The Historical Roles of Institutions and Actors and New Applications in Milk-Sharing Policy (Week4)


Actors involved in the generation of health policy include individuals, interest groups, state elected officials, state judiciary branches, federal elected officials, and federal judiciary members (Kraft & Furlong, 2013). Determining the exact role of each of these actors is difficult, due to the mutual responsibility shared between various actors and levels of government in drafting and operationalizing policy. The role of private citizens as individuals, citizens organized into interest groups, or cooperative groups organized into a cohesive lobbying body varies depending on the nature of the policy and level of engagement of interested parties outside the ranks of elected officials. Engagement in the political process has been discussed in terms of social capital – the degree of connectedness and cohesiveness of a community built on trust from repeated social interactions (Bjornskov, 2006) – with direct respect to impact on the legal process.

Angie Bond and Recipient Boy (2011)

Angie Bond and Recipient Boy (2011)

Social and Political Capitol

Li and colleagues (2005) elaborate the relationship between social determinants such as race/ethnicity, socioeconomic status, and self identified social class and individual abilities and mechanisms of accessing social capital. Teney and Hanquinet (2012) examine these determinants in conjunction with social networks to determine 6 classes of social capital in youth approaching adulthood – Indoor class (little to moderate peer association), Sociable class (little connection with religion, active in social activities), Religious class (primary social interaction takes place through religious affiliation, vocational education is a social norm), Clubber class (highly involved in social activities such as sports and parties with highest SES), Committed class (formal commitment to associations and organizations with the most diverse social capital but relatively high SES in general), and Isolated class (no meaningful social associations). Of these six classes, the Religious and Committed classes exhibited the most frequent and effective political inclination and participation, although the kind and intention of participation varied in ways that are not immediately relevant to this blog.

It is hypothesized that these factors hold true in most political and age groups (Teney and Hanquinet, 2012). If this is the case, with respect to PAMS, it will be critical to determine the class(es) of participants in order to effectively reach and activate them in the health policy process. By tailoring efforts to engage the target audience for involvement in the policy making process, health policy writers, consultants, and legislators can maximize the social capital not only of the process input and feasibility, but in word of mouth acceptance of drafted policy. Conversely, representatives seeking to generate policy in a vacuum of social knowledge and input can equally effectively approach the process in ways that would not garner interested and thus fail to activate other actors.

Specific strategies to engage social capital to political ends can be seen in a variety of programs. Community outreach, diverse political staffers, ever changing modes of communication (speeches and radio to twitter and virtual town halls) are some examples of this altered political leverage from the top down, typically to proactively gain or maintain a political position on social policy which is already established. Grass-roots organizations for activating social capital into political capital spring up most frequently re-actively in opposition to an established or impending change in social policy.

Closing Thoughts

Presently, the PAMS community is strictly reactive, rising to meet policy challenges as they appear as a dispersed group. This strategy is not likely to be effective in the event that several states or a federal agency choosing to become involved with PAMS policy. Support for the practice does not exist in the United States explicitly or under reservation/qualification of degree. It would be premature at this point to speculate on the political ca

pital of participants in PAMS. This area of interest is tangential to the research currently under way which will provide some of this information. Future research and social efforts will need to increase focus on the voice of the practice in impacting local and national views and policy. Challenges in meeting this need include the dispersed nature o

f participants, social stigma, and lack of central organization. Strengths lie in the diversity of participants and the ability to access participants through pre-existing social networks which have already garnered social capital through trust-worthy interactions in research and community maintenance for facilitating PAMS. Only by shifting the historical role of participants as reactive actors to proactive participants in the political policy process can the collective anxiety and stigma be relieved.


Bjørnskov, C. (2006). The multiple facets of social capital. European Journal of Political Economy, 22(1), 22-40. doi:10.1016/j.ejpoleco.2005.05.006

Kraft, M. E., & Furlong, S. R. (2013). Public policy: Politics, analysis, and alternatives (4th ed.). Thousand Oaks, CA: CQ Press.

Teney, C., & Hanquinet, L. (2012). High political participation, high social capital? A relational analysis of youth social capital and political participation. Social Science Research, 41(5), 1213.



6 thoughts on “The Historical Roles of Institutions and Actors and New Applications in Milk-Sharing Policy (Week4)

  1. Angie, you have a good handle on what is going on with this issue in other countries. Has any other country, province, municipality, etc., (other than organizations, e.g. WHO) addressed this issue at all? It only takes one foreward-looking body to acknowledge the practice and look at the evidence before condemning it. Maybe you should focus your efforts on a state/province that historically has been receptive to breastfeeding-related legislation and doesn’t have a milk bank 🙂

    • Funny you bring that up, Janet! I am currently involved in the process of generating the first US policy regarding PAMS for the American Academy of Nursing’s Breastfeeding committee. This was an invitation to participate, and is an excellent opportunity to realistically address milksharing in the US. Nurses are the largest group of professionals in contact with parents and infants, thus have the largest potential for providing support and solutions (Bozette and Posner, 2013 as one example of many). To be able to (hopefully!) provide a policy statement foundation for an organization capable of influencing the curricula and practice of those in greatest contact with parents is critical. Ensuring that the information is accurate, balanced, accessible, and realistic in expectation within the scope of typical nursing contact is even more so. It is an unfortunate thing that it would be so easy to focus on states with no milk banks. It is possible to focus on states which do not receive donor milk, in fact. Very sad state of affairs.

      Bozzette, M., & Posner, T. (2013). Increasing student nurses’ knowledge of breastfeeding in baccalaureate education. Nurse Education in Practice, 13(3), 228. doi:10.1016/j.nepr.2012.08.013

  2. On a separate, but related note, yesterday at work I referred a mom who was breastfeeding twins to Eats on Feets. She needed a source of donor milk since she moved to a new area and did not want to give formula (has never given formula to any of her several children). SInce there is no policy in place sanctioned by the state/county/federal funders, all I could do was advise her to go to the website and educate herself about the safest methods to obtain/process milk. She is not in the traditional health care system so a prescription for banked milk is not an option right now. Having a policy that can be shared with clients and their providers is definitely an advantage for all involved.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s