A total of 23 participants were interviewed (Table 1). Participants’ ages ranged from 19 to 43 years old. Most of the mothers were not working; they were Christian and single. Their educational levels were high school, college or university, with an age range from 19 to 43 years old. Participants were new mothers, those with second babies, and almost half of them had three or more children.
Table 1
Demographic characteristics of participants
Variables | Categories | Number of participants | Percentage (%) |
Age (years) | 19–23 | 2 | 8.70 |
| 24–28 | 9 | 39.14 |
| 29–33 | 6 | 30.14 |
| 34–38 | 0 | 0.00 |
| 39–43 | 5 | 21.74 |
Employment status | Working | 4 | 17.39 |
| Not working | 19 | 82.61 |
Religion | ZCC | 8 | 34.78 |
| Apostolic Church | 7 | 30.43 |
| Christian | 3 | 13.04 |
| Not attending church | 3 | 13.04 |
| Muslim | 1 | 4.35 |
| Roman Catholic | 1 | 4.35 |
Education | High school | 17 | 73.91 |
| College/university | 6 | 26.09 |
Marital status | Single | 17 | 73.91 |
| Married | 2 | 8.70 |
| Living together | 4 | 17.39 |
Number of children including the current baby | 1 | 6 | 26.08 |
| 2 | 7 | 30.43 |
| 3 | 2 | 8.70 |
| 4 | 5 | 21.74 |
| 5 | 1 | 4.35 |
| 6 | 1 | 4.35 |
| 7 | 1 | 4.35 |
Data were analysed, and information shared by the participants was organized into three main questions: Are mothers aware of milk banking? Are mothers willing to accept donor milk? Are mothers willing to donate breast milk?
Seven themes were generated during analysis (Table 2).
Table 2
Summarized themes from interview data
1. Awareness of breast milk bank |
2. Passing of illness |
3. Bonding |
4. Lack of trust |
5. Positive impact of donor milk |
6. Making too much breast milk |
7. Assisting others |
Theme 1: Awareness of breast milk banks.
In this study, participants were mostly unaware of the existence of a breast milk bank in the hospital. Out of twenty-three mothers, only eight mothers were aware of the breast milk bank, and 15 mothers were unaware. For the record, this is the first time I have heard of a breast milk bank. It’s a new story for me” (P001A).
When participants were aware of the breast milk bank, it was not always due to nurses in the wards: “I just asked myself where this milk is coming from, I looked it and asked myself if it is a formula or what. Then, I asked this woman next to me she told me that is donor milk” (P0018B). When information was from a nurse, it was “from the nurse who is working at the breast milk bank requesting mothers to come and donate breast milk” (P002B).
Participants were also unaware of any supply of donor milk in their community: “No I am not aware of mothers who are supplied with donor milk” (P0010C). In one case, the idea was so unfamiliar that although the participant could understand the value, they could not consider participating: “No. I do not disagree with you, but it’s a big deal and it will be challenging for me to give someone my milk this is the first time, I have heard of it. I am even afraid”. (P0016B)
Participants were unaware of this programme and reflected on the cultural aspect: “It is difficult for me to accept breast milk donated by someone, especially if you hear about it for the first time. It is an emotional process from a cultural point of view. I should be trusting that person if that person was my family member I can understand.” (P0016B)
The use of another person’s milk is a deeply personal decision that must be made at an emotional time, but one that is also clearly rooted in a cultural perspective.
Theme 2: Passing on illness.
This concern regarding the safety of the milk and the fear of contracting HIV through breast milk was evident in this study. Participants mentioned that they would accept donor breast milk if the milk was pasteurized due to the unknown status of some of the donors: “Yes, I will agree if the milk is cleaned because I do not know the status of other women” (P002B). In some cases, mothers could not donate even if they were willing due to their HIV status: “No, I am not donating because am drinking medication for HIV. I will not be able to donate”. (P0019E)
This concern about the safety of donor breast milk was prominent, especially about HIV infections: “I do not feel comfortable donating due to infections unless am forced by situations. Even with blood donation I do donate, I do not want somebody’s blood. There are many infections these days”. (P0022C)
A participant added that “It is just a health problem; people are sick these days with different diseases. In case, there can be some mistake, what will happen if my baby gets infected?” (P005D). On the one hand, it was the safety of the donor breast milk and the unknown HIV/AIDS status of the mothers who donated, but there was also a fear among mothers who are willing to donate but do not know their HIV status: “I am scared because of the high level of infections around the world. I do not know if my breast milk has some infections, and if they test me and find it positive for infections, I will be stressed” (P0023D).
Theme 3: Bonding
A significant emotional concern among the participants whose babies were possible recipients of donated milk was the relationship between the recipient baby and that donor mother: “I am asking if there will be no bond created by the intake, but if they are cleaning the milk for the concentration of germs perhaps it may address my concern on the bond that my baby can have with that donor” (P008B).
The unique bond between mother and baby and the potential interference of the use of donated milk was a real concern: “I will accept as long as the mother who is donating will not look at my baby in the eyes, or face so that the baby will not feel or think that the person is her mother, there must not be a bond between the two” (P0015B).
Participants in some instances were not sure what to say about milk donation and raised major breastfeeding benefits that their babies can benefit from the breast milk “No, I do not know why, I would like my baby to feel me, and we have a connection, it will be like drinking water, I want skin to skin and blood to blood”. There must be a bond between me and my baby. “My baby must feel my heartbeat.” (P0023D)
Theme 4: Lack of Trust
The concern was so serious that in one instance, one participant would only accept the donor breast milk if there is a consent form signed between her and the hospital, detailing that if something happens to her baby because of donor breast milk, the hospital is liable: “I will accept if there is an agreement form that we sign both of us in case something can happen to my child” (P0014B).
Accepting donor breast milk was not a problem for the participants if certain requirements were met: “Yes, I accept donor milk on conditions that the milk is first checked and cleaned before usage” (P0018C) and in particular “if the milk will be cleaned and checked for diseases” (P0021F).
The concern for safety was raised by most women in the study: “I will accept donor breast milk only when it is checked and cleaned for diseases” (P0017A)
It was mentioned by participants that during their stay at the hospital, a nurse working at the HBMB explained the requirement for a donation of breast milk and one of them was normal blood pressure in some cases, this was a reason not to participate:” I will not donate yesterday I heard nurses saying if your blood pressure is high you will not be allowed to donate.” (P0019E)
Participants were resistant to the idea when they had no personal need: “Hmmm, no, I won’t agree, to take milk from another woman I have never done that before. Milk from another woman mmm, how will it be? No, no, I won’t agree but I know that a breastfed baby is healthy” (P003D)
Theme 5: Positive impact of donor milk.
The unavoidable reality is that some additional milk is needed when mothers cannot produce enough milk: “I don’t have enough milk and the donor milk is assisting me a lot and my baby is growing well.” (P006B)
Most of the mothers in the neonatal ward had insufficient milk, and donor breast milk was the only option they had: “It is sad for me because I am unable to produce enough milk for my baby and donor breast milk is assisting milk to feed my baby.” (P009A)
One participant said, “I have no issues using donor’s breast: “I was not having any problem with donor milk because I don’t have enough milk and my baby was getting donor milk” (P004B).
The low milk supply for mothers has made mothers see the importance of donor human milk, and they even ask if they can be given the same milk on discharge to feed their babies at home: “When going home, what is going to happen to my baby because am having insufficient milk” (P0011B)
In some cases, this lack of milk was only temporary: “Yes, I did accept donor breast milk as it was assisting my baby while am waiting for my milk to flow. The donor milk was explained to me. It is a good thing, and the milk will make my baby grow well”. (P0010C)
Theme 6: Making too much breast milk.
Participants were willing to donate breast milk when they experienced an oversupply of their breast milk: “Yes, my breast becomes full of breast milk which I may donate” (P001A).
The eagerness to donate was motivated by the impulse to prevent waste and help others: “I will donate breast milk because from my previous breastfeeding experience,
my breast had more milk, and it was free flowing. It is not good to just let breastmilk get wasted.” (P0010C)
The amount of milk that mothers produce is what determined if the participant would consider a donation: “No, I do not agree to donate milk. My child must get enough milk first, if there is no extra milk, I will not manage” (P005B) because “It is not easy; you can’t be feeding someone’s child while yours is dying of hunger” (P005D).
Theme 7: Assisting others.
In some cases, this impulse was a result of being a previous beneficiary of the programme: “I am aware that donor breast milk helps new-borns who aren’t getting enough milk and it has helped me as well, so I want to help others as well (P007F). The life-saving aspect of donated milk was clear: “I will donate milk because I want to save lives” (P0020E) but also to stand in for those mothers who had passed on: “I want to assist those babies whose mothers had passed on” (P001A).
Most participants were not comfortable receiving breast milk. Out of twenty-three mothers, ten mothers were willing to receive without hesitation, while thirteen were not comfortable and stated their uncertainty. The lifeline that donor breast milk represents was clear: “Yes, I will accept donor milk, I see donor breast milk like any other milk which is important, if you do not breastfeed, the baby will not grow well. The baby may be hungry, which may result in him crying and getting sick because of poor feeding.” (P007F)
Breast milk, even if donated, was considered superior to the formula: “Yes, I will agree because these babies need breast milk, and the formula is not good for them” (P004D)
and the potential consequences of not getting enough breast milk were known: “In my personal experience I know that if babies who are not getting enough breast milk, they may develop diseases such as like jaundice, eye problem, and they can become sick” (P001A).
Most mothers in the study were willing to donate; out of twenty-three mothers, fifteen mothers were willing to donate, and only eight mothers were not willing. In some cases, the case would have to be severe enough to overcome a personal aversion to breastfeeding:” I don’t have a reason to donate, only in desperate situations to assist in severe cases. I don’t like breastfeeding personally; it makes me scared” (P0015B).