Current controversy Med Humanities: first published as 10.1136/medhum-2019-011829 on 24 May 2021. Downloaded from as epigenetics rather than what are, for Milk’s Flows: Making and Transmitting many, mundane forms of bodily praxis. Kinship, Health, and Personhood Fluidity and connection Roslyn Malcolm In the practices of mother-infant­ breast- feeding, self and other are enfolded by the feeding of one on another’s body. ABSTRACT tale of a daughter who keeps her father The breast matters both materially and Milk provides a way of thinking about how alive by breastfeeding him after he has semiotically. Post-­partum, a child is no the body is enacted in science, policy and been incarcerated and sentenced to death longer within its mother, yet the latter popular culture. This paper follows the currents by starvation. maintains somatic influence on the of moral and biomedical epistemologies This ancient emphasis on the uniquely former: the mother is manifest in the circulating around milk, including via notions life-giving­ power of breastmilk flows into child who is nourished by internalising of inheritance, the practices of wet nursing, scientific, policy and personal knowledges the contents of her body, who is likewise and emerging scientific knowledge about today. It has been claimed that “[p]ossibly, somatically and emotionally affected by the health-­related benefits of breastfeeding. no other health behaviour can affect such this inter-­corporeal interaction (some- By situating milk’s flows historically and varied outcomes in the two individuals times positively, sometimes adversely). In culturally it shows how constructions of milk who are involved: the mother and the psychoanalyst Melanie Klein’s view, the production, lactation, and infant feeding have child” (Rollins et al. 2016). The ongoing “first gratification which the child derives long served as a ’cultural signal’ of prevailing public health focus on breastfeeding in from the external world is the satisfaction conceptions of bodies and social identities. In the UK and other high-­income countries experienced in being fed” (Klein 1936 cf so doing, it explores the simultaneous power (HICs) reflects this import (McFadden Sutherland 1999, 4). Speaking through of milk as both a source of dispositional and et al. 2016). Groups such as La Leche Klein’s work, Sutherland emphasises a somatic health, and an index of customary League, likewise foreground through civic development of subjective awareness in forms of unity and division. A focus on breast action and local relationship the vital and both child and mother through shared milk further contributes to augmenting and special qualities of breastmilk (Faircloth connection and mutual bodily engage- expanding recent debates about the biology-­ 2013). For many individuals, organisa- ment. She describes the subjectifying qual- society nexus in science and technology tions, and states, there is something very ities of being a breastfeeding mother as “I studies (STS), anthropology, and sociology. special about this ‘white gold’ (Falls 2017). leak, therefore, I am” (Sutherland 1999). Seen within biomedicine today as a carrier of This paper follows the currents of these The human milk that infants imbibe, somatic signals about the environment, the moral and biomedical epistemologies, though, does not always come from article reflects on how milk is bound up in the including via notions of inheritance, the their mothers. With the advent of the responsibilisation of women’s bodies and the practices of wet nursing, and emerging breast pump, formal and informal milk internalising of potential risks to the health scientific knowledge about the health-­ sharing networks connect donors and of their offspring. This implies an unlimited related benefits of human milk. This recipients in novel ways online and via agency for women in averting health risks article builds on existing work on bodily banks in cities across the Global North and in future-­proofing their children to be substance (Carsten 2011, Copeman 2019) (see Cassidy, Dykes, and Mahon 2019; http://mh.bmj.com/ better than well, elides the socioeconomic, and and less normative feeding practices of Falls 2017; Palmquist and Doehler 2014; environmental forces pragmatically limiting informal milk sharing (Falls 2017; Palm- Reyes-­Foster, Carter, and Hinojosa 2017; this assumed agency, and the distinct lack of quist and Doehler 2014; Wilson 2018) Wilson 2018). Older practices of wet material and inter-­personal support for the and banking (Cassidy, Dykes, and Mahon nursing, for instance, have been common perinatal period in many nations. 2019; Reyes-­Foster, Carter, and Hinojosa throughout human cultures. Accounts of 2017). Rather than detail informal milk kinship ties instantiated through breast- INTRODUCTION sharing practices, or the politics of breast feeding in diverse global contexts offer on October 1, 2021 by guest. Protected copyright. The closing scene of John Steinbeck’s The vs bottle I focus on more mundane breast- historical accounts of connection, and Grapes of Wrath offers the powerful and feeding practices. I shift to an exploration simultaneous separation, formed through transgressive image of a young woman of the simultaneity of the power of milk as milk. The Islamic practice of milk kinship breastfeeding an aged, starving man. both a source of dispositional and somatic is a legal institution requiring that those Having lost her own child, she acts to save health, and an index of customary forms nursed by the same woman become ‘milk the man’s life as their respective families’ of unity and division. I seek to make a case siblings’ and are therefore precluded from shelter from a storm in an old barn. The for how historical and cultural attention marriage in the same way as blood rela- scene is situated in the context of dustbowl to milk, and the social connections and tions would be. In Islam, what is prohib- USA and the broken promises of the land separations its flows can produce, provide ited by natal (nasab) kinship is also equally of milk and honey. This subversive scene an entry point to analyses of how the body forbidden by milk kinship (rada’a) (Parkes is a reproduction of the Roman Charity, is enacted in science, policy, and popular 2005). These religious and legal prohibi- a variously depicted ancient Roman moral culture. A focus on breast milk further tions remain today for communities prac- contributes to augmenting and expanding tising cross-­nursing. Accordingly, the use recent debates about the biology-society­ of milk banks is prohibited by this legal Centre for Biomedicine, Self and Society, The University of Edinburgh, Edinburgh, UK nexus in science and technology studies theory of kinship which finds its source (STS), anthropology, and sociology in the Qu’ran: “forbidden to you are… Correspondence to Dr Roslyn Malcolm, Centre (Landecker 2011; Pickersgill et al. 2013; your mothers who have given suck to you, for Biomedicine, Self and Society, The University of Edinburgh, Edinburgh EH8 9LD, UK; Valdez 2018), which have tended to focus your suckling sisters” (Fortier 2007). Milk roslyn.​ ​malcolm@durham.​ ​ac.uk​ on more esoteric sites for theorising such kinship practices have been highlighted

Malcolm R. Med Humanit September 2021 Vol 47 No 3 375 Current controversy Med Humanities: first published as 10.1136/medhum-2019-011829 on 24 May 2021. Downloaded from in the Hindu Kush (Parkes 2001), guise of breast milk substitutes. Cow’s standing. Sexual activity and poor diet, Muslim and Christian communities of the milk forms a central part of the ‘healthy considered signs of moral failing and poor northern Balkans (Parkes 2004), and parts diet’ required of the growing child and, disposition, were believed to compromise of Saharan Africa (Ensel 2002 cf Parkes for many, into adulthood. Yet, it seems a wet nurse’s milk and invited punish- 2005). Sharing milk has been evidenced as only by the removal of the physical ments and fines (Fildes 1988). Anec- an informal practice in the ancient Medi- practice of feeding at the body of the dotes that “the wet nurse’s milk carried terranean (Bradley 1991), and as a canon- animal itself – mediated by the necessary all her physical and mental qualities, her ical impediment to marriage in particular pumping and storing technologies – that emotions” have also been widespread in eastern Christian churches (Parkes 2005). drinking animal milk becomes acceptable Islamic cultures (Ozkan et al. 2012). In the Breastfeeding, then, does not just reflect (Jackson and Leslie 2017). A vast number late middle ages, animal milk was similarly kinship ties: it helps to make them. of humans incorporate cow’s milk, yet understood to transmit temperament and In attempts to square working mothers share no affective connection with their character making specific animals such with breastfeeding practices and with the bovine providers. as stubborn donkeys and flighty horses use of pumps, others including fathers and The trickling of perceptions of the beast- unsuitable as wet nurses (Maillet 2017). If older relatives increasingly engage in the liness of milk feeding into considerations animal wet nurses had to be used because affective practices of feeding an infant of human breastfeeding practices is evident of a lack of other preferred sources of human milk, extending the dyad of child-­ in contemporary reports of women being milk, goats tended to be the preferred mother into a network of human and asked to ‘cover up’ when breastfeeding option. technological actants. When not anony- within public spaces. In the UK, for In recent decades, conceptualisations mised, contemporary milk sharing prac- instance, it only became illegal to exclude around milk’s transmissions contain tices also create new networks and kinship women from public space for nursing their ripples of the older epistemologies noted ties between donor and recipient (Falls infants in 2010 (Griffith 2013). ‘Public’ above. Within HICs the engagement 2017). However, and speaking to this arti- breastfeeding practices pose a challenge by breastfeeding women in ‘healthy cles exploration of the bounding as well to expected Euro-American­ female iden- behaviours’, such as eating a ‘balanced as connectedness enacted by human milk, tities, including workplace expectations. diet’ and taking ‘plenty of exercise’, is these online sharing networks are predom- Clearly, for many people, there is a ‘right’ often perceived to translate into health-­ inantly used by white, middle class women way and a ‘wrong’ way for human milk to giving milk and resilient babies (Kolasa, (Falls 2017; Palmquist and Doehler 2014). be consumed. Firnhaber, and Haven 2015). Breast- Societal striations guiding the flows of this feeding also forms a significant part milk point to the exclusionary effects of of global health strategies in low- and these sharing practices across class and Milk’s transmissions middle-income­ countries (LMICs) where race. Milk coagulates rather than flows Milk connects as well as signal divisions the use of breastmilk substitutes (BMS) in these instances, acting as boundary and does so by transmission: over count- continues to rise (Rollins et al. 2016). The making phenomena. less generations, breastmilk has been salience of breastfeeding to the WHO is Humans are not, of course, the considered to hold different properties clear from their website, and an article only beings to produce milk. Linnaean that can be transmitted from m/other to titled ‘Breast is Always Best, even for HIV-­ taxonomy unifies mammals; those beings infant. For instance, medieval medicine Positive Mothers’ (Langa 2010) noted a that nourish their offspring via milk in Europe drew heavily on Galenic tradi- 2009 change in the WHO’s position to the http://mh.bmj.com/ from the mammary glands. Interspecies tion which held that a mother’s own milk effect that HIV-positive­ mothers should milk feeding was commonplace until the was the best substance for her child for its take antiretroviral drugs, and breastfeed emergence of safe storage and refrig- action of transmitting a substance comple- “until the infant is 12 months old” (Langa eration technologies, and was widely mentary to the blood given in utero. It was 2010). This followed the results of the depicted in the artwork of the occidental believed that in utero blood was whitened WHO-led­ Kesho Bora study which found middle ages (Leslie and Jackson 2018). into milk through dealbation and trans- that giving HIV-positive­ mothers a combi- Romulus and Remus were mythologized mitted some of the same aspects as blood, nation of antiretrovirals during pregnancy, on October 1, 2021 by guest. Protected copyright. as being raised and suckled by a she-wolf­ , such as resemblance (Maillet 2017). delivery, and breastfeeding reduced the and ‘Wild’ Peter of Avalon was depicted Milk has also been judged to transmit risk of HIV transmission to infants by as covered by a thick layer of hair - the psyche as well as soma (Fildes 1986; 42%. The article (and guidance) served result of having been nursed by a bear. Ozkan et al. 2012). Notions that the milk to counter prior information and policy Through wide-­ranging cultural narratives of wet nurses could transmit (defects promoting breastmilk substitute for HIV and imagery, the consumption of milk at of) character and temperament has had positive mothers with the aim of pushing once animalises humans and humanises implications for who was chosen to be a back against emerging formula feeding animals, making permeable the boundaries wet nurse. In Ancient Greece, the ideal cultures in LMICs (given concerns about between humans and other mammals. wet nurse was defined as being Greek, under-­nourishment and diarrhoea, for In the modern period, practices of inter-­ brunette, and composed of a calm temper instance). mammalian infant feeding became framed (Obladen 2012). She was not to be preg- At the same time, contradictory as subversive, and utilised in constructing nant or menstruating, both of which were messages exist, leading to what Carroll distinctions between humans and animals. believed to spoil the milk (Baumgartel, (2014) refers to as the “paradoxical Today, if divisions are formed between Sneeringer, and Cohen 2016). In the presence” of milk. The advice from the particular kinds and statuses of humans, European middle ages, wet nurses again Centres for Disease Control and Preven- then boundaries between species are should be brunette, and composed of a tion on HIV and breastfeeding for mothers perhaps doubly underscored. Still, inter- good disposition. They were expected to in the USA is that “HIV-infected­ mothers species milk feeding remains, with cow’s eat and drink in moderation, have already should not breastfeed their infants” (CDC milk widely consumed by infants in the birthed a son, and hold good social 2018). The uncertainties produced by the

376 Malcolm R. Med Humanit September 2021 Vol 47 No 3 Current controversy Med Humanities: first published as 10.1136/medhum-2019-011829 on 24 May 2021. Downloaded from HIV epidemic and related shifting policy feeding as a market for the production and As well as these exogenous compounds, recommendations, family, community and vast consumption of formula, an industry a host of endogenous compounds are health worker attitudes have had signifi- bucking downward global trends. Such considered to transmit through milk. cant impacts on communities' confidence framings can also depict women’s bodies Reminiscent of much older concerns in breastfeeding in contexts such as South as sites of potential for infant pathogen- about wet-­nurses, pathogenic stress Africa and Zambia (Arpadi et al. 2009; esis and as future-proofing­ environments hormones such as cortisol and inflam- Coovadia et al. 2007) and have resulted in for individual and societal ills. matory cytokines produced in response legal action and the incarceration of HIV-­ Health-­related claims are increas- to social and other stresses are regarded positive breastfeeding women in a number ingly linked to recent findings regarding as flowing into human milk, shaping the of contexts. Hence, a complex nexus of the immunological benefits believed to future experiences of breastfed new-born­ normative discourses and policy impera- be contained in and transmitted by the (Thibeau et al. 2016). Eliding the effects tives regarding culpability for infant (ill-)­ consumption of human milk throughout of poverty and stratified reproduction a health can be discerned. the perinatal period and beyond. These mother’s ‘lifestyle’ - including levels of developments in scientific knowledge are alcohol and illegal drug consumption - are arguably driven by the billion-­dollar infant framed in some public health messages as EMERGENT KNOWLEDGE formula industry that seeks to mimic having the capacity to enter the milk via Contemporary biomedical research, along- human milk as closely as possible. Evoking the blood flow and having chemical traces side global and public health directives, the rhetoric and cachet of personalised and transmitted to the infant (Wilson et al. have often emphasised the perceived nutri- precision medicine breastmilk has been 2017). These emerging epigenetic courses tional benefits of human milk for infants. regarded as the most “exquisite person- of knowledge reflecting human milk as Until recently, conflicting opinion existed alised medicine” (Rollins et al. 2016). It “more than just food” contain tributaries over whether breastfeeding delivered any is understood to transmit elements of the from historical accounts of the transmis- significant impact in contexts where nutri- mother’s microbiome and own immune sions believed to flow between women tion, sanitation, and healthcare were good responses matured throughout her life, as and the infants they nourish. The mingling (Victora et al. 2016). Now, though, human well as multipotential stem cells which have of this diversity of knowledges contributes milk is increasingly framed as “more than been found to persist in infants’ bodies for to significant uncertainty regarding the just food” (UNICEF 2019, 1). It has been some time (Ozkan et al. 2012). Human benefits and risks of breastfeeding. Ulti- argued, for instance, that exclusive breast- milk is now framed as “immunologi- mately, they maintain the responsibilisa- feeding can protect against mortality cally, neurologically, endocrinologically, tion of mothers, and predominantly their and morbidity, namely via the reduction economically, and ecologically superior” bodies, rather than the contexts in which of instances of necrotising enterocolitis, to breastmilk substitutes (McFadden et al. they live. sudden infant death syndrome (SIDS) 2016). Via reports of milk’s power to stim- (Rollins et al. 2016), upper respiratory ulate a ‘healthy’ microbiome in babies, and tract infections, and otitis media (Victora enhance appetite and blood sugar regula- CONCLUSIONS et al. 2016). In a 2016 series in The Lancet tion, breastfeeding is also being increas- Attending to breastfeeding in historical on breastfeeding, it was reported that if ingly framed as a prophylactic against the and cultural perspective in juxtaposition exclusive breastfeeding until 6 months and march of diabetes, overweight, and obesity with more recent biomedical research continued breastfeeding until at least the (Victora et al. 2019). Specific biological and public health policy has highlighted http://mh.bmj.com/ age of two were universal practices, the and inheritable properties of human milk how older moral and somatic epistemol- lives of 20 000 women and 823 000 chil- are being isolated and made visible through ogies trickle into contemporary accounts. dren under the age of five could be saved biomedical technologies. While we should not be surprised about globally each year (ibid.). While claims that ‘breast is best’ are the flowing of old theories into new, These statistics have been increasingly often promoted in biomedical, public Roberts 2002 we can ask: what is at cited in public and global health literatures health, and popular literatures, notions stake in the production of new knowl- since 2016, particularly in relation to the also circulate in biomedicine and beyond edges about milk? In relation to studies on October 1, 2021 by guest. Protected copyright. 2030 Sustainable Development Goals. that breastmilk holds the potential for of environmental effects on epigenetic They have been evaluated economically: transmitting forms of pathogenesis via processes anthropologist Margaret Lock one paper, for instance, titled ‘The Cost maternal disease, stress and poor diet has expressed concern that “the molecular of Not Breastfeeding’ calculates a “level of (Thibeau et al. 2016). Uncertain reports endpoints […] will capture most attention, avoidable mortality and morbidity (that) regarding mother-to-­ infant­ flows of an without shedding light on the complex translates into global health system treat- array of toxic chemical compounds by factors implicated in the perturbations of ment costs of US$1.1 billion annually”, human milk are emerging (Mead 2008). these molecular barometers” (Lock 2013). with “total global economic loses […] A lifetime of absorbing chemicals such as With regards to breastfeeding, I note that estimated to be US$341.3 billion” – i.e., bisphenol A (BPA), and pesticide residues an emphasis on the significance of milk, “0.70% of global gross national income” and toxic metals such as mercury have been and the traces of maternal practices that (Walters, Phan, and Mathisen 2019; see described as concentrating within a moth- it is held to contain, extends the already also Rollins et al. 2016). As in other areas er’s milk supply (Rebelo and Caldas 2016; heavy somatic responsibility of mothers of public health (Hoeyer, Bauer, and Pick- Zimmers et al. 2014). These fears are beyond birth, while the significance of ersgill 2019), the health effects of breast- reflected in the pasteurising and screening the structural factors shaping the maternal feeding, then, are becoming subject to of milk donated to banks (Cassidy, Dykes, body and its movement through the world economic logics that frame value in finan- and Mahon 2019), the flash heating and can be elided. cial terms and present what counts as those screening practices used by informal milk This article has outlined perspectives on which can be counted and costed. This is sharers (Reyes-­Foster, Carter, and Hino- the more mundane transmission of milk very much in line with logics that see infant josa 2017). between m/other and infant, rather than

Malcolm R. Med Humanit September 2021 Vol 47 No 3 377 Current controversy centring on the less common practices of Correction notice This article has been corrected Fildes, V. 1988. Wet Nursing: A History from Antiquity to the Med Humanities: first published as 10.1136/medhum-2019-011829 on 24 May 2021. Downloaded from informal milk sharing (see Cassidy, Dykes, since it was published Online First. Corresponding Present. Wiley-­Blackwell. author email address has been updated. Fortier, C. 2007. “Blood, Sperm and the Embryo in Sunni and Mahon 2019; Falls 2017; Palmquist Islam and in Mauritania: Milk Kinship, Descent and and Doehler 2014; Reyes-­Foster, Carter, Twitter Roslyn Malcolm @Roslyn.Malcolm Medically Assisted Procreation.” Body and Society 13 and Hinojosa 2017; Wilson 2018). Funding This study was funded by Wellcome Trust (3): 15–36. Indeed it is the act of transmission and (grant number: 209519/Z/17/Z; 106612/Z/14/Z). Griffith, L. 2013. “The Equality Act 2010: Further Protection what connections and separations the against Discrimination.” British Journal of Midwifery Competing interests None declared. 18, 11: 732–33. flows of this biological substance serves Patient consent for publication Not required. Hoeyer, K., S. Bauer, and M. Pickersgill. 2019. “Datafication to enact that are in focus here. Seeking to and Accountability in Public Health.” Social Studies of mimic the action of this substance, I have Science 49, 4: 459–75. traced the flows of milk’s symbolic power Jackson, M., and E. Leslie. 2017. Unreliable Matriarchs. Edited by M. Cohen and Y. Otomo. London and NY: through the historical record and reflected Bloomsbury Academic. on its ability to both make fluid relations Kolasa, K. M., G. Firnhaber, and K. Haven. 2015. “Diet for between people and to separate them. As a Healthy Lactating Woman.” Clinical Obstetrics and shown, not only is breastfeeding stratified Open access This is an open access article distributed Gynecology 58 (4): 893–901. in accordance with the Creative Commons Attribution by race and class (Wilson 2018) so too are Landecker, H. 2011. “Food as Exposure: Nutritional 4.0 Unported (CC BY 4.0) license, which permits others Epigenetics and the New Metabolism.” BioSocieties 6 milk sharing practices. to copy, redistribute, remix, transform and build upon (2): 167–94. Milk provides a way of thinking about this work for any purpose, provided the original work Langa, L. 2010. “Breast Is Always Best, Even for HIV-­ how the body is enacted in science, policy is properly cited, a link to the licence is given, and Positive Mothers.” Bulletin of the World Health and popular culture. By historically and indication of whether changes were made. See: https://​ Organization 89 (1): 9–10. creativecommons.org/​ ​licenses/by/​ ​4.0/.​ Lappé, M., and H. Landecker. 2015. “How the Genome culturally situating milk’s movements we Got a Life Span.” New Genetics and Society 34 (2): are offered an edifying pool for reflec- © Author(s) (or their employer(s)) 2021. Re-­use permitted under CC BY. Published by BMJ. 152–76. tion. I build on existing theoretical and Leslie, E., and M. Jackson. 2018. “Milk’s Arrays.” Studies in empirical work that has underscored the the Maternal 10 (1): 1–24. connectedness produced through milk Lock, M. 2013. “The Epigenome and Nature/Nurture Reunification: A Challenge for Anthropology.” Medical flows from m/other or wet-­nurse to infant, To cite Malcolm R. Med Humanit 2021;47:375–379. Anthropology 32 (4): 291–308. but these simultaneously stream through McFadden, A., F. Mason, J. Baker, F. Begin, F. Dykes, L. Accepted 30 April 2020 striations limiting connections. There are Grummer-­Strawn, N. Kenney-Muir­ , H. Whitford, E. Published Online First 24 May 2021 taboos and screening practices (Carroll Zehner, and M. J. Renfrew. 2016. “Spotlight on Infant 2014; Palmquist and Doehler 2014; Med Humanit 2021;47:375–379. doi:10.1136/ Formula: Coordinated Global Action Needed.” The medhum-2019-011829 Lancet 387 (10017): 413–15. Reyes-­Foster, Carter, and Hinojosa 2017 Maillet, E. “More Than Food: Animals, Men, and defining those for whom such transcor- Supernatural Lactation in Occidental Middle Ages’.” In BIBLIOGRAPHY poreal sharing is precluded and this 2017. Making Milk: The Past Present and Future of Our Arpadi, S., A. Fawzy, G. M. Aldrovandi, C. Kankasa, M. separating action of milks flows requires Primary Food, edited by M. Cohen and Y. Otomo, 7–18. Sinkala, M. Mwiya, D. M. Thea, and L. Kuhn. 2009. London and NY: Bloomsbury Academic. further examination. 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