involve strangers and that there may be adverse consequences to milk sharing (Boyer, 2010; Carter, Reyes‐Foster, & Rogers, 2015; David, 2011; Geraghty et al., 2013; Keim, McNamara, et al., 2013; Steele, Martyn, & Foell, 2015; Woo & Spatz, 2007). These concerns are not unconnected to one another as anxieties about the “anonymous Internet” magnify the perception that the milk may not be safe (Carter & Reyes‐Foster, 2016).

The concern about strangers sharing milk is epitomised in the research of Keim and colleagues who quality tested Internet‐sourced milk (Keim, Hogan, et al., 2013; Keim et al., 2015). Because the study design required maintenance of anonymity, and as milk donation sites prohibit anonymous exchange, they purchased milk from milk‐selling websites. They provided sellers with no information about why milk was needed; asked no questions about health, hygiene, or shipping; and excluded sellers who inquired about recipient infants. Milk was thus obtained under conditions where it truly was a case of faceless strangers transacting milk with screening employed only to exclude milk providers who expressed any interest in the end user (Steube, Gribble, & Palmquist, 2015).

Milk obtained in this manner was of poor quality. Nearly three quarters had unacceptable levels of bacterial contamination, and 10% had had the volume inflated by the addition of cows' milk (Keim, Hogan, et al., 2013; Keim et al., 2015). Further, one quarter of shipments arrived with damaged packaging, resulting in milk leakage in some cases, and nearly half contained milk that was no longer cold (Geraghty et al., 2013).

Although the study of Keim et al. supports the popular perception of online milk exchange as dangerous and anonymous, it does not appear to represent normal practice (Bye, 2016; Senapathy, 2016). Parents almost exclusively seek milk via milk donation sites that do not allow for anonymous exchange (Keim, McNamara, et al., 2013). And even where milk is obtained from sites allowing anonymity, parents do not avail themselves of this option (Palmquist & Doehler, 2016). Finally, it appears that it is normal practice for milk recipients to not only know who their donors are but also engage in conversation with them as a part of a safety screening process (Gribble, 2013a).1

When milk exchanges are not anonymous, there is the potential for donors and recipients to move beyond the simple revelation of identity and to develop relationships with each other. Outside of the context of the Internet, milk sharing has been noted as fostering the development and/or deepening of relationships between donors and recipients (Martino & Spatz, 2014; Reyes‐Foster, Carter, & Hinojosa, 2015; Thorley, 2011). However, whether such relationships are developed via Internet‐facilitated milk sharing has not previously been considered. As a part of a larger study examining peer‐to‐peer milk sharing, this study aimed to explore relationships between individuals involved in Internet‐facilitated peer‐to‐peer milk sharing.

2. METHODS

The study used a descriptive survey design containing closed‐ and open‐ended questions to examine the beliefs and practices of individuals involved in milk sharing. To be eligible to participate, individuals were required to have donated or received breast milk via the Internet in the previous six months. A convenience sample of donors and recipients was recruited via advertisement on the Facebook pages of the Internet‐based milk sharing groups Human Milk 4 Human Babies and Eats on Feets. The study questionnaire contained 28 mostly open‐ended questions. Ethics approval was obtained from the Western Sydney University Human Research Ethics Committee.

The results pertaining to the interpersonal relationships between donors and recipients and the repercussions associated with milk sharing are presented here. Closed‐ended questions were analysed using descriptive statistics, and conventional qualitative content analysis was used to analyse open‐ended responses (Hsieh & Shannon, 2005). The coding process involved the researcher reading question responses through identifying ideas being expressed by the respondent and encapsulating these ideas in a short phrase or word. After undertaking this open coding process with 10 questionnaires, preliminary codes were decided upon and the remaining questionnaires were coded using these codes with new codes added as data were encountered that did not fit the existing codes. Once all questionnaires had been coded, all data within a particular code were re‐examined and codes that were conceptually similar were combined, as appropriate. Because this is an explorative study, codes were only combined where this could be achieved without loss of nuance. Given that there was a single researcher, a measurement of interrater reliability was not possible, but at a later date, codes and data were re‐examined, to ensure reliability of the coding, before codes were organised into a hierarchical structure.

3. RESULTS

Ninety‐seven milk donors and 41 milk recipients from North America, Europe, Oceania, and Asia participated in the study; the breakdown of respondent nationality is presented in Table 1. Donors ranged in age from 21 to 43 years and had previous breastfeeding experience from 4 to 120 months. They had one to four children, and 47 were first‐time mothers. Recipients ranged in age from 21 to 45 years and had previous breastfeeding experience of 0 to 118 months. They had one to five children, and 17 were first‐time mothers. Further details about the characteristics of participants can be found in Gribble (2013a).

Table 1.

Breakdown of respondent nationality

Nationality of recipient respondents	Frequency (n = 41)
American	28
Canadian	3
Australian	3
New Zealander	3
Malaysian	2
Serbian	1

Nationality of recipient respondents	Frequency (n = 82)
American	49
Canadian	13
Australian	7
Malaysian	4
New Zealander	4
British	3
Filipino	1
German	1

3.1. Importance of relationships

3.1.1. Recipient views

Thirty‐seven recipient respondents (93%) expressed varying levels of importance in having a relationship with their donors with 11 stating that it was very or extremely important, six stating that it was somewhat important, five stating that it was important, two stating that it was pretty or fairly important, and one stating that it was important if the donation was an ongoing one. A further seven recipients stated that having a relationship with their donors is something that they liked or would like. There was a diversity of reasons for placing some importance on having a relationship with a donor provided by respondents. These reasons were related to creation of or evaluation of safety within the relationship and the intimacy of the exchange of milk and to show gratitude or thankfulness for the donor's giving of milk.

I think it's important if only so you can build trust with someone you are consistently getting milk from. [R2]

Through the connection of having a need met by someone's generosity has forged a bond between us. [R32]

Pretty important! These women are providing immeasurable benefits to my daughter and going to efforts to do so, and doing it simply out of generosity. [R18]

Despite placing some level of importance on having a relationship with their donors, 10 recipient respondents (25%) specifically noted that it was not essential that a relationship develop.

It's NICE but not a REQUIREMENT. Everyone has busy lives and I'm grateful that they take the time to pump and donate to babies like my daughter. [R9]

Three milk recipients (7%) stated that it was not important to have a relationship with their milk donors. One of these recipients indicated that although a relationship was not important, a bond was created nonetheless, and it was not a priority for another recipient who was undergoing treatment for cancer.

A summary of recipient respondents' views about having a relationship with their donors is presented in Table 2.

Table 2.

Recipient respondents' views on the importance of having a relationship with their milk donors

Category of response	Frequency (n = 40)
Important to have a relationship total	37
Would like it or would be nice	7
Somewhat important	6
Important	5
Not very important	5
Pretty or fairly important	2
Important if ongoing	1
Even though a relationship has importance, it is not essential	10
Context of reasoning where a level of importance was placed on a relationship
Build trust, show grateful for donor's work, not all donors are interested, a relationship makes it more intimate, makes it more comfortable, always show gratitude, sharing develops relationship of care, important to meet, feel warm towards them, should know where milk comes from, they are giving something important, thankful, to judge safety, good for donor to know the child they are helping, encourages continued donation, the connection is nice, makes it easier to use another mother's milk, requirement of religion, need health information, do not want to force anything, sharing creates a bond, importance would be more if need were greater, do not want to put pressure on donor, hard to have relationship with many donorsa
Not important to have a relationship	3
Context of reasoning where it was not important to have a relationship
But sharing creates a connection, other things are going on in lifea

^aThemes with three or fewer responses.

3.1.2. Donor views

Donor respondents were less likely to place any importance on having a relationship with their recipients with just 55 (59%) indicating thus. Twenty‐four donor respondents stated that it was not very important to have a relationship, 12 said that they would like a relationship, seven each said that it was very or extremely important or important, and five said that it was somewhat important. The most common reason for placing importance on having a relationship was that the relationship helped with motivating to express milk. Other reasons were having pleasure in seeing the outcome of the milk donation and ensuring that the need for milk was real.

It certainly helps keep me motivated to keep my supply up. I can always produce enough for my baby, but I have to work to keep the surplus supply up. I do this because I know the mother and baby I donate to, and truly care for them. [D8]

I love being able to see her son grow and to know that I contributed to his health. I would not want it any other way. [D55]

It's very important also so I can be sure the milk is being used as intended to be used when I donated it. [D20]

Despite placing some level of importance on having a relationship with donors, 13 (24%) of these respondents volunteered that it was not essential to have a relationship.

Thirty‐nine donor respondents (41%) stated that it was not important for them to have a relationship with their recipients. Rather than the relationship, they placed importance on the child getting milk and helping the mother. Nonetheless, some also indicated that they liked to see how the baby is doing or that having a relationship would be a positive thing, including in assisting with motivating to express milk. One donor indicated that they preferred not to have a relationship with recipients.

Not important. Sometimes I only meet the husband for a split second delivery. No problem. If a baby needs milk, that's good enough. [D4]

A summary of donor respondents' views about having a relationship with their donors is presented in Table 3.

Table 3.

Donor respondents' views on the importance of having a relationship with their milk recipients

Category of response	Frequency (n = 95)
Important to have a relationship total	55
Not very important	24
Would like it	12
Very or extremely important	7
Important	7
Somewhat important	5
Even though a relationship has importance, it is not essential	13
Context of reasoning where a level of importance was placed on a relationship
Helps to keep motivated to express	9
Like seeing how the baby is doing	7
Need to know the milk goes to a baby, just want to help children, would not mind a relationship, like to know the milk is appreciated, like to be comfortable with the recipient, do not expect a relationship, shows that the recipient is not just there for the milk, builds trust, appropriate for giving something personal, not doing it for the mum but for the baby, do not want to impose, prefer some distance, happy to help the mum, it is like donating blood, like to like the recipienta
Not important to have a relationship	39
Context of reasoning where it was not important to have a relationship
But nice to keep in touch or know them	5
But like to hear about or see how babies are doing	4
It is the child getting milk that is important	4
It is helping the mum or child that is important, a relationship is a bonus, relationship helps with motivation, but willing to have a relationship, do not want to impose, not donating to make friends, feel good about donating regardless of any relationship, know the milk is appreciated, prefer some distancea

^aThemes with three or fewer responses.

3.2. Relationship development

3.2.1. Recipient experiences

When asked whether they had a relationship with their donors, 34 recipient respondents (83%) indicated that they had developed a relationship with at least one donor. It was common for recipients to have multiple donors; 25 (60%) had five or more donors, and only seven (17%) had a single donor. It was unusual for recipients to have developed a relationship with all of their donors, and only one recipient indicated that they had done so. Rather circumstances such as whether the donor lived close by, whether the donor was a regular or one‐off donor, and whether a large or small amount of milk had been donated impacted relationship development.

Where a relationship had developed, recipient respondents' comments showed that the depth of relationship varied greatly. In some cases, it was evident that the recipients had developed a close relationship with donors.

I am really good friends w/3 of my donors. We take our kids on play dates to the park, meet up for local family events … & I had one of them over for dinner last week. They have become very good friends who hold a special place in my heart for selflessly giving my son their milk. [D15]

In other cases, relationships appeared to be less close.

We catch up every now and again and keep up with how our kids are going. Sometimes chat on facebook. [D8]

A summary of recipient respondents' experiences with relationships with donors is presented in Table 4.

Table 4.

Recipient respondents' experiences with relationships with donors

Category of response	Frequency (n = 41)
Relationship has developed total	34
A few or some donors	9
Long‐term donor	4
Local donor	3
Large donor	2
Not small or one‐off donors	2
Many donors	2
All donors	1
One donor	1
Descriptions of the form of the relationship
Play dates	10
Enjoy keeping in touch	9
Have things in common	6
Talk about or support in parenting, close friends, send letters, feel like family, in regular contact, involved in daily life, met for coffee, bonded for life, families are friends, enhanced an existing relationship, special place in the heart, come over for dinner, care about them and their families, respect and admire her, give her gifts, really know one another, have a milk kinship relationshipa
No relationship total	9
Context around stating there was no relationship
Talk at drop off, have met, are friendly, plan to send a Christmas present, donor is too far awaya

^aThemes with three or fewer responses.

3.2.2. Donor experiences

Milk donors have less milk sharing partners with which to develop relationships; 49 donors (51%) had a single recipient, and only eight had five or more recipients (8%). Nonetheless, 48 donor respondents (49%) indicated that they had developed a relationship with at least one recipient. Their comments about the form these relationships took echoed that of the recipient respondents in terms of variation of depth from close friendship with regular in‐person contact to occasional online communication.

She has become my best friend. We instantly clicked and began to have playdates with our children and spent more and more time together. [D90]

I still keep in touch with the recipient via email. [D93]

A summary of donor respondents' experiences with relationships with recipients is presented in Table 5.

Table 5.

Donor respondents' experiences with relationships with recipients

Category of response	Frequency (n = 95)
Relationship has developed total	48
One donor	10
Some donors	2
Most donors	2
All donors	2
Local donors	1
Despite distance	1
Descriptions of the form of the relationship
Become friends or close friends	12
Play dates	9
Keep in touch	7
Visit one another	6
Support in parenting	5
Invited to child's birthday party	5
Watch the child grow	4
Given me gifts	4
Email	4
Have things in common	4
Talk about many things, distance an impediment, pre‐existing relationship, called milk mamma, bonded or connected, met for coffee, families are friends, talk regularly, know a little better, getting to know, involved in daily life, talk on the phone, come over for dinner, milk kinship relationship, a little bit, will remain friends after donation, recipient father is a role model for son, in life forever, share information, have given advice, deepened existing relationship, share stories, share time together at milk pick up, provided help with breastfeeding, recipient provided advice, have developed new friendships with others where recipient livesa
No relationship total	36
Context around stating there was no relationship
Too far away	4
Donation friendship, thought a relationship would develop, shared pictures, really private, unfortunately nota

^aThemes with three or fewer responses.

3.2.3. Milk kinship

The development of a milk kinship relationship was described by some recipients and donors. For three respondents, this flowed from their religious beliefs as Muslims.

In Islamic culture we have to maintain the relationship because me giving my milk to another baby has created a familial bond which means my children and my milk children cannot marry one another. [D57]

In other cases, religious beliefs did not appear to play a role, but nonetheless, respondents made statements that were suggestive of the idea that the sharing of milk had created a familial relationship of some sort. For example, one recipient stated,

In helping me to mother my own child, I feel like they are in part his other mothers as well. [R23]

And donors described,

It gives you a kind of lifelong connection. It's hard to explain but I look at my son's “milk siblings” with fondness. [D65]

3.3. Repercussions of milk sharing

3.3.1. Positive repercussions for recipients

Thirty‐eight recipient respondents (93%) stated that there had been positive repercussions to being involved in milk sharing including the positive impact of the milk on the child (30), making friends or connecting with others (13), educating others about milk sharing (7), and showing how mothers can support one another (5).

My son gained ten pounds in 3 months after we started receiving donor milk. He did not gain any weight his first month of life. He is healthy and happy. [R5]

Increased awareness and acceptance of milksharing and of women facing milk supply issues, friendships and a sense of sisterhood with other mothers, increased confidence that I can provide everything my son needs, one way or another. [R23]

For so long I was very cynical about life and other people, but being able to be involved in the modern “It takes a whole village to raise a baby” idea has changed my perceptions of what is going on in our society. [R7]

3.3.2. Positive repercussions for donors

Ninety‐one donor respondents (94%) stated that there had been positive repercussions to being involved in milk sharing including knowing that they had done something good (42), being given a good feeling from donating (41), that the baby got human milk (29), the health impact of the milk on the baby (19), making friends or connecting with others (15), and educating others about milk sharing (12).

I feel good, and people I tell about it get interested. Perhaps in the future they might need milk or be able to provide it to someone else because they heard of me doing it. [D37]

Absolutely. The baby I donate to has been able to stay on exclusively breastmilk for a long time now …. Since being on breastmilk exclusively, he is growing and thriving and experiences none of that discomfort. [D8]

Yes, very positive. I'm a new mama with a very small circle of friends that didn't really exist before I met my first milk baby and her family. I met R and her family and introduced them to another mama I'd just met and we've now formed a small close knit circle of friends with similar interests and I'm so happy with them all. If I hadn't donated milk then I wouldn't have any of that right now. [D11]

3.3.3. Recipient and donor negative repercussions

Twenty‐two recipient respondents (54%) and 65 donor respondents (67%) indicated that there were no negative repercussions to being involved in milk sharing, whereas 18 recipient respondents (44%) and 28 donor respondents (29%) indicated that there were negative repercussions. The negative repercussion most commonly nominated by both recipient (11/18) and donor (11/28) respondents was the attitude of others towards milk sharing.

I think the only negative repercussions were from my family who is not keen on breastfeeding. I got weird looks and disgusted words. [R15]

Other negative repercussions were identified by recipients infrequently and included such problems as cost of storage supplies, worrying about running low on milk, inconvenience of travelling to pick up milk, and having to use a breastfeeding supplementer to feed.

Other negative repercussions identified by donors included the time spent expressing milk, hassles associated with organising transfer of milk, cost of milk storage containers, and negative feelings if not able to express.

4. DISCUSSION

Although the Internet is often portrayed as impersonal and distant, this study identified that Internet‐based peer‐to‐peer milk sharing is facilitating not only the most personal of exchanges but also the development of real relationships. It has long been recognised that individuals can meet on the Internet and form close relationships. However, such relationships are often developed through an extensive period of online communication and in groups where the purpose is the facilitation of interpersonal support (e.g., Valtchanov, Parry, Glover, & Malcahy, 2014).

4.1. Reasons behind relationship development

The question must then be asked, why are so many individuals involved in peer‐to‐peer milk sharing developing relationships with one another? This research identified that there are several factors that support relationship development in peer‐to‐peer milk sharing including that it involves the giving and receiving of something that is extremely personal and highly valued; the process requires a high level of trust; and recipients and donors often share similarities in life circumstances and are at a life stage when they are seeking new relationships.

4.1.1. Giving and receiving milk is very personal, the milk is highly valued, and the donation is viewed as a gift

Breast milk is a body fluid, and, as respondents described, giving and receiving milk is a personal, even intimate, act. As noted elsewhere, those involved in milk sharing consider that they are giving part of themselves when they donate their milk (Gribble, 2013b; Pineau, 2013). Although the sharing of breast milk is normative within some cultural contexts, in the West, from whence the majority of respondents originated, breast milk is generally given only by mothers to their biological children (Shaw, 2004; Thorley, 2011). This enhances the personal nature and symbolic richness of the milk gift (Shaw, 2007).

Peer‐to‐peer milk donors and recipients also highly value breast milk describing it as “precious,” “liquid gold,” and “a miracle” (Palmquist, 2015; Gribble, 2014a; Falls, 2017). The positive impact of the milk on the well‐being of the infant recipient and the emotional well‐being of the recipient parents, as perceived by donors and recipients, adds to the perceived worth of the milk. That the milk is given by a stranger predisposes recipients towards viewing the donation as exceptional.

Milk donation, whether to a milk bank or to a peer, is frequently constructed as a type of gift giving (Falls, 2017; Pineau, 2011; Golden, 1996; Palmquist, 2015; Reyes‐Foster et al., 2015; Thorley, 2011; Weaver & Williams, 1997). Gift giving has symbolic meaning and has been interpreted as “confirmation of the donor's sincere participation in a recipient's tribulations and joys,” so encouraging the formation of social bonds (Sherry, 1983). The greater the value the gift holds for the giver and receiver, and the more intimate the gift, the stronger the signal of commitment provided by the giving and acceptance of the gift (Larsen & Watson, 2001). Positive emotional responses to receiving a gift, such as pleasure, gratitude, or appreciation, often elicit similar responses in givers (Areni, Kiecker, & Palan, 1998). The giving and receiving of a personal, voluntarily provided, highly valued, and appreciated gift in milk so inclines recipient and donors towards further reciprocal exchanges and relationship development.

Process of milk sharing requires recipients to trust donors

Trust is considered to be an essential prerequisite to the development of close interpersonal relationships (Larzelere & Huston, 1980). Trust is required in milk sharing because it is possible that donors could provide adulterated milk and indeed some have described milk sharing as “playing Russian roulette” (Carter et al., 2015). However, as social theorists have described, any trust relationship is a gamble wherein risks and benefits are balanced (Skirbekk, 2009). Thus, accepting milk and feeding it to their baby requires recipients to determine that the benefits of accepting the milk outweigh the risks (Gribble, 2013a).

There are a number of factors that predispose recipients to trusting donors including that recipients are in a vulnerable situation and required to trust; that recipients and donors share very personal information with one another; and that recipients and donors are often similar to one another.

Results of this study published elsewhere identified that milk recipient respondents had experienced difficulty in making sufficient milk for their babies due to a medical condition and that they had sought assistance from appropriate health workers before seeking peer‐shared milk (Gribble, 2014b). The inability of milk recipients to provide all of their own milk to their baby requires them to seek the assistance of another and so places them in a position of vulnerability. It is known that the more vulnerable a person is, the greater the trust engendered where someone assists them (Nys, 2016). Trust normally develops over time and through multiple interactions (Rempel, Holmes, & Zanna, 1985); however, milk recipients are required to trust donors at the beginning of the relationship. Once milk has been accepted, this demonstration of trust primes donors to further trust recipients, including through the release of the trust hormone oxytocin (Zak, Kurzban, & Matzner, 2004, 2005). That milk donors and many milk recipients are lactating women with already elevated oxytocin levels may be another factor predisposing peer‐to‐peer milk donors and recipients to trust one another (White‐Traut et al., 2009).

Donors and recipients screen each other, and through this screening process personal information is shared. Donors want to ensure that their milk goes to a baby who really needs it, and so recipients share information about medical conditions that they or their child have, their distress about not being able to provide their baby with all the milk they need, and their personal breastfeeding history (Gribble, 2013b). Recipients want to know that the milk that the donor is offering is safe and so seek information regarding aspects of donors' diet, health, and lifestyle; use of drugs or medications; sexual history; serological testing results; and motivation to donate (Gribble, 2013a; Palmquist, 2015). Such interactions do not follow the general rule that only superficial information is shared in the early stages of relationship development (Berger & Calabrese, 1975). Rather, donors and recipients are often sharing deeply personal information about themselves to individuals whom they have just met. Sharing of personal information has been shown to facilitate the development of trust between the receiver and discloser of the personal information, and milk recipients have identified that the sharing of this personal information enables them to trust donors (Wheeless & Grotz, 1977; Gribble, 2013a). Self‐disclosure not only engenders trust but also independently promotes relationship development (Sheldon, 2009).

4.1.2. Recipients and donors share similarities in life circumstances and may be at a time in their lives when they are seeking new relationships

Peer‐to‐peer milk donors and recipients often share common characteristics, views, and experiences. They are all parents, have similar aged children, and they often live in the same community. They place a high value on breast milk and may share other parenting views associated with prioritising breastfeeding. Such perceived similarity between individuals encourages them to trust one another, like one another, and develop relationships (Byrne, 1997; Whitmore & Dunsmore, 2014).

Becoming a mother is a major life transition requiring reorganisation of lifestyle, expectations, and friendships (Hartup & Stevens, 1997). It is a time when isolation and loneliness are common and when women actively seek friendships with other mothers (Nolan et al., 2012; Taggart, Short, & Barclay, 2000). The nearly half of respondents who were first‐time mothers were therefore at a time of life when forming new friendships is a priority and meeting other new mothers through milk sharing provides a convenient opportunity for new friendship development.

4.2. Milk kinship relationships

Some respondents described relationships that could only be created through the sharing of milk, that is, milk kinship. Milk kinship is most commonly understood in the context of Islam where religious teaching describes the formation of a familial relationship through a child being fed the milk of another woman (El‐Khuffash & Unger, 2012). Individuals who become kin via milk sharing are unable to marry one another (El‐Khuffash & Unger, 2012). Non‐Islamic milk kinship has been recognised in a variety of past and current cultural contexts including in France, Greece, Turkey, Poland, the Caucasus, and the Balkan states (Thorley, 2014). However, even where the predominant culture does not recognise milk kinship, individuals' experience may be that milk sharing can create a type of familial relationship (Thorley, 2014). Although it has been proposed that Internet‐based milk sharing might not result in the creation of milk kinship relationships (Thorley, 2014), this study indicates that for some donors and recipients it does. Furthermore, even where milk kinship is not specifically acknowledged, some donors and recipient respondents recognised the creation of a “special bond” from the sharing of milk. Intriguingly, there may be a biological underpinning of such beliefs as it has been identified that genetic material can be transmitted via breast milk (Ozkan, Tuzun, Kumral, & Duman, 2012).

4.3. Milk sharing stigma

Negative views about milk sharing were commonly encountered by recipient and donor respondents. Recipient respondents were understandably distressed by reactions that questioned their goodness as mothers. Such responses are a reflection of societal attitudes towards infants being fed milk from other than their biological mother. As Carter and Reyes‐Foster (2016) identified, the very morality of recipient mothers in peer‐to‐peer milk sharing is suspect.

In contrast, donor respondents were less likely to indicate that the view of others was a negative repercussion of milk sharing (61% vs. 40%). This may be a reflection of the different way that milk donors and recipients are viewed as it has been identified that rather than being presented as poor mothers, milk donors are commonly perceived as heroes (Carter et al., 2015). Thus, although peer‐to‐peer milk donors may be subject to negative attitudes towards breast milk and milk sharing, that is, the yuk factor, their identity as good mothers or people is not undermined (and may be enhanced) by engaging in milk sharing (Boyer, 2010; Carter & Reyes‐Foster, 2016; Shaw, 2004).

Mothers who engage in practices deemed to be risky will seek to justify themselves (Murphy, 1999). Almost all recipient respondents (93%) indicated that they placed some importance on having a relationship with their milk donors, and a significant majority (83%) had developed a relationship with at least one donor. That milk recipients commonly rely upon their knowledge of, and relationship with, their donors for evaluation of the safety of their milk has previously been identified (Palmquist, 2015; Gribble, 2013a). It may also be that the desire to protect themselves from accusations of poor mothering at least partially underlay the desire of recipients to have a relationship with donors. This is because the existence of a relationship provides a defence from the accusation of having taken milk from a stranger. Having a relationship with donors also assists recipients in justifying their decision to themselves including in feeling reconciled to using another mother's milk. Finally, recipients may place importance on a relationship with their donors in order to increase the motivation of donors to provide safe milk to them.

4.4. Cooperative mothering and reciprocity

Peer‐to‐peer milk sharing may be considered to be a type of cooperative mothering. Cooperative mothering is a social system wherein women assist in the care of offspring who are not their own. Cooperative mothering in the form of breastfeeding is an ancient practice that has persisted from prehistory until the present (Kramer, 2010; Long, 2003; Thorley, 2008, 2011). However, it is the “newly mobile” status of breast milk that has enabled milk sharing as a modern type of cooperative mothering (Boyer, 2010).

The emotional underpinnings that motivate individuals to engage in cooperative mothering include empathy, fairness, and sympathy; all of which have been identified in peer‐to‐peer milk donation (Kramer, 2010; Gribble, 2014a). In addition, some recipient and donor respondents viewed milk sharing as being part of a community of care and expressed their beliefs in the importance of mothers helping one another.

However, it is also evident that milk donors personally gain from giving their milk, and so milk sharing involves elements of reciprocity. Reciprocity describes the giving and receiving between people to the mutual advantage of both (Shaw, 2007). In the more traditional form of cooperative mothering via breastfeeding, reciprocity might involve women physically caring for and breastfeeding each other's infants (Long, 2003; Shaw, 2007). In peer‐to‐peer milk sharing, reciprocity includes the good feelings and the associated health benefits from engaging in altruistic behaviour that donors experience (Post, 2005). It also includes the pleasure that donors gain from seeing recipient infants thriving on their milk (a benefit that recipients often consciously provided). Finally, the relationship between donors and recipients can be viewed as a form of reciprocity with some recipient respondents viewing offering friendship as a way of showing gratitude. In this latter instance, many recipient respondents also experienced the relationship as a benefit to themselves.

4.5. Potential problems of relationships in milk exchanges

Although it appeared that many peer‐to‐peer milk donors and recipients view the personal disclosure and the opportunity for relationship development as a positive and safety‐promoting aspect of milk sharing, others have not viewed it so. For example, Keim, McNamara, et al. (2013) stated that the lack of anonymity in peer‐to‐peer milk sharing posed a risk to privacy and safety for those involved in the practice. Indeed, even donors and recipients involved in this study were aware that dealing with a stranger was a potential source of risk (Gribble, 2013a).

It is perhaps simply a reflection of reality that wherever human beings interact with one another, there is a potential for conflict and difficulty even as there is also a potential for support and friendship. It might be expected, for example, that difficulty could arise between milk sharing partners if there were very different expectations in terms of having a relationship. Nevertheless, although it is entirely possible that unhealthy or unhelpful relationships could develop between peer‐to‐peer milk donors and recipients, this did not occur among the 137 individuals involved in this research. Rather, the friendships and connections created through milk sharing were commonly reported as a positive repercussion of milk sharing. It seems that recipients and donors were respectful of the desires and needs of their milk sharing partners in relation to relationships and that relationships developed or did not develop according to the desires and circumstances of the individuals involved. In addition, this research identified that many recipients had multiple donors and many donors had multiple recipients, which may assist in keeping expectations manageable—those who want relationships can have them and those who do not can have that too. However, it is also possible that individuals who had had negative experiences with relationships in milk sharing may have been less likely to participate in this study.

Nonetheless, it may be helpful for those considering milk sharing that although developing a relationship with milk sharing partners is common, it is not a universal experience. Furthermore, it is more common for recipients to have relationships with donors than donors with recipients. This latter finding may be a function of several factors including that recipient respondents placed a greater importance on having a relationship than donor respondents did but also that recipient respondents had many more milk sharing partners than donors. The probability of recipients encountering a donor with whom they connect is thus made greater simply by the greater number of milk sharing partners they have in comparison to donors.

4.6. Limitations

The conclusions that can be drawn from this study are limited by the use of a convenience sample of milk sharers, and although care was taken to recruit as diverse a sample as possible, it is unknown how representative their views and experiences are of the population of individuals involved in peer‐to‐peer milk sharing. In particular, it may be that individuals who had had negative experiences with milk sharing may have been less likely to be recruited from milk sharing websites and to have participated in the study. It is a further limitation of this study that it required respondents to be able to complete the study questionnaire in English. This likely limited the participation of donors and recipients in countries where languages other than English predominate. Finally, the fact that a single researcher analysed the qualitative data is a limitation of the study.

5. CONCLUSIONS

Although the purpose of peer‐to‐peer milk sharing is to provide human milk to an infant whose own parent is unable to provide any or sufficient milk themselves, this study identified that milk sharing is sometimes providing much more to donors and recipients in the form of friendship. Peer‐to‐peer milk sharing should be recognised as a modern manifestation of the ancient practice of cooperative mothering and as promoting community. Health professionals working with parents considering obtaining peer‐shared milk for their infant should be aware of the negative impact of milk sharing stigma on individuals and provide guidance and support in a way that does not undermine positive identity.

CONFLICTS OF INTEREST

The author declares no conflict of interest.

CONTRIBUTIONS

KG conceived and designed the study, collected and analysed the data, and wrote the manuscript.

Gribble K. “Someone's generosity has formed a bond between us”: Interpersonal relationships in Internet‐facilitated peer‐to‐peer milk sharing. Matern Child Nutr. 2018;14(S6):e12575 10.1111/mcn.12575