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)