UNIVERSITY OF CALIFORNIA Los Angeles Liquid Gold: Breast Milk Banking in the United States A dissertation submitted in partial satisfaction of the requirement for the degree Doctor of Philosophy in Sociology by Marisa Gerstein Pineau 2012 ABSTRACT OF THE DISSERTATION Liquid Gold: Breast Milk Banking in America by Marisa Gerstein Pineau Doctor of Philosophy in Sociology University of California, Los Angeles, 2012 Professor Rebecca Emigh, Chair Over the course of the 20th Century, breast milk banks have facilitated the exchange of breast milk from mothers with an excess supply to infants in need. But while early banks used a seller model, purchasing milk as a commodity from lower class women, today banks use a donor model, relying on middle class women who give their milk away as a gift. This dissertation explores why the commodified model of breast milk banking first arose, and why banked breast milk was giftified (but still commodified) by the end of the century. I use content analysis of institutional records from three banks operating in three different eras, and interviews with current milk bank managers, donors, and parents of recipients to address these questions. My analysis indicates that in each era a confluence of factors, in particular women’s employment, conceptions of motherhood, medical practices and beliefs, and technologies shapes the exchange of banked breast milk. In the early 20th century new technologies made the physical disembodiment of breast milk possible, while mothering practices and medical authorities’ preferences promoted breast milk’s symbolic disembodiment, promoting the milk’s ii commodification, while limited employment opportunities created a pool of willing sellers. During the 1960s new mothering practices and related changes in physicians’ preferences sacralized the milk, making its sale by mothers culturally inappropriate. Today, high levels of maternal employment and portable, efficient breast pumps create an excess supply of milk that mothers are loath to dispose of due to its sacralized status, sustaining the donor model. But banks still sell the milk as a commodity, albeit a non-profit one, to parents who use the milk both as food and as a form of good parenting in a bottle. Breast milk banking therefore involves both gift and commodity exchange. And as interviews with donors and parents of recipients demonstrate, many middle class donors want to be paid, while middle class parents who purchase the milk reject the idea of donor compensation, pointing to breast milk’s ambiguous status even among those intimately involved in its exchange, and the role of social class in mediating actors’ perceptions and experiences. iii This dissertation of Marisa Gerstein Pineau is approved. Hannah Landecker Abigail Saguy Mary Terrall Rebecca Emigh, Chair University of California, Los Angeles 2012 iv TABLE OF CONTENTS List of tables vi Acknowledgments vii Vita x 1 Introduction 1 2 An Infant’s Natural Food: The Origins of Milk Banking in Boston 1910-1939 40 3 From Anonymous Sellers to Mothers of Missionary Zeal: The San Francisco Mothers’ Milk Bank 1948-1977 72 4 Giving of Themselves: The San Jose Mothers’ Milk Bank, 1974 – Present 106 5 Supply and Demand: Intensive Parenthood and Medical Practices and Beliefs 144 6 Giftifying and Commodifying: Perceptions of Breast Milk’s Exchangeability 188 7 Conclusion 237 References 262 v LIST OF TABLES Table 1. Characteristics of Donors and Recipients, San Jose Mothers' Milk Bank, 2011 31 Table 2. Socioeconomic characteristics of donors, and method of interview 34 Table 3. Socioeconomic characteristics parents of recipients, and method of interview 35 Table 4. Socioeconomic characteristics parents of recipients, and method of interview 36 Table 5. Reasons Infant Recipients were Prescribed Donor Milk 37 Table 6. Supply and Demand at the Mothers’ Milk Bank, 1974-2011 141 Table 7. Reasons Infants Prescribed Breast Milk at San Jose, 2000 and San Jose and HMBANA Banks 2002-2004 143 vi ACKNOWLEDGMENTS Although I spent many lonely hours researching and writing this dissertation, I think of it as a group project that could not have been completed without the input and support of my family, friends, and academic mentors. If it takes a village to raise a child, it certainly takes one to create a dissertation, and therefore I must acknowledge the many wonderful people in my life who made this project possible and supported and cared for me throughout graduate school and my life up to now. First I would like to thank my committee, in particular my chair Rebecca Emigh, whose guidance, drive, and insistence that I always make things as clear as possible provided me with a roadmap for navigating both the dissertation and graduate school in general. She always balanced her insistence on clarity with support for my choices, for which I am grateful. It is rare to find an advisor who is willing to provide so much time to her students’ work, and I know I benefited a great deal from her guidance. I am also grateful to Hannah Landecker, Abigail Saguy, and Mary Terrall for their invaluable insights and their gentle reminders to think beyond of my occasionally narrow approach to my data. Hannah has been both a mentor and a friend, and her non-sociological interpretations are often revelations to me that push me to think of problems in a completely new way. Abigail, meanwhile, provided me with excellent feedback on both my Master’s thesis and this dissertation, and was always willing to meet with me and discuss her questions and comments despite her busy schedule, for which I am very grateful. I particularly appreciate her reminders about the importance of social class and race when I got stuck viewing the world through a gender prism. I am also very grateful to Mary for her constant reminders that what sociologists think of as ideologies or “cultural conceptions” are ideas that originate with people, vii exist as part of our perceptions and interactions, and are not monolithic social structures. I may not have managed to avoid the pitfalls of structure vs. agency in this dissertation, but Mary’s comments will continue to resonate with me and influence my approach in the future. I also want to acknowledge the many people in the Sociology Department at UCLA that made graduate school not just bearable, but a joy these past 7 years. I would like to thank Bill Roy for convincing me to come to UCLA when I visited for recruitment weekend. I would also like to thank Ruth Milkman for bringing me back to the study of gender; Zsuzsa Berend and Ana Maria Goldani for being teaching mentors and friends; Wendy Fujinami for guiding me through the occasional administrative nightmare that is UCLA, and all the sociology staff for being friendly and helpful when I come to them with often very silly questions. Of course the best advisors anyone has for navigating life in graduate school are fellow graduate students. I am incredibly grateful to my fellow Emights, including Corey O’Malley, Isaac Speer, Rennie Lee, Molly Jacobs, and Faustina DuCross for providing me with feedback and thoughtful questions that pushed me to think about my work in new ways. I also want to thank Anthony Alvarez, Nazgol Ghandnoosh, Sylvia Zamora, Rocio Rosales, Amada Armenta, Anthony Ocampo, and Wes Hiers for their intelligent insights, invigorating conversations, and helpful advice, and for making graduate school not just intellectually exhilarating, but lots of fun. I could always call on them to make me feel better when I was feeling down or needed a happy hour to get me out of my lonely home office. I will always be grateful for their friendships. Of course, without the love and support of my family none of this would have been possible. Many, many thanks to my mother, Martha Sherman Gerstein, my sisters Marigold and Sarah and their significant others, Erik and Scott, and my mother-in-law Nicole Pineau for being viii supportive of me even though I moved my husband and myself 3000 miles away for long seven years. Our repeated declaration that we would be back “in two more years,” as year after year passed tested their patience, but they have borne it would good grace, which I deeply appreciate. I also thank Marianna Gerstein for her avid interest in my work and willingness to edit on a tight deadline, and my sister Jayna for being such a wonderful sister and aunt. A very special thank you to my grandparents, Marilyn and Malcolm Gerstein, for the deep love and care they give to me and all their family, without which none of us would be here. Extra special thanks go to my dad, Dean Gerstein, for inspiring me to follow in him into the family business, and for always challenging me to think harder and be better at what I do. I hope I can make him as proud of me as I am of him. Finally, my greatest thanks go to my husband Bernie and daughter Ilona. As my first baby (this dissertation being the second) Ilona has brought light and joy and new challenges to my life in a way I never thought possible, while her “idiosyncratic” nursing style made me appreciate the trials and tribulations of my interviewees in ways I never would have otherwise. And Bernie has been my anchor, my savior, the love of my life. He has supported me emotionally, intellectually, and financially, and never let me forget how proud he was of me. Thank you so much, Bernie. I love you. ix Curriculum Vita INTERESTS Gender, Class Inequality, Family, Medical Sociology, Economic Sociology EDUCATION Ph.D., Department of Sociology, University of California, Los Angeles, June, 2012. Ph.D.