Discussion
Overall, we found a low degree of human milk banking awareness among the
study population given that only 27.3% of the participants had prior
knowledge of the practice. The awareness level observed is slightly
higher than what was recorded in a feasibility study in the country
which was conducted before the establishment of the only HMB in Kenya.
This study reported 23% of the respondents who took part in the
quantitative survey knew about the practice of human milk banking
(Kimani-Murage et al., 2019). The increase in awareness observed in our
study may be due to the current
human milk banking activities at the study site which may have exposed
mothers to the practice.
Similar studies conducted in other countries have established low human
milk banking awareness. A study among postnatal mothers in KwaZulu
Natal, South Africa reported that only 18.9% of mothers interviewed had
prior knowledge of human milk banking (Bhoola & Biggs, 2021). A study
among pregnant women in Uganda indicated that only 24.6% of respondents
knew about human milk banking (Namuddu et al., 2023). Additionally, a
study in Southeast China revealed that only 17% of postpartum women
interviewed knew about human milk banking (Tu et al., 2022).
Accordingly, our study’s findings that health professionals were the
most popular information source regarding human milk banking are in line
with findings from another study conducted in south-south Nigeria
(Abhulimhen-Iyoha et al., 2015). Contrarily, a survey in Turkey found
that 85.7% of respondents’ information sources for human milk banking
came from the media (Gürol et al., 2014). These differences might be
attributed to mothers in developed countries having greater access to
electronic media and internet compared to their counterparts in
resource-constrained regions.
Participants with human milk banking knowledge were more inclined to
accept DHM compared to those who had no prior knowledge about it. In a
comparable mixed-method study conducted in Ethiopia, women who were
aware of the practice were 5.8 times more inclined to use DHM in
comparison with those without prior knowledge of the practice (Gelano et
al., 2018). A cross-sectional survey in Nigeria found that acceptance of
donor human milk was significantly predicted by knowledge of human milk
banking (Iloh et al., 2018). According to a study conducted in Wuhan,
China, being knowledgeable on human milk banking was a significantly
associated with acceptance of DHM (Zhang et al.,
2020). Furthermore, another research conducted in
Southeast China showed prior knowledge of the practice was showed
positive association with willingness to accept DHM (Tu et al., 2022).
Most of the women interviewed had minimal experience with the use of DHM
and human milk donation. Only 10.9% of mothers had previously donated
while 11.9% reported to have used donor human milk to feed their
infants. This corresponds to a nationwide survey among women living in
America, where it was recorded that 12% of those interviewed had
previously donated human milk at an HMB and 6.8% had utilized donor
human milk for their newborns through the mom-to-mom milk sharing
initiative (O’Sullivan et al., 2018).
We were able to establish that mothers who had infants at the Special
Care Nursery (SCN) at our study site had a higher likelihood of having
used DHM. This conclusion is in line with the rise in DHM use in caring
for preterm babies across many developed nations over the previous
decade. Based on a nationwide survey conducted in 2013, 45% of Neonatal
Intensive Care Units (NICUs) in America used DHM largely to lower the
incidence of necrotizing enterocolitis in premature babies who were
unable to access mother’s milk (O’Sullivan et al., 2018). Clinical
demand for DHM is anticipated to rise due to the current expansion of
DHM use among NICUs and SCNs, which will increase the need for human
milk donation. To ensure a steady supply of DHM, it will be crucial to
raise awareness of the different settings in which DHM is used including
opportunities for donating human
milk.
The investigation highlighted the feasibility of human milk banking
practice. The majority (70.8%) of the women indicated they would give
their infants’ donor human milk, while 78.1% were open to the prospect
of donating human milk. Kimani-Murage et al reported similar results in
the country, stating that 59% of respondents would use DHM to feed
their babies and 79% of respondents would donate their breast milk
(Kimani-Murage et al., 2019). This observation is similar to that of a
research carried out in southeast China among women, which found that
44.6% of the participants were open to using DHM to feed their babies
and 73.4% of the participants would donate breast milk at an HMB (Tu et
al., 2022). Similar research where 448 mothers in Izmir, Turkey were
interviewed revealed that 71.3% would accept DHM and 68.8% would
donate human milk to an HMB (Ekşioğlu et al., 2015).
Mother’s primary reason for acceptance to donate human milk was to help
babies in need. Many participants were against the financial
compensation of human milk donors. Similar findings from Southeast China
(Tu et al., 2022) show that mothers’ motivation to donate was primarily
altruistic rather than motivated by financial gain.
Considering human milk banking is uncommon in many developing countries,
the bright outlook regarding the practice was not without drawbacks.
Even though most participants were positive about human milk donation,
some were reluctant to feed their babies milk donated by other lactating
women citing fear of disease transmission. The worry about the safety of
DHM corresponds to findings from studies in South Africa, and Turkey
(Coutsoudis et al., 2011; Ekşioğlu et al., 2015) where concerns about
the safety of DHM especially in settings with high HIV/AIDs prevalence
were singled out as major obstacles to DHM acceptance. Similar to our
study findings, most mothers in Australia reported they would give their
infants’ DHM if they had the surety it was safe (Mackenzie et al.,
2013).
Mother’s preference for donating breast milk over using human donor milk
is noteworthy, nevertheless. This can be explained by the maternal
protective instinct; while the satisfaction of helping another infant in
need makes them inclined to donate human milk, their worry of spreading
disease to their babies discourages them from using DHM.
Highly educated participants were more inclined to donating human milk
as well as using DHM for infant feeding. These results are comparable to
those of a New York study that examined postpartum women’s attitude
towards DHM and found that 64% of participants with higher education
agreed that DHM is more advantageous to babies (Pal et al., 2019).
Studies conducted in southeast Nigeria, and China showed that mothers
who are educated are more likely to know about DHM and to participate in
human milk banking (Iloh et al., 2018; Tian et al., 2021)