Supporting an Environment of Innovation for PAMS Part I : Time and Scope (Week 13)

ImageReferring back to the definition of innovation in Week 11, the last two blogs of this semester will flesh out some aspects of time, place, and actors in the policy landscape of private arrangement milk-sharing. In shifting the focus to the phenomenon of PAMS as a grassroots innovation, the definition will refocus a bit as well. Per Smith and colleagues (2014), a grass roots innovation as opposed to an innovation specifically of health policy movements “seek innovation processes that are socially inclusive towards local communities in terms of the knowledge, processes and outcomes involved  (pg. 2)”. Specific to social movements, Smith and colleagues further note that innovation from grass roots movements frequently result from dissenting voices with regard to some aspect of current hegemony, thus requiring practices and visions unique from those of main stream organized innovation. Grass roots innovation also has the distinction of engage local communities from the outset in instances where innovation began outside the immediate community, thus generating from inside specific communities and moving outward (Smith et al., 2014). 

This distinction from innovation as previously discussed sets the stage to discuss sustaining innovation in the specific context of PAMS. Firstly in discussing aspects of time and timing this week as they relate to scope of PAMS as a social movement of innovation in allocating human milk. Part II of this topic will focus on the people and places of the PAMS innovation movement and their critical role in sustaining the practice. Longest (2010) discusses factors pertinent to the environment from which innovation springs – 1) diverse health related problem, 2) development of possible solutions, and 3) dynamic political circumstances related to each and both. Further discussion of these factors also indicates that a characteristic of bureaucracy essential for successful innovation of policy is longevity.

Time and Timing of PAMS Innovation

Sharing of milk between families in communities is not a novel practice. From the origins of human kind, infants were fostered at the breast or on the milk of donors in times of need. The agelessness of the practice has somewhat clouded the appreciation of the exceptional alignment of events and technology at the time of PAMS gaining a foothold. Lactation and breastfeeding were only just beginning to gain some of the momentum in 2010 that we now enjoy. The many health risks to formula feeding and “booby traps” obstructing the goals of breastfeeding dyads created an environment of varied health problems families were attempting to avoid or minimize through the provision of human milk. Social media was still booming, and the reputation of Facebook as a fairly grassroots idea had not yet tarnished. Families were beginning to find comfort and support in virtual communities to support like minded parenting and lifestyle decisions. The age of “going viral” was upon the interwebs. Information access was expanding horizons of what low infrastructure and budget organizations were capable of building.

At this point, Eats On Feets was a single page in Central Arizona. Quickly it became several pages run by close knit volunteers. From there it was grown to dozens of pages all over the globe. Then the network had a philosophical rift, resulting in the original network and the newly spun off Human Milk 4 Human Babies. This in a span of months. Now there were well over 100 pages where families were connecting for PAMS, and two large networks of volunteer page administrators spending hours and hours of their own time supporting and building their local networks. Now, coming up on 4 years later, there are several more milk-sharing networks, all still founded on the original model of donated time, and dedication to local communities. To balance the interests of discussion while maintaining brevity, only Eats on Feets and Human Milk 4 Human Babies will be discussed in any specific detail.

Scope of PAMS

With respect to PAMS, I will use scope as “breadth, depth, and potential capacity”. This entire social movement began as the simple passing along of a request for milk of a single recipient needing a short term arrangement. In that capacity, the mother of the movement, Shell Walker, had no more scope of involvement than passing on a request. With the founding of the original page, that scope expanded to include a general philosophy about the sharing of human milk. When many pages began the early foundations of a network, a concerted effort was made to provide guidance for families that were not familiar with the practicalities of milk-sharing. Significant effort was made to ensure that information provided was evidence based and updated regularly. This is a very dedicated scope in the sense of breadth and depth. As a solution to the varied health concerns of the diverse participants, such a resource for PAMS is essential to the community.

Human Milk 4 Human Babies is less inclined toward resource, but far more dedicated to areas believed to be essential to social normalization of the practice. These activities include a significant presence in the media, social blogging, and a larger network. From the standpoint of scope, this is a potential capacity focus more so than an introverted depth and breadth. Both networks serve the community in the same fundamental way, enabling exchange of milk, but do so with individualized focus.

The practice as a whole is bounded in scope only by the energies of the volunteers within the network and the needs of families. Social media has enabled these networks to secure local volunteers to operate and maintain the pages, thus adding creative and energetic capacity rather than depleting a finite amount from a static number of volunteers and facilitators. The longevity and dedication of network founders has sustained the practice and enable local communities to reach out to a greater global community in times of challenge.

Closing Thoughts

It is difficult even with the best of information, intention, and available resources to generate health policy for a well defined population and practice in a way that does not need frequent correction to minimize the detrimental effects that may or may not have been foreseeable when policy was enacted (Longest, 2010). Considering the significant work still needed to describe participants and participation, policy generation at this time is premature. Considering the nature of human milk as discussed in previous posts and elaborated on through commentary by Elizabeth Brooks, it is not even clear that human milk allocation will benefit from direct policy oversight. The innovative spirit of this social movement seeking to fill a void left by insufficient support for lactation and ensuring human milk is available to all babies may not be able to continue to adapt as a global community supporting local specifics of practice with direct oversight. Where then would that leave families who have come to rely on one another to facilitate their infant feeding decisions?


Longest, B. B. (2010). Health policymaking in the United States (5th Ed.). Chicago, IL: 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




4 thoughts on “Supporting an Environment of Innovation for PAMS Part I : Time and Scope (Week 13)

  1. Angie, You did a great job of pulling it all together this week. You brought up a good point of how the social media factor has caused an explosion of a practice that was formerly confined to acquaintances and family, etc. and now has global implications. I think some policy has to be enacted…it doesn’t have to dictate what the donors and recipients should be doing, but rather serve as guidance for those helping families who would like some direction. As Longest has commented, the experience acquired with policy implementation can influence the modification. In the case of PAMS, policy would surely have to be modified regularly, as more and more of us learn about the practice and encounter PAMS families.

    • Thanks, Janet! A thoughtful response, as always. I should have been more clear. I do not believe that legislative policy is of benefit at this time. I absolutely believe that professional organizations should have policy in place (hence my efforts with AAN). Witnessing the legislative attempts in New Jersey and Tennessee, there is little faith in my jaded heart of hearts that reason or efforts to educate would result in a realistic effort. The Assemblywoman backing the New Jersey bill states her greatest concern with PAMS is the transfer of hepatitis via the milk. Apparently even the CDC cannot convince her otherwise. In each case, the bills were advised on by OB/GYNs, no longer in practice, who had no additional training in lactation support beyond their experience in medical school. As you know, this is problematic because it does not prepare physicians to support the gamut of lactation needs. Until legislators are willing to discuss the actual nature of PAMS, and to seek advisement from lactation professionals and researchers of the practice, I don’t see legislation being effective or ethical. In the case of professional organizations, a policy and/or protocol would enable practitioners to operate with a framework and resources, and that is a critical component in conscientious PAMS.

  2. Angie it was interesting to go through your post, where you have focused on many aspects of sustaining the innovative process of PAMS, How networking in this social movement has crossed the national boundaries? I know this was the practice of families especially in the rural India when women from the agriculture households, were working in the fields, they were leaving their infants with some relative or family member who was lactating mother. So it is really wonderful to see this concept visibly through PAMS but there are many legal and ethical issues which policy makers have to take into consideration and I think you are doing a great job to focus on them through your blogs.

    • Thanks for your consideration, Ramesh! PAMS has many international chapter on the various networks. In completing my data collection, the majority of participants who engaged in my research were from the United States, Canada, the United Kingdom, New Zealand, and Australia. I did have respondents from 8 other countries, however, so it is a world-wide practice taking place via social media.
      The legal and ethical issues are potentially great. With the networks set up founded on the premise of informed consent of all participants, breast milk not being considered a biohazard, and breast milk not covered in any regulation or policy pertaining to tissue and organ donation, there is no precedent to base policy from. This lack of ground work for policy regarding PAMS leads me to believe that it is premature to attempt to create policy by municipalities or at the national level. There are simply too many unknowns, and no basis for regulations. This needs to be a thoughtful and informed process, and that will take time.

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