Human milk-sharing practices and infant-feeding behaviours: A comparison of donors and recipients

Peer-to-Peer Human Milk Sharing Through Social Media Groups: The Experiences of Women Donors and Recipients in Hong Kong

AIM

To explore the lived experience of donors and recipients involved in peer-to-peer human milk donation.

DESIGN

An exploratory descriptive qualitative study.

METHOD

Semi-structured interviews were conducted between November 2022 and April 2023. A total of 50 women consisting of 34 donors and 16 recipients were recruited using purposive sampling from specific social media groups in Hong Kong that focus on breast milk donation and sharing. Data were analysed based on thematic analysis.

RESULTS

Five key themes were identified in this study: Motivation; Milk sharing as a social act; Not a Norm; Recommendation to formal milk banks; and Formal donation as the preferred route.

CONCLUSION

The findings indicate informal milk sharing is seen as an inferior alternative to formal milk donation systems. The establishment of formal milk banks is viewed as a way to address the shortcomings of informal sharing.

IMPLICATIONS FOR THE PROFESSION

The findings have implications for the healthcare field, particularly in improving the experiences of those involved in informal milk sharing. The insights gained from the experiences of informal milk sharers can directly inform and enhance the services provided by formal milk banks.

IMPACT

Given the growing prevalence of online informal milk sharing, healthcare professionals should enhance their understanding of this practice. However, the practice has remained understudied, particularly in Asian region. This study brings together the experiences of both milk donors and recipients, providing a comprehensive view on the phenomenon.

REPORTING METHOD

The Standards for Reporting Qualitative Research (SRQR).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Formal and informal human milk donation in New Zealand: a mixed-method national survey

BACKGROUND

Mother's milk provides optimal nutrition for infants. Donor human milk (DHM) is recommended for low birthweight infants when mother's milk is unavailable. Little is known about human milk (HM) donation practices in New Zealand (NZ), where few HM banks are available. This study aimed to investigate parents' and health professionals' (HP) experiences with formal and informal HM donation in NZ.

METHODS

Two electronic surveys were disseminated in 2022 to parents and HPs involved with HM donation in NZ. The surveys covered respondents' views and experiences with HM donation. HPs were also asked about HM donation practices in their workplace. Chi-squared and Fisher-Freeman-Halton exact tests were used for quantitative analysis and qualitative data were thematically analysed using inductive approach.

RESULTS

A total of 232 HP and 496 parents completed the surveys. Most parents either donated (52%) or sought DHM (26%) for their infant and most donations were informal, arranged between individuals (52%) or through hospital staff (22%). HP reported DHM was used in 86% of facilities, with only 20% of donations facilitated by HM banks. Almost half (48%) of HP stated they would like to use DHM in their workplace but access was limited. The most common screening processes undertaken by parents and HP before informal HM donation were lifestyle including smoking status, medication, drug and alcohol intake (44% and 36%, respectively) and serological screening such as CMV, HIV, Hepatitis C or B (30% and 39%, respectively). Pasteurisation of DHM obtained informally was not common. Most donors were satisfied with their HM donation experiences (informal and/or formal, 91%) and most respondents supported use of DHM in hospitals and community. Participants reported HM donation could be improved (e.g., better access) and identified potential benefits (e.g., species-specific nutrition) and risks (e.g., pathogens) for the infant. Potential benefits for the donor were also identified (e.g., altruism), but respondents acknowledged potential negative impacts (e.g., cost).

CONCLUSION

Informal HM donation in NZ is common. Most parents and HP support the use of DHM; however, improvements to current practices are needed to ensure safer and more equitable access to DHM.

Factors associated with informal human milk sharing among donors and recipients: A mixed-methods systematic review

BACKGROUND

The multiple benefits associated with the provision of human milk exceed individual health outcomes, engendering substantial economic, societal and environmental domains. Human milk is the absolute, unparalleled source of nutrition for infants. Informal human milk sharing is a modernistic and rapidly progressing practice. No systematic review of the factors associated with this contemporary practice among donors and recipients of informal human milk sharing exists.

AIM

The aim of this review was to identify, evaluate, synthesize and integrate the evidence on the factors associated with informal human milk sharing among donors and recipients.

METHODS

A mixed methods systematic review was conducted according to the Joanna Briggs Institute methodological guidance utilizing a convergent integrated approach. The following databases were systematically searched: CINAHL, Scopus, Medline and Embase and Web of Science between inception to August 2023. A grey literature search was conducted using multiple techniques. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Twenty-four studies were included in this review. Ten integrated findings relating to the factors associated with informal human milk sharing among donors and recipients were identified. The four integrated findings pertaining to donors included: altruistic motivation and value, resistance to commercialization and overcoming inaccessibility, uniting digital and personal connectedness and lack of awareness and acceptance of informal human milk sharing in healthcare settings. The six integrated findings relating to recipients included: maternal or infant factors, superiority and advantageous impact of breastmilk, human milk bank influences, digital connections and transparency, healthcare professional facilitation of informal human milk sharing, and professional and logistical implications.

CONCLUSION

This review highlighted a multitude of factors that motivate, facilitate and impede the practice of informal human milk sharing. Future research is required to explore these factors further within broader geographical locations to enhance the generalizability and rigor of the body of knowledge. Further studies should consider the exploration of the experiences and psychological impact of informal human milk sharing on donors and recipients. The provision of human milk to all infants is an imperative public health endeavor and thus positioning this as a key benchmark for research and practice is crucial.

The Ethics of Ancient Lactation and the Cult of the Perfect Breastfeeding Mother

Breastfeeding is a key issue found in ancient sources that resonates with public debates today, affecting women in different parts of the world and of all social classes. The aim of this research was to identify breastfeeding narratives in ancient medical and philosophical texts from the 1st to the 6th century CE that address ethical issues in the medical management and social perception of new mothers. We examined 15 literary sources and one funerary inscription on lactation and critically evaluated the ancient idea of the perfect breastfeeding mother versus the non-breastfeeding mother. We then discussed our historical data in terms of objectivity and significance in relation to contemporary attitudes towards motherhood and lactation, e.g., (1) the cult of the perfect, breastfeeding mother in contemporary lactation education and (2) the onset of conditions which may affect normal breastfeeding, such as dysphoric milk ejection reflex (D-MER), breastfeeding aversion response (BAR) or post-partum depression. The analysis of the results showed that in both ancient and contemporary postnatal health care: (1) good mothering is associated with breastfeeding and (2) alternative feeding methods are acknowledged, but never as the best, natural option. Finally, our analysis shows that public health policies on breastfeeding and mothers' own knowledge of their bodies are contested between nursing theories, social expectations and economic factors.

Perspectives and factors associated with informal human milk sharing: a mixed-methods systematic review protocol

Background

The practice of informal human milk sharing is a relatively new phenomenon and poses significant questions in the domain of infant feeding. Informal human milk sharing is a means of donating human milk from another lactating individual who is not the child's biological parent, in a casual manner, that is, without the involvement of health professionals or agencies. The advent of digital technology has facilitated the donation and receipt of human milk through digital online platforms and thus has amplified this modern practice. This research aims to comprehensively examine and synthesize evidence about the motivations, barriers, facilitators and experiences of individuals who both donate (donors) and the primary care givers of the infants who receive (recipients) human milk informally to provide to infants.

Methods

A mixed-methods systematic review will be undertaken. This review will consider qualitative, quantitative and primary mixed-methods studies which report on the factors associated with informal milk sharing, and on donors' and recipients' experiences of the practice. Primary mixed-method studies will be included if the individual qualitative and quantitative components can be extracted. Five databases will be searched for studies on informal human milk sharing published from inception of the database. Study quality will be evaluated using the standardized JBI critical appraisal tools, selected based on the methodology in each individual study. Data extraction will be conducted using the JBI mixed methods data extraction form followed by data transformation, synthesis and integration. This mixed-methods systematic review will follow a convergent integrated approach in accordance with JBI guidance.

Discussion

Informal human milk sharing is a novel practice in the domain of infant feeding. This review will enable a thorough understanding of this practice from both the donors and recipients' perspective and will have implications for healthcare professionals, policy and future clinical decision-making.

Protocol registration number

PROSPERO CRD42023405653.

A scoping review on current technology-based approaches to support breastfeeding and informal human milk exchange practices

Informal human milk exchange is the practice of donating and receiving expressed human milk based on mutual consent between the donor and receiver in the need of human milk for infants below 2 years old. Main concerns related to informal human milk exchange is related to milk siblings and safety handling of the expressed breastmilk. Even though there are countries which have policies and procedures related to human milk bank, informal milk exchange has not been given much attention. Compared to human milk bank, informal human milk exchange is not regulated. This study aims to identify the system focused on personalized breastfeeding tracking and monitoring, online discussion forum, web-based consultation, and breastfeeding station locator. Review of current applications in supporting breastfeeding practices was conducted based on the PRISMA-ScR framework. A literature search was conducted in Scopus and Google Scholar databases to identify articles published in English or Malay and containing systems/applications related to breastfeeding, milk sharing, milk exchange, milk siblings/kinship within the societal context. According to the scoping review, current scientific publications mostly focused on breast milk, breastfeeding, and milk banking concerns, with recurring themes including social reasons, lactation insufficiency, and unsolved nursing problems. These themes highlight the complexities and complexities of informal human milk exchange practices. Two reviewers screened the articles, and the data were extracted and narratively synthesized. During the primary database search, 360 articles were found based on the related titles, abstracts, and keywords. Seventy eight met the inclusion criteria and were finalized in this review. We found that most scholarly works focused on breast milk, breastfeeding and milk banking challenges and issues with recurrent themes i.e., societies, lactation inadequacy and unresolved nursing problems. Based on our literature search and to the best of our knowledge, there is no recent scoping reviews which focuses on technology-based approaches on informal human milk exchange. Findings from this scoping review is important for advancing research and practice in this field, as well as improving outcomes for individuals and families affected by informal human milk exchange.