Attitudes towards Donor Breast Milk in an Inner City Population

Views on wet nursing and expressing breastmilk for sharing and human milk bank donation among mothers in two parenting social media communities in Vietnam

Nutrition in early life plays a key role in shaping an infant's future health. There is limited understanding of the perspectives of Vietnamese mothers with children under 24 months of age regarding breastmilk expression, donation and use. In this cross-sectional study, an online survey was administered through two parenting social media communities to assess opinions on breastmilk expression, breastmilk donation including contributions from bereaved mothers and the use of donor human milk. A 4-point Likert scale was used to evaluate respondents' opinions, and demographic and breastfeeding information was collected. Among 375 respondents, almost 30% had received breastmilk from another woman, either through direct breastfeeding (14.7%), expressed breastmilk (12.5%) or from a human milk bank (2.7%). In this survey of 375 mothers, 84.0% indicated they would store excess breastmilk, while 75.7% and 69.6% would donate to a human milk bank or another mother, respectively. When faced with insufficient breastmilk, 88.5% of mothers would seek ways to increase supply, whereas 23.8% considered using commercial milk formula. Regarding milk expression among the 375 mothers, 78.4% preferred electric pumps, compared to 48.6% for manual pumps and 45.9% for hand expression. Additionally, 80.5% of the 375 mothers would suggest donating stored milk to bereaved peers and 85.6% would suggest mothers with mild COVID-19 to continue breastfeeding with precautions. These findings indicate that this sample has positive views on breastfeeding, breastmilk donation and the use of donor human milk.

Beliefs and views of breastfeeding mothers regarding human milk banking: A qualitative study

OBJECTIVE

The aim of the study was to determine the beliefs and opinions of breastfeeding mothers about human milk banking.

METHODS

This study was conducted as a case study, which is a qualitative research method. The population researched consisted of women who applied to the Gaziantep Health Care Family Health Center between June and December 2022. The sample included 30 mothers selected through purposive sampling. The data were collected using a descriptive characteristics form and a semistructured interview form. Ethical committee and institutional approvals were obtained. The data were analyzed using the MAXQDA qualitative research software program.

RESULTS

The majority of the breastfeeding mothers had limited knowledge about human milk banking and considered it religiously problematic. They held the belief that breastfeeding siblings should not marry each other on religious grounds. The mothers were willing to act as wet nurses in case of necessity, but they expressed a preference against having their own baby nursed by another woman. They also stated that they would consider using milk banks only if the information provided was limited to the mother and baby. Additionally, it was observed that if they found themselves in a difficult situation, they would only seek a wet nurse from their immediate social circle.

CONCLUSION

The breastfeeding mothers expressed that milk banking was a beneficial practice; however, they had religious reservations about it. It was observed that they would be willing to donate their milk to these banks and use them in times of need under certain conditions. These conditions included ensuring that the milk is not mixed, providing information about the mother and baby to families, having babies of the same sex, and adhering to strict cleanliness and hygiene measures.

Acceptability of donated breast milk among pregnant women in selected hospitals in central Uganda: a cross-sectional study

BACKGROUND

Donated breast milk is considered beneficial to vulnerable infants. Thus, Uganda launched its first human milk bank in November 2021 to provide breast milk to preterm, low birthweight and sick babies. However, there is a scarcity of information on the acceptability of donated breast milk in Uganda. The study sought to assess the acceptability of using donated breast milk and associated factors among pregnant women at a private and a public hospital in central Uganda.

METHODS

This cross-sectional study enrolled pregnant women attending antenatal care at the selected hospitals between July and October 2020. All pregnant women recruited had already given birth to at least one child. Data were collected using a semi-structured questionnaire, and we recruited participants through systematic sampling. Used frequencies, percentages and means with standard deviations to summarize variables. Assessed the association between the acceptability of donated milk and selected factors by comparing their arithmetic means using a generalized linear model to allow for clustering at the health facility level. Used a normal distribution and an identity link and calculated the adjusted mean differences together with 95% CIs [generated using robust variance estimators to correct for model misspecification].

RESULTS

A total of 244 pregnant women with a mean age of 30 (± 5.25) years were enrolled. Sixty-one-point 5% (150/244) of the women reported that they would accept donated breast milk. Higher education (adjusted mean difference, technical versus primary level: 1.33; 95% CI 0.64, 2.02), being Muslim (adjusted mean difference, Muslim versus Christian: 1.24; 95% CI 0.77, 1.70), having heard of donated breast milk banking (adjusted mean difference, ever versus never: 0.62; 95% CI 0.18, 1.06) and presence of a serious medical condition (adjusted mean difference, preference of donated milk versus other feeds in a serious medical condition: 3.96; 95% CI, 3.28, 4.64) were associated with acceptability of donated breast milk.

CONCLUSIONS

The acceptability of using donated breast milk for infant feeding was high among pregnant women. Public sensitization and education campaigns are indispensable for the acceptability of donated milk. These programs should be designed to include women with lower education levels.

"It's just like a blood transfusion": perceptions on the use of donated breast milk in selected hospitals in central Uganda: a qualitative study

BACKGROUND

Breast milk is crucial for the nutritional and developmental milestones in the first two years of life. Uganda has recognized the need for a human milk bank as an opportunity that offers reliable and healthy milk to babies who lack access to their mothers. However, there is little information on the perceptions towards donated breast milk in Uganda. This study aimed to explore the perceptions of mothers, fathers, and health workers on the use of donated breast milk at Nsambya and Naguru hospitals in Kampala district, central Uganda.

METHODS

A qualitative descriptive study was conducted at Nsambya and Naguru hospitals in central Uganda. The study consisted of 8 focus group discussions (FGDs) of 6 participants each and 19 key informant interviews (KIIs) among mothers, fathers, and health workers. Participants were purposively selected. Data collected were transcribed, translated from Luganda to English, and analyzed using thematic analysis. All data were organized and managed in Nvivo version 12.0.

RESULTS

A total of 67 participants were involved in the study. Two main themes were identified: positive perceptions and negative perceptions. Participants linked donated breast milk to blood transfusion, believed it had nutrients comparable to the biological mother's milk, and thought it was an opportunity to avoid formula or cow milk and help babies that cannot access breast milk. However, the notable negative perceptions were; the feeling that donated breast milk is disgusting, could result in acquiring non-parental genes and traits, and that it was unsafe. Participants also feared that donated breast milk could be expensive and affect the bond between mother and child.

CONCLUSION

In summary, participants had positive perceptions about donated breast milk but were concerned about the potential side effects. Health workers should take extra precautions to ensure that donated breast milk is safe. The development of appropriate information and communication programs to sensitize the public about the benefits of donated breast milk will improve the uptake. Further research should focus on understanding the social-cultural beliefs regarding donated breast milk.

Impact of Donor Human Milk in an Urban NICU Population

The American Academy of Pediatrics recommends the use of donor human milk in infants when mother’s own milk is not available. Our objective was to analyze whether the use of donor human milk in preterm, very-low-birth-weight (VLBW, <1500 g) infants affected the rates of necrotizing enterocolitis, duration of parenteral nutrition (PN), growth, culture-positive sepsis, length of hospital stay, and mortality in an urban NICU population with low exclusive breast-feeding rates. A retrospective cohort study was conducted comparing two 2-year epochs of VLBW neonates before and after the introduction of donor breast milk in our neonatal intensive care unit (NICU). With the introduction of donor human milk, there was a significant reduction in the rate of necrotizing enterocolitis (NEC) (5% vs. 13%; p = 0.04) and less severe NEC as defined by Stage III based on the Modified Bell Staging Criteria (10% to 3%; p = 0.04). In the donor milk era, there was earlier initiation of enteral feeding (2.69 days vs. 3.84; p = 0.006) and a more rapid return to birthweight (9.5 days. 10.9 days; p = 0.006). In this study, a change in practice to the use of donor breast milk in a population with low rates of human milk provision was associated with earlier initiation of enteral feeding, faster return to birth weight, and a reduced incidence of NEC.

KUZEY SURİYELİ KADINLARIN SÜT BANKALARI VE SÜT BAĞIŞINA İLİŞKİN BİLGİ, GÖRÜŞ VE TUTUMLARININ DEĞERLENDİRİLMESİ

Amaç: Araştırmamızda Suriyeli annelerin süt bankası hakkındaki bilgi, tutum ve görüşlerini değerlendirmeyi ve bölgede süt bankalarının açılması için farkındalık oluşturmayı amaçladık. Metod: Çalışmamıza Kuzey Suriye bölgesindeki hastanelere 02/12/2020-02/03/2021tarihleri arasında başvuran 536 anne dahil edilmiştir. Süt bağışı ve süt damlası merkezi’ne ilişkin bilgi, görüş ve tutumları değerlendirmeye yönelik Arapça olarak hazırlanan anketimiz katılımcılara yüz yüze görüşme tekniğiyle uygulanmıştır. Bulgular: Katılımcıların tamamı kadın ve Müslüman, yaş ortalaması 29.79∓7.69 yıl idi. 47.2% katılımcı süt bankası kurulmalı, 37.5% katılımcı kurulmamalı görüşündeydi. Süt damlası merkezi kurulmasını onaylayanların 81.3%’ü bebeğini emziremediği durumda süt damlası merkezinden yararlanmak istediğini belirtti (p=0.000). Süt bankası kurulmamalı diyenlerin %49.4’ü dini sakıncalar nedeniyle istemediğini belirtti. Süt damlası merkezi kurulmasını destekleyen katılımcıların 41.5%’i, karşı çıkanların da 14.4% ü Türkiye güvencesi altında süt bankaları kurulmasının kendilerini olumlu etkileyeceğini ifade etti (p=0.000). Sonuç: Müslüman toplumlarda dini çekinceler nedeniyle süt bankalarına olumsuz bir bakış mevcuttur. Bu nedenle sağlam kayıt sistemlerinin oluşturulması ve dini önderlerin de sürece katılması, yine toplumun doğru bilgilendirilmesi ve eğitilmesi farkındalık yaratacak ve olumsuz bakış açısını değiştirecektir.

Human Milk for the Term Newborn

Human milk provides optimal nutrition for term newborns, but the prevalence of its use is below target, and risks have been identified. Infants of black mothers as well as term newborns admitted to the neonatal intensive care unit are at risk for not receiving human milk. To improve human milk intake, multiple individual-level interventions have been shown to be effective, but some popular system-level interventions are ineffective or harmful. Expressed milk and donor milk may be less beneficial than direct breastfeeding. Nuanced public policies can help support lactation while promoting individual choice and equity.

The Current State of Donor Human Milk Use and Practice

Human milk contains nutrients and immune factors that promote health and growth of an infant. Donor human milk is recommended as the best alternative for infants whose mothers' breast milk is unavailable. This article describes the current status of donor human milk practice and suggests the areas of educational and research needs. Articles published in the last 10 years were reviewed, and findings were summarized under 4 themes: (1) women's knowledge and concerns about donor human milk use, (2) hospital practices, (3) cost-effectiveness, and (4) access and affordability of donor human milk. Women were concerned about donor human milk contamination, disease transmission, cost, and access to bank donor human milk, due to lack of knowledge and awareness of donor human milk benefits and its processing procedures. The absence of health care providers' support for donor human milk adds to the confusion. There is a rising trend of donor human milk use in hospitals for both healthy and vulnerable newborns and infants with varying policies on screening for donor human milk use, cost coverage, or consent procedure. However, a shortage of safe and affordable donor human milk is a barrier to its adoption. A standardized guideline is needed for hospitals regarding donor human milk implementation and cost coverage. Education programs for health care providers are needed to improve knowledge and understanding of donor human milk benefits and safety to provide guidance to parents. It is crucial to develop legislation expanding insurance coverage to achieve donor human milk equity and optimizing long-term human milk diet outcomes.

Factors Affecting the Decision of Postnatal Mothers to Donate Milk at a Government Satellite Human Milk Bank Site, in KwaZulu Natal, South Africa

BACKGROUND

The need for donor human milk has accelerated both locally and globally. To remain sustainable, human milk banks need to maintain effective recruitment including frequent donations of adequate volumes.

RESEARCH AIMS

To determine (1) which factors influenced mothers' willingness to give or receive donor human milk, and the influence of (2) socio-demographics, (3) pregnancy, (4) breastfeeding history, (5) prior knowledge of human milk banks, and (6) general factors on milk donations.

METHODS

This was a cross-sectional, prospective, descriptive study. Interviewer administered questionnaires were used (N = 148). Independent sample t-tests and one-sample t-tests were used to determining differences in variables.

RESULTS

The sample population consisted of mainly single (n = 104, 70.3%) Black African mothers (n = 127, 85.8%) who identified as Christian (n = 97, 65.6%) with a mean age of 24.8 (SD = 5.63) years. The majority (n = 120, 81.1%) had no prior knowledge of human milk banks; however, most (n = 78, 52.7%) were significantly likely to donate. The main factors that influenced the participants' willingness to donate were altruism (n = 99, 66.9%), information provided by staff at hospitals/clinics (n = 92, 62.2%), amount of milk produced (n = 69, 46.4%), fear of not having enough milk for their own infant (n = 68, 45.9%), and support from family/friends/partner (n = 67, 45.3%).

CONCLUSION

There is a strong need to increase visibility and information sharing with potential donor mothers to ensure a sustainable supply and system of human milk banks.

Current Trends in Research on Human Milk Exchange for Infant Feeding

Breastfeeding is critical for the healthy growth and development of infants. A diverse range of infant-feeding methods are used around the world today. Many methods involve feeding infants with expressed human milk obtained through human milk exchange. Human milk exchange includes human milk banking, human milk sharing, and markets in which human milk may be purchased or sold by individuals or commercial entities. In this review, we examine peer-reviewed scholarly literature pertaining to human milk exchange in the social sciences and basic human milk sciences. We also examine current position and policy statements for human milk sharing. Our review highlights areas in need of future research. This review is a valuable resource for healthcare professionals and others who provide evidence-based care to families about infant feeding.