Tuesday, December 10, 2013

Social marketing donor milk banking

"Propaganda becomes ineffective the moment we are aware of it."
                                           --Joseph Goebbels

The definition of social marketing at a CDC website is, "the application of commercial marketing technologies to analysis, planning, execution, and evaluation of programs designed to influence voluntary behavior of target audiences in order to imporve their personal welfare and that of society."  The CDC should know the definition since they budget and employ people to influence people to vaccinate, use condoms, get tested for hiv/aids, etc.  They enlist mommy bloggers, just like the infant formula industry enlists mommy bloggers to market their products.

Propaganda is defined, "as the deliberate, systemic attempt to shape perceptions, manipulate cognitions, and direct behavior to achieve a response that furthers the desired intent of the propagandist." by Jowett & O'Donnell

It seems we are living in times, where every health organization and many non-profits employ media specialists to socially market their interests or their products.  I remember back in the 1990s attending a breastfeeding conference and one of the sessions was on socially marketing breastfeeding.  I walked out about half-way. I probably should have stayed and listened but I couldn't get past the thought that what they were really talking about was propaganda.  It's the only time I have ever walked out of a session in a Conference.  I look back and think who would have believed that so many organizations have embraced social marketing/social media.  The concerns I had back then have not changed.  The major concern was that social marketing is governed by the supposed truths of an organization.  Organizations are run by individuals who don't necessarily have a direct line to the "truth."  In fact no one has a direct line to the truth because we are human.  We, humans, often have no idea how others live, their cultures, their needs.  We, humans, can only see our needs.  Improving someone else's welfare is a tricky business and often social marketing does not account for the many factors of why people do what they do.  Social marketing is dependent on who runs the organizations and their agendas, and this does not necessarily equate to the common good.

Over the years, I have watched the social marketing of donor milk banking and been rather perturbed over it.  The number of not-for-profit milk banks in the USA and globally has expanded.  We even have two for-profit milk banks in the USA (although the person who founded Prolacta also started Medolac).  This expansion of donor milk banking has coincided with the growth of the breast pump/bottle industry.  One sort of piggy-backing on the other.  More and more women believing that breastfeeding requires the purchase of pumps and bottles.  Many women trying to breastfeed but finding it next to impossible to maintain.  Of course it also coincides with more and more women with young babies in the workplace (with little time-off or social/financial support for staying home).  In the USA, we are witnessing an increase of preterm birth and better survival of these tiny babies.

This merging of events seems to have created a steady need for more and more donor milk.  The not-for-profit milk banks in the past have complained about Prolacta Bioscience (the for profit milk bank)competing against them and impacting donations to their not-for profit banks.  In more recent times HMBANA has publicly complained about informal milk sharing on the internet.  The target seems to be Eats on Feets and strangely enough not the other internet milk sharing service called HM4HB (Human Milk for Human Babies).  Not sure why one organization is the target, because it appears to me that some of the same people that are involved with the one organization are also involved in the other organization.  But maybe I misread the internet stories and news, and maybe a lot of it is the masks and mirrors of social marketing.

As I have written before HMBANA has wanted regulation of "informal milk sharing on the internet."  This was stated in 1999 on Lactnet by Mary Rose Tully who at that time was the Chair of HMBANA, when it appeared that there was a web page milk exchange going on.  In 2000 she met with the FDA and again expressed her concern about  "informal milk sharing on the internet."  Knowing this, makes it very surprising that HM4HB seemed so willing to advertise the need for donor milk by non-profit milk banks on their websites.  But then maybe these groups did not understand that since 1999, HMBANA has wanted internet milk sharing stopped.  Back in 2010, I was concerned that HM4HB was not really a grassroots organization but astroturf (from Sourcewatch-astroturf refers to apparently grassroots-based citizen groups or coalitions that are primarily conceived, created, or funded by corporations, industry trade associations, political interests or public relations firms).  I was told by their 300 or so administrators that I was totally wrong about my concerns.http://vwmcclain.blogspot.com/2011/07/is-hm4hb-grassroots-organization-or.html

I find myself once again wondering about internet milk sharing organizations.  Why is their petition on the web only directed at the one bill and not at the bill regarding licensing of milk banks?  The bill on licensing milk banks appears to be directed at anyone who attempts a milk banking service (which in my mind means it is directed at stopping internet service organizations like Eats on Feets and HM4HB) Why would a petition signed by people of all different countries make NJ legislators rethink this bill?  Legislators mostly care about their constituents (voters in New Jersey) and wouldn't really care what someone from another country thinks.  Its rather amazing to watch how many people signed this petition within a short period of time. 

It will be interesting to see what happens next in the world of social media.  One would think that the NJ Department of Health would be more interested in stopping internet milk selling rather than internet milk sharing. Obviously people selling human milk are not going to report it on their income tax.  But you know the reality is that we don't know the actual statistics of how much human milk is being shared or sold on the internet.  So we have to believe in the truth of the internet, that this has become a booming business/service in need of curtailing.  Funny thing is I just read an abstract from the JHL entitled, "Donor Human Milk Bank Data Collection in North America," by Brownell, et al. (10-28-13).  The study concluded (according to the abstract), "Without standardized data across all HMBANA sites, the creation of a centralized data repository is not yet feasible.  Lack of standardization and transparency may deter implementation of donor milk programs in the neonatal intensive care unit setting and hinder benchmarking, research, and quality improvement initiatives."  I kind of laughed because I was amazed they got any data from HMBANA milk banks (only 8 out of 13 sites consented to participate).  Basically we don't know donor demographics to milk banks.  We don't know some basic information about donor milk banking or internet milk sharing or internet milk selling.  And yet, here we are creating bills with little background information on how much of this is really going on nor do we know the demographics of women who donate to non-profit milk banks.  
Copyright 2013 Valerie W. McClain

*In December 2010 the FDA Working Group held meetings on Banked Human Milk.  I was amazed that the FDA stated that they just had been made aware of a large scale human milk company, Prolacta Bioscience.  The company was launched in 2001.  So we have a company that is making human milk products for preterm infants, and the FDA in 2010 just became aware of it.  Fascinating.


  1. Hi, Valerie. It seems that you --like many others--do not have a sense of how women of childbearing age (20 and 30-year-olds) use social media networks today. Unlike older generations, these younger folks use Facebook much like a telephone; it is a tool for communication, nothing more nothing less. So when you talk in your post above about the way you see as "best" for women to be sharing their milk, what you don't realise is that this is *already* how it is happening; women and families are getting together at the local level to share milk. They may start out on Facebook, and use it as a point of contact, but they do live locally and they do get to know one another in person from that initial "meeting place" on the internet (Facebook). Furthermore, the communities are set up in such a way so as to facilitate LOCAL sharing right at the outset. Moms start out by seeing requests or offers from people in their area on the Facebook page, and then the parties typically take the discussion to private messaging. From there, they get to know each other, and then they meet up in real life and get to know each other further, asking the health questions and doing further screening in person --typically right in their own homes. Facebook is just a platform to put local women and families in touch with each other, and you seem to have missed that entirely. Indeed, preliminary research tells us that 98% of internet-facilitated peer-to-peer milksharing happens between parties face to face. That is to say that the vast majority of families involved in p2p milksharing are known to each other and do NOT ship their milk anonymously to one another, and they DO actually meet in person. What is that, if not local, in-person sharing? The families are working in their own communities to feed the babies in need. To assert otherwise is proof that you haven't done your homework regarding just how peer-to-peer milksharing actually works.

  2. Emma, it is not me you have to convince. I don't agree with you on quite a few points but it doesn't matter what I think. It does matter what the NJ Health Department and NJ legislators think regarding this issue because they will determine whether New Jersey embarks on a social marketing campaign to stop "casual" milk sharing.

    1. If you understood how the peer-to-peer milksharing on Facebook actually worked, you would see why the companion bill NJ A3703 is not directed at the families or individuals involved in p2p milk *sharing* (not selling). The network does not match up donors or recipients in any way, shape or form. It's nothing more than a "bulletin board" set-up or scaffolding, and the individuals looking to share (not sell) milk do all of the leg-work in establishing the donor-recipient relationship. The community pages on Facebook are simply a space held open, a virtual meeting place for families to come and connect with one another.

    2. Emma, I hope you are correct in that belief that NJ A3703 is not directed at your organizations. The media reports in various cities across the country and even in Canada detail concerns by HMBANA (non-profit milk banks) about sharing milk through websites and mention in particular Eats on Feets and sometimes HM4HB. Thus there is currently a media campaign regarding the safety of milk sharing and milk selling. Legislators, state health department and/health care decision makers are usually people in their fifties or sixties and it is their perspective or understanding (or lack of understanding) that will decide how this issue will turn out. If one believes the media, it appears to me that these organizations, for various reasons, want to stop internet milk sharing as well as selling. The media can be all smoke and mirrors but when legislators start to make bills on regulation it should be looked at as a warning sign.

  3. Totally agree, Valerie. But the law will be upheld once anyone does actually look at how donor women and recipient families share milk "online", and there is no way to regulate what women do with their bodies (not in the case of "gifting" milk to a baby in need). Selling, sure. An organization which matches donors and recipients or collects and provides processed human milk to babies in need (which HM4HB is *not*, by the way), sure. But not women simply feeding babies in the context of a voluntary, gracious, and informed choice.

    1. Your response does not make sense to me. What law will be upheld? The law of truth? Justice will prevail? Truth and justice is not necessarily an end result in legislation. Thus, when you irritate a sleeping giant (US Department of Health), all hell can break loose. I would like to know who has reassured you that these bills are not directed at your organizations?