10.6092/issn.2038-3460/17407
This paper critically examines hybridity and complexity in human biobanking, focusing on current forms of human milk banking in Madrid (Spain). We present and analyze three practices where human breast milk is stored and circulated: the “12 de Octubre” human milk bank, set in a neonatology unit and based on altruistic donations; informal human milk sharing among mothers; and drug-development practices that use donated human milk as a source of probiotics. Our analysis show that these practices rely on complex socio-technical assemblages, which are also characterised by hybrid zones and points of intersection between them. By understanding bacteria as a boundary object, we analyze the entanglements, disentanglements and re-entanglements of microbiota in the mechanisms of human milk bio-objectification that each of these biobanking practices entails. The distinctions or confusions between “virtuous” and “wicked” bacteria are part of a complex choreography where political, technical and sociocultural aspects get entangled.
application/pdf
2038-3460
17407
2
en
Pablo Santoro
https://creativecommons.org/licenses/by-nc-sa/2.5/
Tecnoscienza – Italian Journal of Science & Technology Studies
microbiota
Hybrid Zones, Bio-objectification and Microbiota in Human Breast Milk Banking
Text.Serial.Journal
https://tecnoscienza.unibo.it/
9
Essays
2019-01-31
2023-06-25
2019-01-31
2023-08-31
33-60
TS
Pablo Santoro
2018
10.6092/issn.2038-3460/17407
33
Complutense University of Madrid
2038-3460
2
microbiota
en
60
Hybrid Zones, Bio-objectification and Microbiota in Human Breast Milk Banking
https://tecnoscienza.unibo.it/article/download/17407/16265
9
                                                                                           Essay
                                                                                                   33




Hybrid Zones, Bio-objectification and
Microbiota in Human Breast Milk
Banking
 Carmen Romero-Bachiller                                        Pablo Santoro
        Complutense University of Madrid                    Complutense University of Madrid



     Abstract: This paper critically examines hybridity and complexity in human
     biobanking, focusing on current forms of human milk banking in Madrid
     (Spain). We present and analyze three practices where human breast milk is
     stored and circulated: the “12 de Octubre” human milk bank, set in a
     neonatology unit and based on altruistic donations; informal human milk
     sharing among mothers; and drug-development practices that use donated
     human milk as a source of probiotics. Our analysis show that these practices
     rely on complex socio-technical assemblages, which are also characterised
     by hybrid zones and points of intersection between them. By understanding
     bacteria as a boundary object, we analyze the entanglements,
     disentanglements and re-entanglements of microbiota in the mechanisms of
     human milk bio-objectification that each of these biobanking practices entails.
     The distinctions or confusions between “virtuous” and “wicked” bacteria are
     part of a complex choreography where political, technical and sociocultural
     aspects get entangled.

     Keywords: human milk banks; biobanking; intercorporeality; bio-objectifi-
     cation; microbiota.

     Submitted: September 27, 2017 – Accepted: July 11, 2018

     Corresponding author: Carmen Romero-Bachiller, 2504, Facultad de CC.
     Políticas y Sociología, UCM, Campus de Somosaguas, Pozuelo de Alarcón,
     28223, Spain. Email: c.romero@cps.ucm.es




1. Introduction

    While a common definition of biobanks equates them with the large,
population-based repositories of biosamples and health-related
information that have proliferated in recent decades, there are a wide
variety of other places where cells, tissues, organs, fluids, genetic data and

 TECNOSCIENZA
 Italian Journal of Science and Technology Studies
 9 (2) pp. 33-60 – ISSN 2038–3460
 www.tecnoscienza.net                                2018
34                                                         Tecnoscienza – 9 (2)

other types of bodily materials are collected, processed, preserved and
circulated – from blood and organ banks to tissue culture collections, egg
and sperm banks, diagnostic archives or genetic databases. If the
development of large-scale research biobanks is somehow recent, many of
these other kinds of biobanks have a longer and richer history, entangled
with the evolution of biosciences since the 19th century. However, all of
them have proliferated in recent years, becoming an essential cornerstone
of the bioeconomy (Pavone and Goven 2017). All biobanks share one
thing: they rely on the procurement of biomaterials or biodata by
individuals (Cooper and Waldby 2014; Santoro and Romero-Bachiller
2017). There are different forms by which biobanks can establish this
procurement – from altruistic donation to direct selling, with many
intermediate arrangements – but in any case, the generation of biovalue, in
any of the many senses of the concept (Birch and Tyfield 2013), is not
possible without it.
    Scholarly attention to biobanks started to increase from the 2000s
onwards. While bioethics has focused on debates which are still far from
resolved about informed consent, property of the body and privacy, social
sciences and STS have studied the socio-technical arrangements where
biobanking takes place. In the beginning, most approaches in one way or
another pursued a classification of different types of biobanks, a
clarification on “what was new” about new biobanks – an elaboration of
distinctions. For instance, the literature on new forms of private
biobanking showed the difference between public systems, based on
altruistic donation and search for the public good, and new commercial
banks, based on market logics and individual profit. The way in which cord
blood banking differed in public banks versus private companies was a
particularly useful example (Waldby 2002a; Brown and Kraft 2006;
Santoro 2009).
    But gradually STS and social science perspectives on biobanks have
changed their focus of interest: STS scholars increasingly emphasize the
hybrid character of the widely different forms of biobanking. Comparative
studies have shown the complex entanglements of biomedical practices,
economic interests, ethical values and forms of public involvement that
come together, sometimes in conflicting ways, in biobanks in different
sectors of the global bioeconomy (Gottweiss and Lauss 2012). Whereas
cord blood banking was once used as an example of the opposition
between public and private regimes, current perspectives have focused on
the blurring of boundaries between public and private banks, as well as on
the growth of hybrid models (Brown and Williams 2015; Hauskeller and
Beltrame 2016; Sleeboom-Faulkner and Chang 2016). From a feminist STS
perspective, the notion of care has put complexity and ambivalence at the
forefront of studies on biomedical practices – donation to biobanks among
them (Mol, Moser and Pols 2010; Santoro and Romero-Bachiller 2017).
The empirical literature on biobank donors and their motivations has also
increasingly noted the complexity of values and logics behind donation,
Romero-Bachiller & Santoro                                                  35

which cannot be limited to the idea of “pure” altruism versus “pure”
benefit/exploitation (Lipworth et al. 2011; Locock and Boylan 2016).
Even informed consent in biobank donation appears to be a much messier
affair now, related to personal as well as social motivations (Hoeyer and
Linöe 2006), not to mention its role in other areas of biobanking directly
linked to private companies, such as egg donation (Lafuente 2017).
    In this paper, we want to pursue this line of investigation and critically
examine hybridity and complexity in human milk biobanking. Human milk
is a peculiar biomaterial: hybrid, intercorporeal in itself (Waldby, 2002b)
and, like other liminal biomaterials, difficult to categorize – is it a food? A
tissue? A drug, given its immunological properties? Or all of these things
at once? Nevertheless, it was one of the first biomaterials to be
standardized, banked and medicalized (Swanson 2014). As is the case with
other body parts (Santoro 2011), human milk brings together ancient
symbolic associations related to the mother-child link and novel scientific
attributes – e.g. speculations on its possible use in cancer therapies. Taking
on breast milk banking as an object of research is also interesting because
human milk has always been fraught with tensions and controversies,
perhaps even more so nowadays given the current panorama of renewed
interest in the promotion of breastfeeding from medical institutions and
other social collectives. New kinds of practices involving human milk are
appearing, as can be seen in digital platforms and internet services where
human milk can be shared altruistically or directly bought and sold
(Geraghty et al. 2013). Another layer of tension which will surface
throughout this article has to do with the increase in biomedical research
on human milk and the recent proliferation of human milk labs (Palmquist
2015, 28), a trend which correlates with the growing presence of
bioeconomic private companies interested in developing new commercial
products in this area. Human milk banking intersects with all these
conflicting dimensions at once.
    The aim of the article is to explore practices of human milk banking in
Madrid. We look into the official human milk bank (HBM), the 12 de
Octubre Milk Bank, founded in 2007 as a hospital bank, which currently
provides donated milk at a regional level. But we will also show that formal
human milk banks are not the only form of biobanking in Madrid, and that
there are other practices related to human milk collection, preservation and
circulation. In particular, we will present two other places where human
milk is stored and circulated, generating different forms of biovalue:
informal human milk sharing between mothers, on the one hand, and drug-
development practices that use donated human milk as a source of
probiotics, on the other. Both of these practices, in different scales and
forms, involve aspects of milk biobanking.
    After presenting these three sets of practices, we will proceed to show
their hybrid and complex character: how they come to be entangled and,
to some extent, dependent on one another. These practices – and
particularly the “activation” of donors, the willingness and capacity of
36                                                             Tecnoscienza – 9 (2)

lactating women to donate – rely on complex assemblages, which are full
of “hybrid zones” (Hauskeller and Beltrame 2016): things are messier (Law
2004) than they first appear to be.
    But this is not the end of the story, as even if hybridity and complexity
are evident in these biobanking practices, they have to be restricted,
reduced, especially in more formalized and medicalized environments such
as a human milk bank or a research lab. In the final section of the paper,
we focus on the technical manipulation of human milk in each of these
three scenarios and particularly on the way they deal with bacteria and
microbiota present in human milk. Bio-objectification refers to processes
“in which life is made an object in different settings – in and outside of the
current truth regime of the contemporary biosciences” (Vermeulen et al.
2012, 3). In processes of bio-objectification, there is a need for purification,
for separation. Technical manipulation, standardization and safety and
quality precautions can be seen as performative forms of classification
(Bowker and Star 1999). The three forms of human milk biobanking that
we analyze imply different forms of bio-objectifying milk and of dealing
with bacteria. If, as Mary Douglas (1966) argued, impurity and
contamination are “matter out of place”, what is the place of bacteria here?
We argue that bacteria in these three scenarios function as a boundary
object (Star and Griesemer 1989). Although they gain concrete significance
in each particular case, and require specific interventions, bacteria are
present in all three cases, “maintaining coherence across intersecting social
worlds” (Star and Griesemer 1989, 393). Whether they may be virtuous or
wicked, bacteria manipulation, control and regulation become key, then,
in defining and performing different kinds of bio-objects, and different
versions of what human milk is and does in each of these three scenarios.


2. Methodology and Research Procedures

    This article stems from an ongoing research cluster on feminist
epistemologies and health activism. Within that broader project our
analysis of human milk banking started only recently, and it employs
ethnographic and qualitative methods, as well as secondary analysis of
protocols and medical and official literature. To date we have conducted
ten semi-structured interviews with human milk donors, lactating mothers
who suffer from mastitis and HBM coordination, and scientific and
technical staff. We are still conducting interviews with HMB donors and
we are planning to carry out a second round of field-work with recipient’s
mothers along with a deeper analysis of the emerging industry of human
milk probiotics. HMB staff were contacted through their institutional
email addresses. HMB donors and lactating mothers who suffered from
mastitis were contacted through snowball sampling, opening lines in
different mothering support groups chat and email lists. All the people
interviewed were provided with written and oral information about the
Romero-Bachiller & Santoro                                                  37

research topic and procedures, and they all agreed both in writing and
orally to the interviews, following our protocol of informed consent. In this
paper, we will mostly focus on two in-depth interviews with donors, two
ethnographic visits to the 12 de Octubre Milk Bank, with several on-site
interviews with staff (June and November 2017), and auto-ethnographic
notes from Carmen’s own experiences with mastitis, use of human milk
based probiotics and human milk bacterial analysis. We also surveyed
scientific articles related to “our” milk bank and, as we will explain later, a
patent on human milk microbiota.


3. Biobanking Practices around Human Breast Milk

    A human milk bank is a medical institution that collects, screens, stores
and processes expressed breast milk donated by lactating mothers, in order
to distribute it to newborns – particularly to preterm babies and medically
fragile infants who cannot be breastfed by their own mothers. To guarantee
the safety and quality of the milk, HMBs implement different protocols,
from selection of potential donors to sterility measures, immunological
analyses of donors and samples, pasteurization and freezing (García Lara
et al. 2012).
    The history of HMBs dates back to the beginning of the 20th century.
As Swanson (2014) explains in her historical account of blood, milk and
sperm banks in the United States, the development of “milk stations” and
other doctor-led initiatives since the 1910s that collected, analysed and
distributed breast milk from wet nurses – properly monitored on their diet,
habits and behaviour and instructed to maintain hygiene and sterility – was
one of the first prefigurations of modern biobanks. Swanson suggests, in
fact, that “human milk became the first body product to be institutionally
organized in disembodied form” (Swanson 2014, 17). The creation of milk
banks in different countries – Vienna’s milk bank, opened in 1909, is
generally considered to be the first – signalled the beginning of a process
of medicalization which gradually obscured the long history of wet nursing
and other traditional practices of surrogate breastfeeding (Palmquist, 2015:
26). During the second half of the century, changes in breastfeeding rates,
pediatrics and social conceptions of lactation and motherhood, as well as
biomedical research on human and bovine milk and epidemiological
alarms – such as the emergence of HIV/AIDS during the 1980s, soon
recognized to be transmitted via human milk –, accompanied
transformations in the technical and social configuration of milk banking
(Carroll 2014; Swanson 2014).
    In Spain, however, the implementation of HMBs is quite recent and has
more to do with contemporary developments in neonatal care. The first
Spanish milk bank opened in 2001 in Majorca as part of a tissue and blood
bank. Our case study, the 12 de Octubre Milk Bank, was initiated in 2007
38                                                             Tecnoscienza – 9 (2)

in Madrid and was the first milk bank set up in a neonatology unit (an
institutional location which has become the de facto model for most of the
eleven banks created in Spain since then). Based on scientific evidence
about the benefits of human milk compared to formula substitutes in the
feeding of preterm and fragile newborns in Neonatal Intensive Care Units
(NICUs), this bank currently provides donated human milk to very low
birth weight preterm infants (under 1500 g) and newborns subjected to
surgical interventions who cannot be breastfed by their mothers. Donated
human milk is prescribed specifically to very low birth weight preterm
infants, as human milk it is the only known prevention for necrotizing
enterocolitis, a relatively common condition in preterm babies that consists
of the necrosis of a portion of the bowel, causing high rates of infant
mortality (Carroll 2014). While in its first six years of operation its services
were limited to the hospital in which it is based, the bank has now become
the center of a regional network which coordinates collection points and
neonatology units in seven other public hospitals in Madrid and adjacent
cities, and there are currently plans to extend the network to three more
public hospitals in the region.
    As with all HMBs, the 12 de Octubre Milk Bank relies on donations
from lactating mothers who regularly express their milk, collect it and
bring it to the bank. Since 2007 more than 1600 mothers have donated
milk, approximately 250 each year, according to the bank coordinator. In
significant contrast with the donation of other tissues, milk donation is not
an isolated act, but a prolonged one where mothers are expected to provide
milk on a continuous basis, accompanying their own lactation – most
donors spend between 6 months and a year providing expressed milk,
which they have to deliver to the bank each fortnight at most. Donors are
motivated for altruistic reasons, but many are also “pushed” by personal
experiences: a survey that the bank conducted with its donors between
2007 and 2010 revealed that 45% of donor mothers had had their own
child hospitalized in a neonatal intensive care unit (Sierra Colomina et al,
2014). There is also a relationship with breastfeeding advocacy: the
foundation of an HMB in a certain place is said to increase overall rates of
breastfeeding in the area (García Lara et al. 2012). As we have seen in our
fieldwork, and also according to the bank coordinator, a significant
proportion of donors participate in groups and networks related to
breastfeeding, and the bank itself targets support groups for recent
mothers and midwives’ networks in their donor recruitment strategy.
    At first sight, the 12 de Octubre Milk Bank seems to be the only place
where human breast milk biobanking happens in Madrid. But during our
fieldwork we have come across two other scenarios where there are
different practices that involve milk banking. The first one has to do with
informal practices of human milk sharing. Milk sharing is a practice in
which a breastfeeding mother nourishes a child who is not her own, inside
privately arranged altruistic relationships with the other mother/s but apart
from medical banking platforms (Falls 2017). Palmquist (2015) remarks
Romero-Bachiller & Santoro                                                 39

that wet-nursing, co-nursing and other forms of cooperative breastfeeding
have a long history as popular practices, but that today the popularity – in
the US – of certain webpages such as Eatsonfeets.org or HM4HB.net, set
up as non-profit human milk sharing platforms, as well as other changes in
the understanding of breastfeeding, are giving new life to these practices.
In contrast to studies on informal human milk sharing in other countries –
mostly in the US (Falls 2017; Palmquist, 2015) – in Spain there are no web
pages or similar services that coordinate human milk sharing. Although
wet-nursing was common in the past and forms of breast milk sharing may
still occur, especially between close relatives, these situations appear to be
more rare today. However, in our fieldwork in Madrid we have
encountered a few informal arrangements, where some mothers, while
breastfeeding their own child, provide their milk to friends or relatives who
want to feed human milk to their infants but cannot breastfeed them
temporarily – e.g. due to a medical surgery – or do not have enough milk
for the baby’s needs. In contrast with traditional wet-nursing, nowadays
most milk sharing implies expressing milk and not actual breastfeeding. So,
even in a transient, informal and non-standardized manner, informal milk
sharing also implies biobanking practices. Samples are preserved at home
in the fridge or freezer by the donor after expressing as well as by the
recipient family who receives it. Even though safety measures to avoid
contamination are mentioned in our interviews, informal milk sharing is
officially and actively discouraged by the 12 de Octubre Milk Bank as
potentially dangerous. This echoes medical discourses and wider
controversies around new forms of human milk sharing: for instance,
Carter et al. (2015) have studied recent representations in the US press of
online peer milk sharing platforms, showing that whereas medically
supervised milk banks are represented as safe, sharing milk is repeatedly
characterized as dangerous, and mothers who resort to it are considered
risky and imprudent.
     A third practice around human milk banking moves us away from
altruistic practices to other features of the bioeconomy: probiotic products
that employ bacterial strains derived from human milk to treat mastitis in
lactating women. Mastitis is a common and painful inflammation of a
woman’s breast during lactation caused by infection, due to a
decompensation of mammary microbiota by the overpopulation of a
commensal bacteria colony, or by the presence of a pathogenic agent –
most commonly Staphylococcus aureus. Its symptoms include fever, pain,
abscesses, and difficulties with breastfeeding. During the last fifteen years,
a Spanish research team based at the Complutense University of Madrid –
a public institution – and led by the microbiologist Juan Miguel Rodríguez
has been working on mammary microbiota and mastitis physiology, as well
as on new mastitis treatments with probiotics, produced out of various
strains of lactobacilli isolated from human breast milk (e.g. Arroyo et al.
2010; Marín et al. 2017). Their first results were patented in 2004 (Pey et
al. 2004) by Biosearch Life (previously Puleva Biotech), a Spanish
40                                                           Tecnoscienza – 9 (2)

biopharmaceutical company connected to the dairy industry. After a
successful clinical trial in human subjects (Arroyo et al. 2010), in January
2014 the company released a nutritional supplement named Lactanza
Hereditum directed at breastfeeding mothers and advertised for the
treatment of mastitis. Different clinical trials employing strains derived
from Biosearch Life’s patent can today be found in a variety of national
health system registries, including those of Australia, the US, and the
Netherlands. Increasingly, these probiotic products are extending their
therapeutic aspirations beyond the actual treatment of mastitis to
breastfeeding at large, by claiming to have preventive properties, benefits
for the immune system and intestinal flora of both mother and child and
even the capacity to improve infant colics. All of this informs us of an
internationally emergent business based on the promises of probiotics
derived from human milk.
    The original bacterial strains used in Biosearch Life products were
obtained from donated human breast milk. In the patent, the only
background information given is that it came from a 35 year old woman.
There are two practices of biobanking that take place here. The first has to
do with the collection of tissues, microorganisms and cells: after being
isolated, probiotic cell lines derived from that anonymous woman’s milk
were deposited at the CECT (Colecciόn Española de Cultivos Tipo) in
Valencia (Spain). Any company or researcher who wants to access those
lactobacilli needs to get them from there. Along with hospital diagnostic
collections, type culture collections can be considered one of the earliest
forms of biobanks, with a particular orientation towards research in
microbiology. Though most tissue collections are integrated into
universities or public research centres, since the 1980s they have been
developing ties with pharmaceutical and food industries (Taylor 2016).
The second instance of milk banking and circulation happens in the
laboratories and facilities of the pharmaceutical industry: through the
process of drug manufacturing, samples of breast milk bacterial strains are
transformed into valuable products which are commercialized as probiotic
nutritional supplements.


4. Hybrid Zones and Care Assemblages in Milk Banking

    Though these three forms of human milk biobanking – institutionalized
banking in a public hospital institution; informal practices of peer sharing;
and corporate logics of biomedical research and patenting of milk
components – at first may appear to be completely different, there are, in
fact, several points of intersection among them. In their re-examination of
the narrative of public/private opposition in cord blood banking,
Hauskeller and Beltrame (2016) focus on the proliferation of “hybrid
zones”, areas of institutional intersection between public and private cord
Romero-Bachiller & Santoro                                               41

banks that, to some extent, are blurring the boundaries between these two
cord blood regimes. Our aim is to extend this notion to all formal or
informal practices and arrangements that generate logics of intersection,
exchange or confusion between different forms of biobanking.

4.1 Circuits of Solidarity and Donation: Altruism as “Hybrid
    Zone”

    In human milk banking, one of the easiest ways to find these “hybrid
zones” is by focusing on donors’ accounts. In our interviews with donor
mothers, the distinction between formal donation, informal sharing among
peers and donation to research is not clear-cut. The story of Laura1, one of
our interviewees, is illuminating in this respect.
    As she recounts, after her first daughter was born, Laura got to know
the 12 de Octubre HMB. When her own breastfeeding was established,
she was willing to donate and phoned the bank to get some basic
information about donor eligibility criteria – which she fulfilled – and
procedures of extraction and donation. But she lived far away from the
HMB, and having to take milk samples herself to the hospital ended up
discouraging her. Some time after this aborted attempt at becoming a
donor, and after Laura had a second daughter which she also breastfed,
two close friends had twins. They were low weight newborns – especially
one of them – and required a period of hospitalization, but they did not
enter into the category of “very low birth weight”, as they did not weigh
less than 1500 g. So when the mother had problems expressing milk, they
could not resort to obtaining milk from the bank. Convinced of the
advantages of breastfeeding and wanting to feed their premature babies
human milk instead of formula, they reached an informal arrangement with
Laura in which she would altruistically express and collect her milk for
them. She did this for the duration of the period they spent at the hospital
– not 12 de Octubre but another public one – and three months after that.
This practice of peer milk sharing, however, did not take place without the
knowledge of the hospital staff. Laura and her two friends had a meeting
with the hospital nurses where they were advised on safety procedures and
provided with information on freezing, conservation, etc., in addition to
being supplied with bottles and other materials for preservation and
transportation. Laura continued giving milk to her friends for several
months. But this was not the last experience she had with donating milk.
Few months later, Laura received word, through a mobile group chat of
recent mothers she participated in, of a nurse asking for voluntary
donations to an experimental research project on the use of human milk
for cancer treatment that was being conducted in Jaén, in the south of
Spain. Apparently this nurse had a relative who could benefit from these
experimental therapies. Laura and several other women from the group
chat – some were also donors at 12 de Octubre – got in touch with the
nurse and tried to organise how to proceed with the donations. In the end
42                                                           Tecnoscienza – 9 (2)

the donations were not carried out, as there were some delays and specific
instructions that did not arrive, but Laura remarks that she and the other
mothers had been willing to donate. In her perspective, it was also an
instance of helping others, even if it was less emotionally intense since it
involved adults: “Maybe if it had been therapy for kids… Maybe we didn’t
put as much effort into it because it was for an adult. Being a breastfeeding
mother yourself, it is like you feel more empathy for babies than for adults”.
    We can see in Laura’s story the entanglement of different forms of
biobanking. In Laura’s experience, all forms of donation pertain to a
similar altruistic impulse – to help others, to care for them. A mother who
is willing to donate to the 12 de Octubre bank would also be open to other
practices of donation – even if they are at different levels of “emotional
distance”, something which explains why Laura’s donation to research
never happened. As Palmquist affirms in her study of human milk sharing
in the US: “donors often enter milk sharing after trying to donate to a milk
bank” (2015, 40). We can also see how “circuits” of donor recruitment for
different biobanking practices are mixed-up, intersect with each other –
we could say that the mobile group chat where Laura got to know about
the demand for donated milk for research is, in a way, a “hybrid zone” for
donor recruitment. Drastic differences between donation for therapeutic
use and to research or experimental therapies are also, to some extent,
blurred from the perspective of donors. In the 12 de Octubre bank, in fact,
there are currently several ongoing research projects which employ human
milk samples. According to the coordinator of the bank, most donors are
perfectly comfortable with some of their milk being used for research, even
though they are constantly reminded of the scarcity of donated milk. Like
in Laura’s account, these other uses are probably less valued than the
original one – helping extremely vulnerable newborns –, but not a single
donor has apparently denied the bank’s request for samples for research.
    In the donors’ accounts we can find a second instance of hybridity,
concerning the mix of highly personal and more general motivations.
Laura’s experiences bring together different levels of emotional distance
and personal involvement – from the more abstract ideas of helping
premature babies or contributing to biomedical research to the direct
involvement with her friends’ babies. Even in donation to experimental
therapies, as the example of the nurse demanding human milk for a direct
relative demonstrates, there is a mix of perspectives, from the embodied
and the personal to the abstract and general, which cannot be reduced to
an impersonal idea of a “gift”. Many qualitative studies of tissue donation
also refer to this complex mix of identities, motivations and values
attributed to donation for research biobanks. Locock and Boylan (2016,
806) indicate, for example, how willingness to donate, consideration of
donations as “gifts” and other views on access to research results,
commercial access, etc. vary depending on whether donors themselves
have an illness which could benefit from the research. This is also evident
in the fact that many donors to the 12 de Octubre bank, have personally
Romero-Bachiller & Santoro                                                           43

passed through the experience of having their babies in the NICU,
something which symbolically enables them to understand the hypothetical
position of a recipient’s mother and to construct a sense of reciprocity, a
sort of “hybrid altruism” where the differences between donating to
strangers and helping relatives and friends are not so marked. In contrast
to Titmuss’s (1970) notion of altruism as a pure “gift to strangers”, where
its abstract forms of solidarity imply a clear demarcation between donors
and recipients, human milk donation often mobilizes strong emotional
identifications and symbolic shifts of the position of donor and recipient.
In this respect, these donations are not so different to other collective
practices of informal solidarity common among new parents. In these
chains of reciprocity all kinds of objects circulate and are borrowed – baby
clothes, cradles, carriers, breast pumps, wraps, slings, kangaroos, etc. This
logic is quite clear in the following extract from the interview with Elena,
a mother who became a donor to the HMB following several
hospitalizations of her own son:

    We had to put Hugo [her son] in the hospital when he was just two days
    old… It was so hard. It still sends shivers down my spine. And I imagine
    myself in the shoes of other mothers who have a baby in the incubator and
    who can’t provide enough milk. Being aware that breast milk helps them so
    much… So I thought: “If I can do something…”. I’m not a doctor, there
    are few things I can do to help, but if I can contribute by giving milk… It is
    also an issue of solidarity among women. I think it is also working for life,
    caring for the creatures. There are sometimes babies who weigh a kilo, even
    less… (emphasis added).

4.2 Criss-crossing Institutional Boundaries

    Apart from donors’ experiences and motivations, we can also find
“hybrid zones” in an institutional and organizational sense. Boundaries and
distinctions between public banks, research networks and bioeconomic
companies are traversed and re-configured by diverse lines of contact. The
most obvious are the formal relationships established between the public
12 de Octubre HMB and other non-public institutions. Part of the funding
for the bank comes from a non-profit, but private, organization, Fundación
Aladina, that – even though its main focus is on pediatric oncological care
– funded the remodelling and expansion of the bank’s infrastructures in
2014. Research carried out at the bank also comes into contact with other
public and private actors, and significantly, with the Complutense research
team on the microbiota of human milk that made the original patent for
Biosearch Life on breast milk probiotics. Research personnel, in fact, move
between institutions: the full-time researcher currently employed at the 12
de Octubre HMB worked previously, and was trained, at Probisearch, the
start-up company initiated by the Complutense team. As Hauskeller and
Beltrame (2015) point out, hybrid zones also refer to the criss-crossing of
different economic regimes – like market and redistributive economies.
44                                                           Tecnoscienza – 9 (2)

Boundaries between therapeutic donation, research and pharma-industry
are sometimes blurred here. Also, in the case of informal milk sharing,
distinctions between medical and the non-medical are not completely
clear-cut, as we could see in Laura’s story. Not only because, as Palmquist
writes, “milk sharing is not a rejection of biomedicine per se and in fact, a
scientific evidence base often informs milk sharing decisions” (2015: 34)
but, in Laura’s experience, because of the direct assistance they found from
hospital personnel.

4.3 Care Assemblages and Hybrid Kin

    The donors’ accounts also evoke another instance of hybridity that we
consider relevant: the heterogeneous character of the networks that are
formed around breast milk donation and the role care plays in bringing
them together. Here we can speak of “care assemblages”, where not only
donors and recipients, but also many other actors, both human and non-
human, are coordinated, as care, affectivity and interpersonal support are
not only important in personal peer sharing relationships. Carroll (2015a)
argues that breast milk donors to HMBs engage in a significant amount of
care work, a form of unpaid, invisible labour, in order to follow the
donation guidelines and thus be able to provide HMBs with the quantity
of milk they need, as well as to comply with the strict safety measures. Our
interviewees, accordingly, remarked upon the hard work implied in
regularly expressing milk for donation – especially since they have their
own babies to care for, and since safety requirements for milk donation are
much stricter than those they apply when they express milk for their own
children. Indeed, Elena specifically defined her involvement in milk
donation as a form of “working for life”, as we have seen, emphasizing both
the caring involvement and the effort required by the procedure. Our
informants commented on how they have to find a quiet moment in their
day – moments that are hard to find for a recent mother – so they can
express milk for the HMB. Specific organization and discipline are thus
required to fulfil the rigorous protocols milk donation entails. Practices of
donation are grounded in the everyday activity and micro-decisions of
family life2. Support from partners, relatives and friends is essential – e.g.
in helping to take samples to the hospital.
    But care is not only an issue for donors and their families, but instead a
rationale that involves all of the actors that intervene. For instance, bank
personnel are very close with, friendly and supportive to donors, offering
them help and advice if they have any problem with their own
breastfeeding. Caring for donors is a way of assuring donations, but it is
also part of the greater ideal of promoting breastfeeding and a more
humane type of medical attention. Even technical aspects of the donation
process are traversed by care and personal relationships. One example is
the circulation of breast pumps: the HMB has a number of electric breast
pumps that can be borrowed by donors, but usually donor mothers are
Romero-Bachiller & Santoro                                               45

asked if they can find one themselves – for these are reserved for women
who cannot afford to buy them or get one from acquaintances. According
to the bank coordinator, most donors resort to their personal contacts to
borrow one. As is typical with other baby paraphernalia such as clothes,
breast pumps circulate among friends and relatives, embodying and
strengthening, in a certain sense, those care assemblages which constitute
an essential part of the social environment of donation.
    A final topic regarding “hybrid zones” has to do with forms of
symbolically constructing kinship through donation practices. There has
been much sociological and anthropological literature on the
transformation of traditional logics of kinship brought about by new
medical and reproductive technologies (Strathern 1992; Franklin 2013).
Catherine Waldby (2002b) characterizes different forms of bodily
donation as forms of intercorporeal sharing, stressing their capacities of
intensifying bonds between donors and receivers in sometimes unexpected
ways. “Intercorporeal in the crucial double sense that [they involve] both
a material confusion of bodies, a material indeterminacy and that [they
make] a relationship – in this case, motherhood, fatherhood and kinship.”
(Waldby 2002b, 245). In the case of human milk biobanking, one can
observe that these practices frequently generate symbolic bonds that
surpass the mother-child dyad. Carroll indicates that milk donation “can
stretch anonymously across vast geographic and spatial locales, and can
even transcend the established kinship and community networks of the
donor.” (2015a, 177).
    Our fieldwork also corroborates how human milk biobanking
articulates emergent forms of surrogate, kin-like, relations, “hybrid kin”
identities which are, in many cases, openly adopted by donors. Palmquist
points out how non-profit donors in informal milk sharing webs are often
referred to as “milk mothers”, “milky mamas” or “sisters” (2015, 40) and
Susan Falls starts her ethnography on milk sharing in the US by referring
to the “milk siblings” her own son now has due to those practices (2017,
xi). Our peer sharing interviewees employ this vocabulary of kin too: Laura
refers to her friends’ twins as her “milk sons”. But kinship metaphors also
appear in the public HMB, even explicitly – the book that donors receive
as a gift from the bank at the end of their collaboration is titled Hermanos
de Leche [Milk brothers] (Olza and Burgos 2011) [Image 1].
    These symbolic forms of extended kinship, which bring together
traditional and modern practices, can also be important for some technical
protocols, becoming in itself performative of certain socio-technical
ordering. We find a significant example of this in the 12 de Octubre NICU,
where, unlike what happens in other milk banks and neonatology units
worldwide (Cevese 2015), Muslim families are assured that the donated
milk their children may receive comes only from mothers who are
breastfeeding a child of the same sex, since traditional beliefs in some
Muslim countries consider sexual intercourse between two adults that were
“milk siblings” in the past to be incest. This protocol and the
46                                                           Tecnoscienza – 9 (2)

heteronormative logic it implies are only possible because in the 12 de
Octubre milk bank, in contrast to most milk banks in other countries,
donated milk is not organized in pools of samples from different donors,
but instead only samples from the same donor are pooled together. This
procedure not only guarantees the highest degree of traceability, but it also
allows for the samples to be distributed according to the specific
characteristics and needs of the recipient babies.




  Fig. 1 – Book Hermanos de Leche [Milk brothers] (Olza and Burgos 2011).
Present offered by the 12 de Octubre HMB to donors at the end of the donation
            process (photograph courtesy of one of our informants).

   Whereas other banks that pool together samples from different donors
provide a more homogeneous and standarized product, at the 12 de
Octubre bank the preservation of the different samples offered by different
donors becomes a useful resource to provide personalized prescriptions.
Personalization also returns back to the donor, stressing the bond between
donor and recipients: in the diploma that 12 de Octubre HMB gives to
donors, a mother can find the exact number of babies who have received
milk from her [Image 2].
Romero-Bachiller & Santoro                                                   47




 Fig. 2 – Final diploma given by the 12 de Octubre HMB to donors at the end of
       the donation process (photograph courtesy of one of our informants).

     It is important to note, finally, that this “hybrid kinship” is not without
its ambiguities and displacements. Whereas traditional practices of human
milk-sharing were based on direct breastfeeding of other infant/s, in HMBs
human milk becomes a bio-objectified product that has been processed,
one that comes in bottles. The set of lively relationships embedded in
breastfeeding, a clear form of intercorporeal sharing (Waldby 2002b), is
highly transformed in these practices.3 Yet human milk remains a deeply
charged corporeal fluid, symbolically and culturally. And while in current
forms of milk-sharing there is no longer a direct bodily contact, as the milk
is bottled and processed, and offered to the baby most commonly by their
own progenitors or health professionals, symbolic conceptions linked to
human milk seem to travel with the very milk. Donated human milk
becomes a caring device, that in some way transports with it the donor
mother and caring mothering. This can sometimes be a troubling and
disruptive situation for mothers of recipient babies, as they may feel that
their own mothering capacities and their mother-child bond are put into
question. As Carroll (2015b, 12) notes “despite consenting to donor milk
and expressing gratitude, many NICU mothers experienced great affective
ambivalence associated with it being a bodily tissue and one with such
profound socio-cultural connotations of reproduction and kinship”.
48                                                              Tecnoscienza – 9 (2)

5. Microbiota, Pasteurization and Boundaries: The
Bio-Objectification of Human Milk

    Though human milk biobanking practices are full of hybrid zones, the
bio-objectification of milk requires purification and clarification, reduction
of indeterminacy, an erection of boundaries. The process of bio-
objectification refers to the mechanisms through which indeterminate
body materials are stabilized (Vermeulen et al. 2012; Stephens and Dimond
2015). Bio-objectification is a necessary process for biobanking, which
requires the coordination of a diverse set of devices. Political, socio-
cultural and economic mechanisms of exchange; protocols, patents,
standards and analyses; sterilizing procedures, surgical masks and caps,
breast pumps, freezer packs, labels. All of these configure and sustain a
concrete sociotechnical ordering which is repeatedly activated in its
multiple entanglements, disentanglements and re-entanglements (Callon
1998). All of them participate in the construction of a distinctive bio-object
(Stephens and Dimond 2015).
    One way of approaching the process of bio-objectification is
considering the operations of distinction, classification and purification
involved in it (Bowker and Star 1999). There are many instances where this
boundary work happens, both at a rhetorical level – discourses, metaphors
– and at a material level, where “matter out of place” (Douglas 1966) is
directly manipulated in the physical sense. The combination of both
operations/levels results in a peculiar socio-technical ordering (Law 1994).
In this section we will focus on a particular aspect of the process of bio-
objectification of breastmilk: different forms of manipulation of bacteria
and microbiological organisms naturally present in expressed milk.
Preventing contamination is something that cuts across all discourses and
practices involving human milk donation, either formal or informal. Set
across the “intersection between breastmilk-as-medicine and breastmilk-
as-pollutant” (Palmquist 2015, 30), there is quite a different treatment of
microbial and bacterial milk components in each of the three practices we
are analyzing, which results in different bio-objects. Human milk is, thus,
a fluid bio-object sustained by the entanglements of relations it is inscribed
in. Entanglements where bacteria are considered “virtuous”, and deserve
preservation and cultivation, or “wicked”, pathogenic and dangerous, and
prone to be eradicated. Quality and safety processes and risk discourses
surround bacteria manipulation in all practices of human milk biobanking
(Carroll 2014).

5.1 Human Milk Bank at the 12 de Octubre Hospital: “exquisite
    hygiene”

     As Elena mentioned several times in her interview, milk donation at the
     HMB requires “exquisite hygiene”. The quality manager of the bank
     described to us in great detail the procedures donated milk goes through
Romero-Bachiller & Santoro                                                            49

    prior to being offered to babies at the NICU, which echo the rigour and
    attention to security Caroll (2014) describes in her ethnography of two US
    HMB – although procedures described there are different. After
    completing a questionnaire to identify lifestyle habits and a blood test,
    donors are given all the required materials and taught how to properly clean
    their hands. Before each extraction, donors have to sterilize the breast pump
    and bottle and be sure to keep them sterile during the whole process of
    expressing. Milk is expressed with the donor wearing a mouth and hair
    cover. Once extraction is complete, the bottle is closed, labelled and directly
    stored in the freezer. Every 15 days bottles have to be carried to the HMB
    in a cooler bag with a freezing pack to avoid defrosting. Once there, donated
    milk is added to the database and stored in the raw milk freezers while
    awaiting pasteurization. The 12 de Octubre HMB follows the Holder
    method for pasteurization. First, raw milk bottles are defrosted through a
    controlled process, by introducing them into a bath at 40º C until they are
    defrosted at 50 percent, and completing the defrost in a refrigerator to keep
    the human milk properties at their maximum potential. Later, the raw milk
    bottles are correctly labelled and set into the pasteurizator, where they are
    processed at 62.5 ºC. In the middle of the machine there is a bottle of cow
    milk with a probe connected by a wire to a thermometer set outside. This is
    a security mechanism to guarantee that the temperature is homogeneous
    inside the pasteurizer. After thirty minutes, the pasteurized milk bottles are
    placed in another pasteurizer with crushed ice so that their temperature
    reduces to 4ºC in three to four minutes. Then the bottles are stored in the
    pasteurized milk freezers. This is the Brazilian HMB pasteurization model,
    and it is quite cheap and very efficient – around 95% of donated milk is
    successfully pasteurized. Yet it is quite labour intensive, as it requires a
    laboratory technician to control the whole process. After that, the milk is
    analysed so as to eliminate any contamination and sorted for NICU babies’
    consumption, matching the specific characteristics of the human milk
    samples with those of the recipients. (Notes taken from the first visit to the
    HMB in May 2017 and transcribed by the authors) [Images 3 and 4].

    Exquisite hygiene, rigorous protocols and quality procedures with
severe security controls eliminate all contamination risk and pathogenic
bacteria (Carroll 2014). Banked human milk is a pasteurized and aseptic
fluid, closer to a therapeutic device (Cevese 2015, 103) than to food. Yet
this purification process does not come without its shadows, as the milk
bank coordinator points out:

    Also, there is another big gap and that is that donated milk is never as good
    as milk from the mother herself, because it is processed. Pasteurization
    offers security, but it also entails some unwanted side effects: it eliminates
    pathogenic bacteria, but it also kills the intestinal flora that would colonize
    the newborn’s intestine. And there is increasing scientific evidence on the
    importance of gut flora. In fact, we now provide probiotics to very low
    weight birth babies. [...] We are giving them Infloran©. It has two strains
    of lactobacilli [Lactobacillus acidophilus, Lactobacillus biphidus].
50                                                              Tecnoscienza – 9 (2)




     Fig. 3 – Donated human milk bottles at the pasteurizer following the Holder
        pasteurization protocol at 12 de Octubre HMB (photographed by the
                                       authors).




      Fig. 4 – Storage and traceability of donated human milk samples at 12 de
                    Octubre HMB (photographed by the authors).
Romero-Bachiller & Santoro                                                    51

    Pasteurized “donated milk” appears in this discourse as a different bio-
object than “milk from the mother herself”. Another difference is
constructed between “pathogenic bacteria” and “gut flora”. Bio-
objectification, here, takes place at a material as well as rhetorical level. The
terms employed have connotations and motivate actions: we have to
eliminate “pathogenic bacteria” but preserve or restore “gut flora”. We
have to promote breastfeeding from the mother herself, yet we provide
pasteurized donors’ milk in certain situations. ‘Breastfeeding’ becomes a
contested term in and of itself. Does it refer to milk originating in the breast
or directly fed from the breast? (Rasmussen et al. 2017). Most mothers at
the NICU do not feed their babies with their breast, yet they often provide
expressed breast milk in different quantities. Words are not elements
separated from a given socio-technical ordering but rather an important
aspect of it. Definitions and terminology are repeatedly used to reinforce
boundaries between different types of biobanking. The HMB coordinator
consistently referred to practices of informal human milk donation as
“uncontrolled donations”. The term places at the forefront the opposition
between the rigour and control of HMB laboratory-pasteurized milk and
the potential “risk” of raw milk shared informally, to which we now turn.

5.2 Informal Human Milk Sharing: Extending Symbiotic Relations

    Issues of potential risks and potential benefits stretch in informal
human milk sharing practices. In Laura’s account, risks are equated with
an indeterminate potential external contamination and not with the “raw”
milk in itself, given that she keeps “good habits”. Safety practices in this
case emulate the HMB ones related to milk expressing, yet the level of
detailed protocols and “exquisite higiene” mentioned by Elena is never
reached. As Mary Douglas (1966) showed, pollution, contamination and
risk are anthropologically related to what is considered “matter out place”.
Here, risk is contained by keeping expressed milk “in place”: caring
attention is given to the expressed milk and a significant effort is made to
keep the “cold-chain”. But there is also an aspect of everyday familiarity to
this process that places it closer to other expressing practices by lactating
mothers than to those of donors doing it for the HMB.
    While they accepted Laura and her friends’ decision to share milk
informally, the hospital staff did also stress the risks involved for Laura and
her friends. The milk would be raw and no pasteurization or analysis of the
milk was going to be performed, so a certain threshold of uncertainty
would remain. Discussing potential risks in milk sharing practices in the
US, Palmquist (2015, 37-38) contrasts the ways risk is controlled in HMBs
through informed consent, as opposed to what she identifies as “informed
choice” in informal sharing.
52                                                                Tecnoscienza – 9 (2)




     Fig. 5 – Frozen human milk samples stored in a household refrigerator along
          with other frozen food supplies (photograph courtesy of one of our
                                     informants).

    Boundary work is constructed here both rhetorically and materially. In
the relationship between informal donors and recipients, unlike the
detached safety of tested and pasteurized milk, trust and personal bonds
emerge as relational sources of security. This has a material consequence:
sharing goes beyond “human” milk, as human milk is never quite only
“human”: all the mammary microbiota of the donor’s milk is shared as well.
Palmquist (2015, 43) suggests that, in informal milk sharing, identities of
donor and receiver are in a sense symbiotic. We can consider milk sharing
as extending symbiotic relations beyond the human scale to engulf the
microbiotic one: flora gut colonization in receivers’ babies’ may have the
imprint of the donor, as each person develops a unique microbiota (Cacho
et al. 2017). Extended forms of hybrid-kin and inter-corporeality open
possible speculative futures here (Haraway 2016; Waldby 2002b).

5.3 Human Milk as a Source for Cultivating Bacteria

    While human milk in HMBs is pasteurized, and in sharing practices it
is kept raw, containing both the promise and risk of the ambivalent
presence of uncontrolled gut flora, in the production of a probiotic
nutritional supplement such as Lactanza Hereditum, raw human milk
becomes a source for the cultivation of bacteria. This bio-objectification
process depends on a different understanding of what human milk is “in
Romero-Bachiller & Santoro                                                  53

and of itself”, an understanding which is based on the natural development
of the human mammary microbiota. According to Bergmann et al. (2014,
1121), bacteria appear in the milk ducts during the last three months of
pregnancy, with the concentration of bacteria reaching “a maximum
during peripartum and then slowly decreases during the nursing period.
During the weaning period, there is a sharp decrease in bacterial counts”.
Human breast milk is, thus, a live tissue inhabited by various strains of
bacterial colonies that vary in quantity and composition throughout the
breastfeeding process. Changes in this composition can imply an excessive
proliferation that may become pathogenic or facilitate the incursion of
pathogenic strains. The most common problems related to bacterial
proliferation at the breasts are mastitis and obstructed ducts. We could
argue that there is certain bacterial choreography, a certain dance in the
human microbiota that promotes unstable equilibriums both in the
mother’s lactating body and in the breastfeeding baby, a relation very often
referred to as symbiotic.
    The production of the probiotic nutritional supplements based on the
patent of Lactobacillus fermentum LC40 (CECT5716) and Lactobacillus
salivarius (CECT5713) not only required donated human milk for the
isolation of potentially beneficial strains. It also depended on more donated
human milk, this time from the lactating mothers with mastitis who
participated in the clinical trial and in several studies on the different
responses of mastitis to antibiotic treatments and probiotics (Arroyo et. al.,
2010; Marin et.al, 2017). Yet procedures to collect human milk samples for
research and microbiota analysis entail a completely different procedure to
the one proposed at the HMB. Arroyo et.al (2011) describe this procedure
in detail, that was experienced by Carmen and described in her own
autoethnographic notes4. Collection should take place two hours, at the
earliest, after the last breastfeeding of the baby. Neither creams nor silicone
nipple shields should be used, and if they are, the nipple and areola should
be washed. Hands should be carefully washed as milk will be expressed
manually, without the use of a breast-pump or associated device.
Expressed milk should be collected in an aseptic container and handed in
to the lab less than one hour later, at room temperature, or between one to
twelve hours later if refrigerated. These samples are then cultivated in
Baird-Parker Agar laboratory inverted plates and incubated at 35º to 37ºC
in an aerobic atmosphere. Plate readings are performed at 24 and 48 hours
(Arroyo et al. 2011). Human milk as bio-object is radically different in this
procedure. Far from being an aseptic tissue, it becomes a sort of
“primordial soup”, involved in the production of magmatic and
effervescent bacterial lives. Through the manipulation and ingestion of
probiotic nutritional supplements, control over bacterial strain
communities is expected, and therefore relief from breastfeeding illness
and pains due to mastitis or obstructed ducts. Furthermore, the most
recent research developed by the Complutense team and also by Biosearch
Life is directed towards the use of probiotic nutritional supplements for
54                                                          Tecnoscienza – 9 (2)

baby feed with formula to promote their own gut flora and to prevent
infant colics (Bergmann et al. 2017).


5. Conclusions: Virtuous and Wicked Bacteria at Dance

    Throughout the paper, we have surveyed the complexity surrounding
human milk banking practices in Madrid. We started with the recognition
that hospital milk banks are not the only form of biobanking, but that other
practices, notably informal milk sharing and the manufacturing of certain
probiotics, also involve forms of human milk banking. We then, proceeded
to show the various hybrid zones between these three sets of practices, as
can be analysed in donors’ accounts, but also in institutional arrangements,
heterogeneous care assemblages and symbolic constructions of “hybrid
kin”. The final section of the paper presented the forms of purification and
technical manipulation of donated milk at play in each of the settings. If
“purity” may at first seem to be more important in institutional biobanking
practices and less so in other forms of milk sharing, our analysis suggests,
on the contrary, that ideals of “purity” and “contamination” are present in
every setting. That is to say, none of the assemblages can be thought
without norms and boundaries that configure what are purity and pollution
in each case. The 12 de Octubre Human Milk Bank purification process
seeks to eliminate all potentially dangerous bacteria through “exquisite
hygiene” requirements, and extremely rigorous processes of
pasteurization, manipulation and traceability. At the lab, bacterial grown
is favoured – yet only of those strains inhabiting the breasts – , both when
producing probiotics or when analyzing human milk during mastitis. In
informal human milk sharing, purity includes mutual trust, linking it to
other “everyday” strategies for avoiding bacterial pollution. The different
ways of manipulating bacteria and microbiota, thus, result in distinct
processes of bio-objectification and generate different versions of human
milk.
    We could argue that what distinguishes and what unites these three
forms of biobanking are bacteria manipulation, definition and treatment.
Different processes of purification and bio-objectivization gain shape in
concrete assemblages of bacteria colonies and human milk. Bacteria work
as a boundary object that circulates and is diversely enacted in different
social worlds, such as bio-banks, homes, labs, drug delivery plants, tissue
collections, mothering networks, commercialized bio-materials, and in
objects such as breast-pump devices, frozen human milk cristal bottles,
containers, pasteurizers, samples, syringes. But mothering imperatives to
care, construction of trust, emotional identifications, vulnerability, pain
and joy are also involved. Far from being detached elements, all of these
assemble and reassemble in concrete and recurrent doings, with bacteria
running through them all, hybridizing yet differentiating the three sets of
Romero-Bachiller & Santoro                                               55

bio-objectification processes. Depending on the particular definition and
treatment it receives, microbiota can shift from being wicked and a
dangerous pollutant to virtuous and potentially healing.
    The practices of human milk donation and biobanking we have
analysed here all entail forms of intercorporeal sharing (Waldby 2002b),
intensifying bonds and creating ties of care and affect even when donors
and receivers are unknown to each other. Those bonds and affects
articulate some forms of “hybrid kin”. Forms of kinship that sometimes
take place symbolically, as with the book offered as a gift to HMB donors
at the end of their donation. Other times they are articulated as caring
assemblages, as in the case of Laura with her friends and their twins, where
she extended her maternal role to others beyond her own children. And
other times they manifest in deeply intercorporeal ways, yet overflowing
the limits of the human, as in studies on the benefits of probiotics and
mammary microbiota. This last aspect is perhaps the most promising one
when thinking hybridity and kinship at once. Recent studies on
personalization of donor breast milk with the live microbiota of the
biological mother’s own milk seek to extend the immunological properties
of maternal breast milk microbiota to pasteurized donated human milk
(Cacho et al. 2017). Yet, in doing so, they work to preserve the mother-
child bond besides the donor milk consumption. We could understand,
somehow, the inheritance of the mother microbiota as a biological
extension of the self beyond the self. This same inheritance happens in
informal milk sharing, as milk circulates raw: therefore, the microbiota of
the donor mother can colonize the bowel of the baby who receives it. If the
latest estimates of microbiota in humans bodies suggest that bacteria cells
are as least as abundant as human cells in our bodies (Gilbert et al. 2018;
Sender, Fuchs and Milo 2016), circulation and colonization of microbiota
imply extended forms of intercorporality and bonds: bacteria sharing in
itself configures certain forms of “hybrid kinship”. Those ideas, and other
recent research such as the Human Microbiome Project, lead us to
reconsider limits and boundaries between individuals of different species,
in a move closer to Haraway’s reading of Lynn Margulis’ holobiont figures
(Haraway 2016). Bacteria become symbiotic entities, undetachable of
ourselves, questioning even the very idea of “self”.
    These ideas may remain highly speculative, but what our study clearly
shows is that, despite it sometimes being treated as sacred or valued, as
“white gold” (Falls 2017) or “liquid gold” (Carroll 2014), human milk is
never a “pure” and aseptic fluid, but instead a deeply hybrid and enmeshed
one. A lively substance that not only changes according to the baby’s needs
or the mother’s physiology, but also one that cannot be understood without
addressing the colonies of bacterial life dwelling within it. Understanding
the complexities of the circulation and biobanking of human milk requires
that we pay special attention to the possible and impossible crossings of
microbiota, and to how they draw boundaries and reshape human milk as
a specific bio-object. In those crossings and circulations, in their
56                                                                 Tecnoscienza – 9 (2)

boundaries and regulations, a whole set of assemblages beyond the
technical are re-enacted: identities, kinship ties, solidarity ties, and public
and private arrangements. But also, in quite uncertain ways, the boundaries
between the human and the non-human.
   If we put hybridity and complexity at the forefront when studying
biobanking, as we have tried to do throughout the article, a final question
could be: how can we account for this “intimacy with strangers” (Haraway
2016, 60)?


Acknowledgments

    This paper is part of the research project “Feminist Epistemologies and Health
Activisms” (FEM2016-76797-R), funded by Spanish State I+D+i Program. We
would like to thank to all the staff at 12 de Octubre BHM and all the donors
interviewed for their invaluable collaboration. We would like to thank as well to
the Special Issue editors and to three anonymous reviewers for the comments and
suggestions offer that without a doubt have help to strengthen and enrich the
article.



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    1
      Fictional name – all fragments of interviews have been anonymized.
    2
      We would like to thank an anonymous reviewer for this clarification.
    3
      We would like to thank the editors of the special issue, Lorenzo Beltrame and
Christine Hauskeller, for their suggestion of developing this idea.
    4
      Notes were taken in February 2014 after an acute mastitis when Carmen got
in contact with Probisearch SL, a spin-off of the Complutense research group
directed by Juan Miguel Rodriguez, to get her mammalian microbiota analyzed.
She got to know about the group through the midwife in her public health local
60                                                                   Tecnoscienza – 9 (2)


centre. The midwife gave her Juan Miguel Rodríguez’s email and introduced him
as “the veterinarian of mastitis”, telling her to get in contact with him as he offered
women with mastitis probiotics to hail the infection. Two of the women we later
interviewed also had this experience of accessing probiotics informally previous to
its commercial distribution.
