Maintaining a grass roots environment of innovation involves 4 key factors (Kingdon, 2011; Longest, 2010; Smith et al., 2014):
- Timing of the innovation or movement coincides with interest and means to move forward.
- The community innovates from within, spreading the change in thought, behavior, or policy in gradually increasing size of scope.
- A place must exist both within the philosophy of the community and in the physical sense for the innovation to to derive from.
- Sustained support of people involved in guiding the innovation must be realized.
Last week’s post set-up the critical timing and scope of PAMS inception and continued viability, this week will focus on the significance of people and places. In this case, place is both the environment of most PAMS initial interactions, as well as the geographical location of participants. People are part of the place as admins, participants, and supporters. People will also be discussed in the context of the origination of PAMS, and the sustained efforts to maintain the innovation.
Finding a Place
The foundation of PAMS as a modern reprisal of an ancient practice was built on the Facebook platform for social media. Networks communicate almost exclusively among the global pages through groups on Facebook, pages for participants to connect are hosted on Facebook, and the spread of awareness of the practice and networks occurred through social media networking. Place within the parenting community has been assumed to be many things, but the reality based on my own preliminary research, that of Dr. Gribble in Australia, and Dr. Palmquist in Canada indicates that there is no singular social group participating in PAMS (Gribble, 2013; Palmquist, 2014). It seems, therefore, that the place of PAMS is one of broad social inclusion and growing acceptance. Place within healthcare and policy environments are far less clear and acceptable, as discussed in several previous posts.
Place in the geographical sense is also important regarding PAMS. The social environment surrounding lactation and breastfeeding in general impacts the scope of the practice in local communities. In countries/regions where breastfeeding is highly valued and seeing a resurgence, the pages for milksharing tend to have greater involvement. In New Zealand, as an example, the culture of PAMS also closely aligns with the values of families who choose to use cloth diapers, exchange home made and homesteaded items, and thus include PAMS as part of a greater cultural movement. The support from the general community is such that other practices, such as Grabaride (a ride sharing network) have become involved to help facilitate family connections. Here in Arizona, there are several hospitals, many IBCLCs, pediatricians (MD and NMD), midwives, and other birth workers who have supported and empowered PAMS participants. Families from all parts of the Phoenix Metro area from many different backgrounds and many different needs participate. It is a really fascinating thing to see many who receive milk in one circumstance pay forward and donate milk when their own need is resolved, or with a subsequent pregnancy.
Sustained by People
Shell Walker was the founder of the very first PAMS page and community on Facebook. Upon filling the need of a single client, and seeing the number of needs and offers to exchange milk, Shell quietly created a local page which sparked what is now a global phenomenon. Most pages within the PAMS networks have multiple volunteer administrators and technical support persons. With the number of milksharing pages from all networks numbering nearly 200, it is a safe estimate that at least 500 volunteers are involved in keeping these networks running at any given time. Some chose to be involved as long as they are participating in PAMS as donors or recipients, some have become involved even with grown children, and some chose to become involved and stay involved long term.
Aside from those maintaining the pages and websites for the networks, there are the participants themselves. If there was no demand for such a practice to exist, there would not be a thriving global community. If there was no need for human milk to be exchanged outside of the milk banking models of the world, there would not be for-profit companies and classified advertising seeking to benefit financially from a generally not-for-profit endeavor. Without the families who make the informed decision to engage in the practice of Private Arrangement Milk-Sharing, the questions of how have and how will PAMS networks support innovation would be moot.
A less obvious component of both people and place regarding PAMS is time. Timing of the inception of the practice was critical in that an early decade would not have had the technological comfort and savvy necessary to support this practice. The time involved in building, maintaining, advocating, supporting, and researching how best to serve PAMS communities frequently tallies at 15 hours a week – per page administrator and support person. Remember, there are 500+ such people sustaining this community. Many families that choose to participate will spend several hours per exchange communicating via the networks, private messages, text messages, phone calls, emails, travel, and collecting health information. Considering the average participation duration of families being between 3-6 months, this potentially equates to dozens of hours sustaining participation per participant, per exchange (Bond, unpublished).
PAMS is a unique, innovative intervention and work around developed from grass-roots organization to address a shortcoming of a systemic lack of support for providing human milk as the primary first food to infants around the globe. This practice is little understood by many who would seek to regulate it, even with insufficient evidence to effectively do so. Some organizations, such as the American Academy of Nursing, have reached out to begin supporting practitioners in discussing PAMS to facilitate informed consent. As a symptom of the growing dis-ease with present lactation supports particularly in the United States, PAMS provides a unique opportunity to examine parental decision making, information accessing behaviors, and experienced shortcomings of the current hegemony. Rather than dismissing this practice outright, or seeking to move against it out of ignorance, PAMS could be seen as an opportunity to generate greater social policy regarding the support, acceptance, and facilitation of lactation through conscientious, consumer driven policy.
Kingdon. (2010). Agendas, Alternatives, and Public Policies, Update Edition (2nd ed.). London: Longman Publishing Group.
Longest, B. B. (2010). Health policymaking in the united states. Fifth Edition. Chicago: Health Administration Press.
Smith, A., Fressoli, M., & Thomas, H. (2014). Grassroots innovation movements: Challenges and contributions. Journal of Cleaner Production, 63, 114. doi:10.1016/j.jclepro.2012.12.025