Human Milk for Vulnerable Infants: Breastfeeding and Milk Sharing Practice among Ghanaian Women

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.

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.

Untold Narratives: Perceptions of Human Milk Banking and Donor Human Milk Among Ghanaian Immigrant Women Living in the United States

BACKGROUND

Donor human milk (DHM) though primarily administered in the NICU setting is increasingly being offered in well baby nurseries to promote exclusive breastfeeding. Despite the evidence supporting the use of DHM as a preferred supplement when mother's own milk (MOM) is unavailable or insufficient, foreign-born non-Hispanic black women are less likely to use DHM. Recognizing the cultural diversity and uniqueness among foreign-born non-Hispanic black communities in the USA, this exploratory study sought to understand perceptions of DHM and human milk banking (HMB) as well as factors influencing decision-making toward DHM among Ghanaian immigrant women living in the USA.

METHODS

Semi-structured interviews were conducted with 16 Ghanaian women living in the USA. Using a narrative thematic approach, interview transcripts were coded, analyzed, and organized into categories and themes.

RESULTS

Findings indicate mixed sentiments toward DHM/HMB among Ghanaian immigrant women. Regarding decision-making toward DHM utilization and donation, four themes were identified: (1) women's decision-making which is informed by external influences, (2) health provider's role in promoting human milk utilization, (3) the importance of addressing barriers to human milk utilization and donation, and (4) superstition and spirituality.

CONCLUSIONS

Maternal perceptions of DHM/HMB are influenced by individual-, interpersonal-, and community-level factors. It is imperative that health promotion efforts adopt multi-level approaches to addressing the disparities in DHM access and utilization as well as factors that impact milk donation in order to ensure optimum health outcomes for neonates of foreign-born non-Hispanic black populations.

Acceptability of breast milk donor banking: A qualitative study among health workers in Greater Accra Regional Hospital, Ghana

Despite the compelling evidence demonstrating the immediate and long-term health advantages of prompt breastfeeding from birth, not all newborns are breastfed exclusively for a variety of reasons. As a result, the World Health Organization has made new recommendations for the adoption of breastmilk donor banks to make sure that children receive breastmilk when mothers are unable to produce it. In order to better understand how health professionals at the Greater Accra Regional Hospital, who would be leading the charge in putting this policy into practice, perceive and accept the practice of storing breastmilk, this study was conducted. At the Greater Accra Regional Hospital, 18 healthcare professionals were chosen using maximum variation purposive sampling procedures. They were made up of eleven midwives, a medical officer, six nurses, and two nutritionists and all participants were interviewed face to face using a semi structured interview guide. Data was transcribed verbatim and was analyzed using thematic analysis. Participants in the study admitted that they would be open to using or contributing to a bank of breastmilk. Participants also said that if safety precautions are taken, they would urge their customers to give breastmilk and recommend breastmilk from a breastmilk bank to them when the situation calls for it. Health professionals recommended that education be provided prior to the installation of breast milk donor banking to lessen or eliminate any misconceptions people may have about it. The concept of breastmilk donor banking was fairly accepted among health workers. Misconceptions about the safety of breast milk was the main concern. The results emphasize the necessity of greater stakeholder engagement and education prior to the implementation of this policy in order to boost acceptance and uptake.

Women's perspectives on human milk banking in Ghana: results from a cross-sectional study

Background

Although political and academic interest exists in Ghana to include human milk banks (HMB) into current maternal and child health programs, efforts to establish a HMB have not yet been subjected to any real empirical inspection with the view toward implementation. Furthermore, views toward the establishment of a HMB in Ghana have not been assessed among Ghanaian women. The aims of the current study were to examine Ghanaian women's views about HMB, and to investigate women's willingness to donate to a HMB.

Methods

Quantitative and qualitative responses were received from Ghanaian females (n = 1,270) aged 18+ years. Excluding outliers and missing data (n = 321), a final sample of 949 was retained for final analysis. Chi-square tests and logistic regression analysis were computed on quantitative data; Thematic analysis was performed on the qualitative responses.

Results

In our sample, 64.7% of respondents indicated that Ghana is ready for a HMB. The majority (77.2%) were willing to donate milk, and 69.4% believed that donating to the HMB would favor their child. The main concerns for the unwillingness to donate excess milk included: (i) the idea of HMBs as strange/bizarre (n = 47), (ii) fear of infections (n = 15), (iii) religious beliefs (n = 9), and (iv) insufficient information (n = 24). This study serves as the first step toward the development of a HMB in Ghana.

Conclusions

Overall, Ghanaian women support the building of a HMB to enhance infant nutrition and reduce childhood morbidity and mortality.

Efficacy and safety of acupuncture for postpartum hypogalactia: protocol for a systematic review and meta-analysis

INTRODUCTION

Breast milk is recognised as the best natural food for neonates, but many women experience postpartum hypogalactia (PH). Randomised trials have found that acupuncture exert therapeutic effect on women with PH. However, systematic reviews on the efficacy and safety of acupuncture are still lacking; therefore, this systematic review aims to evaluate the efficacy and safety of acupuncture for PH.

METHODS AND ANALYSIS

Six English databases (PubMed, Cochrane Library, EMBASE, EBSCO, Scopus, and Web of Science) and four Chinese databases (China National Knowledge Infrastructure, Wan-Fang, Chinese Biomedical Literature and Chinese Scientific Journal) will be systematically searched from their establishment to 1 September 2022. Randomised controlled trials of the efficacy of acupuncture for PH will be reviewed. The study selection, data extraction and research quality evaluation will be conducted independently by two reviewers. The primary outcome is the change in serum prolactin level from baseline to the end of treatment. Secondary results include milk secretion volume, total effectiveness rate, degree of mammary fullness, rate of exclusive breast feeding, and adverse events. A meta-analysis will be performed using RevMan V.5.4 statistical software. Otherwise, a descriptive analysis will be conducted. The risk of bias will be assessed using the revised Cochrane risk-of-bias tool.

ETHICS AND DISSEMINATION

This systematic review protocol does not require ethical approval because it does not include private information/data of the participants. This article will be published in peer-reviewed journals.

PROSPERO REGISTRATION NUMBER

CRD42022351849.