See discussions, stats, and author profiles for this publication at: [Link]

net/publication/331942375

Factors Influencing Donations to Human Milk Bank: A Systematic Review of

Facilitators and Barriers

Article  in  Breastfeeding Medicine · March 2019

DOI: 10.1089/bfm.2019.0002

CITATIONS READS
24 1,122

3 authors, including:

Leila Doshmangir
School of Management and Medical Informatics Tabriz University of Medical Sciences
160 PUBLICATIONS   7,393 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Primary health care View project

Hospital Autonomy View project

All content following this page was uploaded by Leila Doshmangir on 10 April 2020.

The user has requested enhancement of the downloaded file.

 BREASTFEEDING MEDICINE
Volume 14, Number 5, 2019 Review
ª Mary Ann Liebert, Inc.
DOI: 10.1089/bfm.2019.0002

Factors Influencing Donations to Human Milk Bank:

A Systematic Review of Facilitators and Barriers

Leila Doshmangir,1,2 Maryam Naghshi,3 and Roghayeh Khabiri4

Abstract

Introduction: Mother’s own milk has long been accepted as the best source of nutrition for the newborn. In those
cases where mother’s milk is not available, the best choice is the human milk provided by selected donors. Human
Downloaded by [Link] from [Link] at 04/10/20. For personal use only.

milk banks are the most institutionalized method of milk sharing and play a vital role for neonates that cannot be
breastfed. This study aims at systematically reviewing factors influencing donation to human milk banks.
Materials and Methods: A systematic review of the literature was performed on authentic electronic resources,
including PubMed, Scopus, Embase, ScienceDirect, and Web of Science with no time limitation. To increase the
sensitivity and to find additional studies for systematic review, the reference list of the published studies was
examined as well. Data extraction and quality appraisal were carried out by two independent reviewers. The study
was qualitatively summarized to generate descriptive and explanatory themes that emerged from the literature.
Results: From a total of 1,157 articles, 31 met the inclusion criteria in which 64 factors are extracted. From
these, 26 factors act as barriers and 38 factors act as facilitators of milk donation. Having excess milk, altruism,
and helping other babies are found to be the most important facilitators of milk donation, while the most
important barriers are religious and cultural concerns.
Conclusion: Developing practical strategies to attract milk donors are crucial for successfully establishing
human milk banks. These include providing reliable information regarding the milk bank goals and functions
and developing breastfeeding polices with regard to differences in countries’ contexts and trying to resolve any
uncertainties regarding milk donation, especially those arising for religious concerns.

Keywords: breastfeeding, milk bank, mother’s milk, breast milk, milk donation

Introduction are widely acknowledged, not all neonates are able to

breastfeed. Infants such as very preterm (before 37 completed

M other’s milk has long been accepted as the best

source of nutrition for the newborn particularly during
the first days of life.1 The World Health Organization (WHO)
weeks of gestation) and/or very low birth weight, as well as
other sick newborns, are at greatest risk of not receiving their
own mother’s milk. Therefore, in case of insufficient or un-
recommends breastfeeding as the exclusive nutrition for in- available mother milk, the WHO and other international
fants until the age of 6 months.2 The health benefits of scientific societies in the field of Pediatrics recommend that
breastfeeding for infants include promoting an improved host the preferred choice before formula is the donor milk from a
defense and gastrointestinal function, reduced acute respira- human milk bank.1,7 Human milk banks are nonprofit health
tory infection and diarrhea deaths, improved cognitive and institutions organized for the collection, processing, and
physical development, and reduced risk of infectious diseases distribution of donated human milk and supporting breast-
in infancy.1,3–6 Although the health benefits of breastfeeding feeding in preterm infants.1 The practice of milk banking is

1
Department of Health Services Management, Tabriz Health Services Management Research Centre, Iranian Center of Excellence in
Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
2
Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of
Medical Sciences, Tabriz, Iran.
3
Department of Knowledge Translation, National Public Health Management Center (NPMC), Tabriz University of Medical Sciences,
Tabriz, Iran.
4
Department of Health Management, Tabriz Health Services Management Research Center, Health Management and safety Promotion
Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.

298
 FACTORS INFLUENCING DONATIONS TO HUMAN MILK BANK 299

well over 100 years old and older than blood banking.8 In Data analysis
1909 the first human milk bank was established in Vienna,8 Facilitators and barriers to milk donation were extracted
with the second to follow in the United States in Boston in using content analysis and were divided into individual,
1919.7,9 Today, human milk banks have been established systemic, and social factors. In analyzing content of publi-
throughout the world. It is estimated that the number of hu- cations we systematically compressed words of text into
man milk banks in Europe increased to 233 active human fewer categories based on explicit rules of coding. Categories
milk banks in 28 countries within Europe, with 14 more were established following some preliminary examination of
planned as of November 2018,10 Asia 44, Australia 5, Africa the data.
10, United States and Canada 26, South America 258, and
Central America, including Caribbean islands 45, by 2015.11
To develop and provide high performing human milk Results
banks, it is important to identify the factors that inhibit or From a total of 1,157 articles, after excluding duplicates, a
facilitate milk donations. Thus, the purpose of this article is to total of 541 studies were screened. Fifty-six full-text articles
systematically review the factors that affect donations to were assessed for eligibility, of which 31 studies met the
human milk banks. inclusion criteria. The flowchart of the selection process in
the systematic review is shown in Figure 1. Generally, the
Methods included studies were of moderate-to-good quality based on
the JBI quality assessment scale. The characteristics of the
Study search and selection strategy included articles are presented in Table 1. The articles were
Downloaded by [Link] from [Link] at 04/10/20. For personal use only.

The systematic review of the literature was performed to published between 2000 and 2018. The mean age of the
identify factors influencing milk bank donations around the participants ranged between 24.73 and 42 years. The sample
world. The search was conducted on five databases, including sizes of participants varied from 7 to 1,042, with a total
PubMed, Scopus, Embase, ScienceDirect, and Web of Sci- sample size of 6,057 people. The participants of the included
ence, on December 16, 2018. Search terms included: milk studies were from 17 different countries or regions, including
bank, human milk, mother’s milk, breast milk, donate, milk United States,13,14 Brazil,15–19 Australia,20–22 France,11,23,24
sharing, breastfeed, and breastfeeding. Kuwait,25 South Africa,26 Spain,27,28 Turkey,29–33 India,34 and
The systematic review was conducted using the Preferred Ethiopia.35 Most of studies used a cross-sectional and a qual-
Reporting Items for Systematic Reviews and Meta-analysis itative design.
(PRISMA) guidelines.12 In all these studies, the donors were highly educated, and
Extracted articles were screened based on titles, abstracts, the numbers of donors with one to three children were higher
and full texts. Afterward, citation search and manual search than those having more than three children.
were performed in Google Scholar. All these steps were With regard to the factors related to milk donation of the
conducted by two researchers (L.D. and M.N.). To find rel- participants, based on the predefined criteria, 29 studies were
evant studies, reference lists from the selected publications reviewed and 128 factors were identified. Sixty-four factors
were also screened. remained after removing redundant ones: 26 barriers and 38
facilitators of donations to human milk banks (HMBs).
The reviewed facilitators and barriers to milk donation
Inclusion and exclusion criteria
were divided into individual (donor), systemic (health sys-
English language, peer reviewed published studies were tem), and social factors. The list of facilitators and barriers is
included with no time limitation. Publications of any level presented in Tables 2 and 3, respectively. Among individual
of evidence, including abstracts, conference proceedings, facilitators, ‘‘having excess milk,’’11,13,16,17,20–25,27,28,36,37
commentaries, and editorial articles, and full text of original ‘‘hoping someone else will do the same for them if need-
articles and systematic reviews were included in the review. ed,’’23,24,27 and ‘‘a strong belief in the value of human
Other studies that did not focus on the factors related to the milk’’13,27 were the most frequently cited. In systemic fa-
donated milk, donors, and the reasons for donation were cilitators, ‘‘health staff and professionals’’15,18,21,27,28,37 and
excluded. ‘‘education’’21,25,26,30,33,34 were, respectively, the most im-
portant factors. ‘‘Altruism’’17,22–24,27,28,36,37 and ‘‘helping
Data extraction others’’13,14,21–24,37 were among the major social facilitators
of milk donation. ‘‘Religious beliefs’’11,16,20,26,30–33 in Is-
A data-extraction sheet was developed in Microsoft Excel. lamic countries and ‘‘lack of knowledge about milk bank-
Characteristics of the studies that were included are as fol- ing’’13,17,20,21,35 were significant social barriers.
lows: first author of the article, publication year, participants’
country of origin, type of participants and their mean age, Discussion
sample size, and study design.
The majority of the studies included in this study were a
qualitative study and involved both developed (i.e., United
Quality appraisal
States, Spain, France, and Australia)36 and developing
Owing to the wide range of included studies, we used the countries (i.e., India, Kuwait, Turkey, South Africa, Ethiopia,
Joanna Briggs Institute ( JBI) checklists according to the type and Brazil).36
of included studies. Two researchers independently appraised The main facilitators of milk donation were individual and
the quality of included studies. All discrepancies were re- social factors. Major barriers to milk donation were systemic
solved through consultation with the third reviewer. and social, the most important of which was religious beliefs.
 300 DOSHMANGIR ET AL.

FIG. 1. Article search and review

flowchart of studies.
Downloaded by [Link] from [Link] at 04/10/20. For personal use only.

The religious beliefs is an important challenge in Islamic A study on Spanish milk donors showed that the main
countries, where it is believed that a woman’s milk creates motivations to donate were as follows: belief in the benefits
kinship and an impediment to marriage.11,33 of breastfeeding, altruism, hoping someone else will do the
In preterm infants, physiological functions and behavioral same for them if needed, and having milk surplus.27 Milk
characteristics required to adapt to the environment outside bank information and perceived social and family environ-
the womb are not fully developed. Neonatal intensive care ment were the main factors that influenced the decision to
unit (NICU) provides an environment where the child can become a human milk donor. Moreover, lack of knowledge of
develop with minimal damage.29 One important action taken other health professionals, distance from the milk bank, in-
in NICU is to feed preterm newborn infants with donated comprehension at work, and reduction of milk by the process
human milk. of breastfeeding itself were identified as the main barriers to
A study in India showed that the number of deliveries was milk donation.27
inversely related to milk donation, and for the donors that Encouragement of a health professional can be a major
have fewer children, milk donation is linearly related to ed- reason for donating human milk, as donors come to know of
ucation and was not affected by income.34 the need for donor milk and feel that it is a social responsi-
Fluid intake, type of diet, and presence of negative emo- bility.18 Also people who have previously donated their milk
tions are mentioned in the literature as factors influencing the can encourage new people to become milk donors.23
increase or decrease in milk production, and milk banks can Mothers with perinatal loss can potentially become milk
have a positive effect on milk donations by supporting the donors if they are well trained and supported by an HMB. By
donors.19 donating their milk, they can identify as a mother again and
In a study on 27 donors, most of whom were white, edu- more easily deal with their loss.14
cated, married, and with middle income, 5 reasons were It has been shown that there are obstacles to establishing
identified as to why women with a surplus of milk come to the HMBs in Muslim countries. Some mothers refuse to donate
decision to share their milk with a peer rather than donate to a their milk due to religious concerns, and even some families
milk bank: a strong belief in the value of mother milk, un- avoid receiving donated milk.11 al-Naqeeb et al. propose a
expected versus planned donation, sources of information culturally accepted approach to donor milk banking and ar-
regarding milk exchange, concerns and knowledge gaps gue that HMBs in Muslim countries should require the donor
about milk banks, and helping and connecting.13 and the receiver to know each other’s identity.25
 Downloaded by [Link] from [Link] at 04/10/20. For personal use only.

Table 1. Descriptive Statistics of the Included Studies (n = 31)

Sample Age mean
No. Author (year) Country Study type size Target group (range) Donor characteristics Quality
13
1 Perrin et al. (2016) United States Qualitative study 27 Women who had shared milk with a 28.6 (21–35) Average No. of children: 1.7 Moderate
peer, but not with a milk bank Education: 19 (70.3%) donors with college
education; 8 (29.62%) donors without
college education
Race: White (81.4%)
2 De Alencar and Seidl Brazil Exploratory, cross- 36 Women enrolled in two HMBs of the 24.7 (14–33) Moderate
(2010)19 sectional public health system of the Federal
District
3 Gribble (2013)20 Australia Descriptive study 139 98 Milk donors and 41 milk recipients 30 Average No. of children: 1.7 Good
4 Pimenteira Thomaz Brazil Cross-sectional survey 666 737 Human milk donors to all the 39.4 No. of children: donors with 0–3 children; 43 Moderate
et al. (2008)18 HMBs in the State of Alagoas, donors with 4–7 children; 9 donors with >8
Brazil, from March 2004 to February children
2005 Education: 402 donors with primary education;
245 with secondary education; 39 with
higher education; 40 with no education
Employment: 188 employed; 437 employed
5 Osbaldiston and France Survey 106 87 Donors and 19 nondonors — Age: 18% 25–29 years; 48% 30–34 years; 25% Good
Mingle (2007)23 35–39 years
Education: 17% with no college education;
53% with bachelor’s degree; 30% with
master’s degree
Employment: 40% full-time employees; 25%

301
part-time employees; 35% unemployed
Race: 87% White; 8% Asian; 5% other
ethnicities
No. of children: 39% with 1 child; 41% with 2
children; 14% with 3 children
6 Welborn (2012)14 United States Qualitative study — 21 Bereaved mothers who donated their — — Moderate
milk
7 Mackenzie et al. Australia Qualitative study 21 12 Mothers who were breastfeeding — — Moderate
(2013)21 and/or had preterm or sick babies; 5
mothers as potential donors for focus
group and 4 mothers of preterm or
high-risk infants for other focus
group
8 al-Naqeeb et al. Kuwait Report Three case histories are used to describe — — Poor
(2000)25 the process by which milk donation
was made possible in an intensive
care unit in a Kuwaiti hospital
9 Coutsoudis et al. South Africa Qualitative study 20 8 Focus group discussions: 20 mothers; — — Moderate
(2011)26 5 grandmothers; 4 partners; 8 nurses;
11 doctors
10 Azema and Callahan France Cross-sectional study 103 Women 30.6 (20–42) No. of children: 46.6% with 1 child; 35.9% Moderate
(2003)24 with 2 children; 13.6% with 3 children;
3.9% with 4 children
Employment: 51.5% full-time employees;
48.5% unemployed
(continued)
 Downloaded by [Link] from [Link] at 04/10/20. For personal use only.

Table 1. (Continued)
Sample Age mean
No. Author (year) Country Study type size Target group (range) Donor characteristics Quality
11 Alencar and Seidl Brazil Exploratory, cross- 36 Women registered at two HMBs 24.7 (14–33) No. of children: 61.1% with 1 child; 30.6% Moderate
(2009)17 sectional, with 2 children; 8.3% with >3 children
descriptive study Employment: 2.8% freelancers; 5.6%
unemployed; 41.6% employees; 2.8%
workers; 5.6% students; 41.6% housewives
12 Machado et al. Spain Descriptive, 7 Women who donated milk — Age: age range of 21–39 years; average age of Good
(2015)27 qualitative study 32.42 years
Education: 100% educated donors
Employment: 6 employed; 1 student
No. of children: 4 donors with 1 child
(57.14%); 3 donors with 2 children
(42.85%)
13 Karadag et al. Turkey Descriptive, cross- 1,042 Mothers who delivered their babies at — Moderate
(2015)32 sectional Inonu University Turgut Ozal
Medical Centre and Malatya State
Hospital
14 Gribble (2014)22 Australia Descriptive 97 Milk donors from North America, 30 Average No. of children: 1.7 Good
Europe, Oceania, and Asia
participated in the study
15 Gürol et al. (2014)31 Turkey Descriptive 350 Women referred to family health — — Moderate
centers
16 Khalil et al. (2016)11 France Review — — — —
17 Eksxioğlu et al. Turkey Cross-sectional, 404 Mothers who gave birth in two 28.4 (16–46) Age: 5.4% <20 years; 58.9% 20–30 years; Moderate

302
(2015)30 descriptive study maternity hospitals and one 21.06% 26–30 years; 7.7% 30 years and
_
university hospital in Izmir above
Education: 45.5% primary school, 20.5%
secondary school, 25% high school, 8.9%
university
Employment: 82.2% unemployed; 17.8%
employed
No. of children: 75.7% with >3 children
18 Katke and Saraogi India Retrospective study 948 — — Age: 10.4% 20 years and lower; 60.8% 21–25 Poor
(2014)34 years; 21.1% 26–30 years; 7.7% 30 years
and above
Education: 32% uneducated; 36.9% primary
education; 22% up to secondary school; 6%
up to junior college; 2.2% graduate degree;
0.8% postgraduate degree
Religion: 43% Hindu; 52.11% Muslim; 3.1%
Catholic; 10% other
19 Martı́nez-Sabater Spain Review — — — — Poor
et al. (2014)28
20 dos Santos et al. Brazil Cross-sectional study 155 Donors (18–34) Education: 85.2% students Moderate
(2017)16 Employment: 45.2% unemployed; 54.8%
employed
(continued)
 Downloaded by [Link] from [Link] at 04/10/20. For personal use only.

Table 1. (Continued)
Sample Age mean
No. Author (year) Country Study type size Target group (range) Donor characteristics Quality
21 Meneses et al. Brazil Cross-sectional study 695 Mothers of children under 1 year (13–45) Age: 22.7% 13–19 years; 77.3% 20–45 years Good
(2017)15 of age Education (level of schooling): 22.4% up to 7
full years; 77.6% 8 full years or more
Ethnicity: 73.5% Non-White; 26.5% White
22 Senol and Aslan Turkey Cross-sectional, 231 Married women 30.2 Education: 44% primary education Moderate
(2017)29 descriptive study 22% were smokers
Average No. of children: 1.4 – 2.4
23 Gelano et al. (2018)35 Ethiopia Cross-sectional, 1,085 The breastfeeding and pregnant mothers 27.7 Age: 90.7% 18–34 years; 9.3% 35–48 years Moderate
descriptive study Education: 24.8% illiterate; 75.2% literate
Employment: 59.5% house wife; 12.4%
trading/merchant; 18% government
employed; 10.1% private employed
Religion: 27.8% Orthodox; 65.5% Muslim;
1.4% Catholic; 5.3% Protestant
No. of children: 76.2% with 1–3 children;
23.8% with 4 and over children
24 Perrin et al. (2014)40 United States Mixed-methods 954 Individuals participating in milk sharing — — Moderate
observational study
41
25 Cole et al. (2018) Philadelphia Case report Two case examples for milk donation — — Moderate
after perinatal loss
26 Ergin and Uzun Turkey Cross-sectional, 240 Mothers who gave birth within the past (15–49) Age: 62.1% 19–29 years; 37.9% 30–45 years Moderate

303
(2018)33 descriptive study 5 years and who were in a family Education: 50.8% primary school or less;
health center in Honaz, Denizli, 49.2% secondary school or higher
Turkey Employment: 15.4% working; 84.6% not
working
27 Candelaria et al. United States Qualitative, 12 12 Human Milk Banking Association of — Age: 50.0% 20–29 years; 50.0% 30–39 years Moderate
(2018)37 phenomenological North America (HMBANA)- No. of children: 50.0% with 1 child; 33.3%
design approved milk donors older than 21 with 2 children; 16.6% with ‡3 children
years with infants hospitalized in the
NICU
28 Arnold (2006)42 Brazil Review — — — — Moderate
29 Iloh et al. (2018)43 Nigeria Cross-sectional 1,235 Mothers who were pregnant or 31.1 Age: 6% <20 years; 41% 20–29 years; 42% Good
multicenter study breastfeeding or have a child that is 30–39 years; 11% ‡ 40 years
<1 year Education: 5% primary education or less; 32%
completed secondary; 63% postsecondary
Employment: 25% unemployed; 23%
unskilled or low earners; 35% semiskilled
or middle earners; 17% skilled or high
earners
30 Gibbins et al. Canada Review — — — — Moderate
(2013)44
31 Williams et al. United Systematic review — — — — Good
(2016)45 Kingdom
HMBANA, Human Milk Banking Association of North America; NICU, neonatal intensive care unit.
 304 DOSHMANGIR ET AL.

Table 2. Facilitators Influencing Milk Donation Table 3. Barriers to Milk Donation

Individual facilitators Individual barriers
(1) A strong belief in the value of breastfeeding13,27 (1) The need for the donor to plan for donating
(2) Helping and connecting13,17,37 to the milk bank13
(3) Having excess milk11,13,16,17,20–25,27,28,36 (2) Anonymity of the identities of donors and
(4) Knowledge of the benefits of mother milk for preterm recipients20,32
infants13 (3) Not qualifying for milk donation20,46
(5) Sense of satisfaction gained from helping a child20,41 (4) Milk pasteurization13,35
(6) Understanding the needs of the babies18,41 (5) Willingness to help mothers and children that are
(7) Social involvement18 not considered qualified by the milk bank20
(8) Having a history of milk donations23 (6) Pumping inconvenience13,20
(9) Knowing the needs of the milk bank23 (7) Donating milk through unofficial channels20,21
(10) Hoping someone else will do the same for them if (8) Reduction of milk17,27
needed23,24,27,37 Systemic barriers
(11) Having a positive attitude toward milk donation21 (1) Lack of health care centers as a source of information
(12) Avoiding waste17,36 about milk exchange13
(13) Feeling of motherhood following a perinatal loss14,41 (2) Lack of milk banks20,21
(14) Finding meaning in and integrating the experience of (3) Time-consuming process20
perinatal loss14 (4) The milk bank process13,20,21
(15) A way for bereaved mothers to grieve their loss14 (5) Lack of knowledge of other professionals27
Downloaded by [Link] from [Link] at 04/10/20. For personal use only.

(16) Pumping milk to stimulate lactation24 (6) Lack of access to the milk bank27,46
(17) Having self-confidence17,37 (7) Lack of support from health professionals21
(18) Financial inducement43 (8) Long screening tests25
Systemic facilitators (9) Absence of personal connection in donating milk to a
(1) Verbal encouragement to donate19 milk bank13
(2) Support from the milk banks for the donor19 Social barriers
(3) Benefits for donors19 (1) Lack of knowledge about milk banking13,17,20,21,35
(4) Provide guidance on appropriate procedures for (2) Misconceptions about the costs of milk banks13,20
collection and storage of milk at home19 (3) Not knowing whether the milk bank is for profit or
(5) Financial support19 nonprofit13
(6) Provision of information about donating during (4) Misinformation27
pregnancy/prenatal care19,21 (5) Resistance to creation of Western-style milk banks32
(7) Visits of donors to the HMBs to understand the (6) Religious beliefs11,16,20,26,30–33,35
process of pasteurization17,19 (7) Cultural beliefs11,31
(8) Health staff and professionals15,18,21,27,28,37,41 (8) Incomprehension at work27
(9) Supporting bereaved mothers in their lactation (9) Concerns about the safety of the donated milk21,26,30
needs14,41
Social facilitators
(1) Friends15,18,27
(2) Family17,18,21,27,28
(3) Sources of information regarding milk exchange13,27 Wet-nursing for full-term babies is a well-recognized
(4) Altruism17,22–24,27,28,36,37 practice in Kuwait and Turkey,25,33 but in Kuwait the
(5) Helping others13,14,21–24,37 Western-style milk donation for preterm babies in NICUs is
(6) Media17,19,21,30 not formally organized.25
(7) Advertising18 In Sweden, a single-donor policy is in place, and pooling of
(8) Education21,25,26,30,34 donated milk is not recommended so as to allow for tracking
(9) Social values34 infection and certain factors.38
(10) Society21,27,36 A study on mothers’ knowledge of and attitudes toward
(11) Local culture34 human milk banking in South Australia showed that the
participants unanimously supported donating their milk to a
human milk bank, provided it would be easy and not time
consuming. Health staff and professionals were identified as
In Turkey, 98% of the population has religious beliefs.32 In an important source of information for donors. This study
the study of Gürol et al., 90.6% of the 350 nursing mothers also recommended extensive advertising to inform the gen-
had no previous knowledge of human milk banking and, after eral public, parents, donors, and receivers.21
being informed of such a place, 64% said that they would Religious beliefs and concerns due to the risk of infectious
donate their milk. Of the participants, 36.3% expressed some diseases were found to be the most important barriers to the
kind of religious concerns, and 28.9% believed that it would establishment of milk banking in Turkey, and efforts should
lead to social and moral problems.31 Turkish people support be made by health care providers and the media to raise
an HMB that follows a single-donor policy, whereby the awareness about the importance of mother milk and breast-
child received milk from a single donor, and both the donor feeding.30
and the receiver know each other’s identity.32 In the Ethiopia Regarding concerns about transmission of genetic material
due to lack of information and misconceptions about the from the donor to the infant that receives her milk, evidence
safety of breast milk, the acceptance of breast milk donation has shown that these materials are removed during the pro-
for banking and its use for feeding infants is very low.35 cess of pasteurization.39
 FACTORS INFLUENCING DONATIONS TO HUMAN MILK BANK 305

Given the difficulties and the complexity of establishing 10. Clemens J, Gottlieb JD. Do physicians’ financial incentives
HMBs in Islamic countries, taking certain measures can be affect medical treatment and patient health?. Am Econ Rev
effective in the development of milk banking in these coun- 2014;104:1320–1349.
tries. The HMB must pasteurize the milk it receives and 11. Khalil A, Buffin R, Sanlaville D, et al. Milk kinship is not an
provide it to newborn infants that are prone to risk, such as obstacle to using donor human milk to feed preterm infants
preterm babies weighing <2,000 g. Implementing a single- in Muslim countries. Acta Paediatr 2016;105:462–467.
donor policy allows for the donor and the receiver to know 12. Moher D, Yoon U, Vogt PM. Preferred reporting items for
each other and pooling milk from at least three donors can systematic reviews and meta-analyses: The PRISMA
help alleviate religious concerns.11 statement. PLoS Med 2009;6:e1000097.
13. Perrin MT, Goodell LS, Fogleman A, et al. Expanding the
supply of pasteurized donor milk: Understanding why peer-
Conclusion to-peer milk sharers in the United States do not donate to
If the health system of a country has the policy to develop milk banks. J Hum Lact 2016;32:229–237.
the milk bank, it is necessary to invest on attracting milk 14. Welborn JM. The experience of expressing and donating
donors. Educating mothers during pregnancy and nursing breast milk following a perinatal loss. J Hum Lact 2012;28:
506–510.
can foster a strong belief in the value of breastfeeding and
15. Meneses TMX, Oliveira MIC, Boccolini CS. Prevalence
inform them about the reasons for donating milk and how to
and factors associated with breast milk donation in banks
donate their excess milk. Promoting altruism and the sense of that receive human milk in primary health care units.
helping others and educating health staff and professionals J Pediatr (Rio J) 2017;93:382–388.
Downloaded by [Link] from [Link] at 04/10/20. For personal use only.

could be influential in increasing the number of human milk 16. dos Santos JAB, Serva VMSB, Caminha MFC. Reasons for
donors. Families play a key role in encouraging mothers to human milk donation according to different per capita in-
donate their milk. Religious beliefs in Islamic countries and come. Rev Bras Saúde Mater Infant 2017;17:307–315.
the lack of enough knowledge about donor human milk 17. Alencar LC, Seidl EM. Breast milk donation: Women’s
banking procedures and processes are the main barriers to donor experience. Rev Saude Publica 2009;43:70–77.
milk donation, and the uncertainties and concerns arising 18. Pimenteira Thomaz AC, Maia Loureiro LV, da Silva Oli-
from them can be mitigated through education. veira T, et al. The human milk donation experience: Mo-
tives, influencing factors, and regular donation. J Hum Lact
Disclosure Statement 2008;24:69–76.
19. De Alencar LC, Seidl EM. Breast milk donation and social
The authors declared no potential conflicts of interest with support: Reports of women donors. Rev Lat Am En-
respect to the research, authorship, and publication of this fermagem 2010;18:381–389.
study. 20. Gribble KD. Peer-to-peer milk donors’ and recipients’ ex-
periences and perceptions of donor milk banks. J Obstet
Gynecol Neonatal Nurs 2013;42:451–461.
References
21. Mackenzie C, Javanparast S, Newman L. Mothers’
1. Duijts L, Jaddoe VW, Hofman A, et al. Prolonged and knowledge of and attitudes toward human milk banking in
exclusive breastfeeding reduces the risk of infectious dis- South Australia: A qualitative study. J Hum Lact 2013;29:
eases in infancy. Pediatrics 2010;126:e18–e25. 222–229.
2. Keikha M, Bahreynian M, Saleki M, et al. Macro- and 22. Gribble KD. ‘‘I’m happy to be able to help’’: Why women
micronutrients of human milk composition: Are they re- donate milk to a peer via Internet-based milk sharing net-
lated to maternal diet? A comprehensive systematic review. works. Breastfeed Med 2014;9:251–256.
Breastfeed Med 2017;12:517–527. 23. Osbaldiston R, Mingle LA. Characterization of human milk
3. Tully DB, Jones F, Tully MR. Donor milk: What’s in it and donors. J Hum Lact 2007;23:350–357.
what’s not. J Hum Lact 2001;17:152–155. 24. Azema E, Callahan S. Breast milk donors in France: A
4. Schanler RJ, Hurst NM, Lau C. The use of human milk and portrait of the typical donor and the utility of milk banking
breastfeeding in premature infants. Clin Perinatol 1999;26: in the French breastfeeding context. J Hum Lact 2003;19:
379–398, vii. 199–202.
5. Daniels MC, Adair LS. Breast-feeding influences cognitive 25. al-Naqeeb NA, Azab A, Eliwa MS, et al. The introduction
development in Filipino children. J Nutr 2005;135:2589– of breast milk donation in a Muslim country. J Hum Lact
2595. 2000;16:346–350.
6. Arifeen S, Black RE, Antelman G. Exclusive breastfeeding 26. Coutsoudis I, Petrites A, Coutsoudis A. Acceptability of
reduces acute respiratory infection and diarrhea deaths donated breast milk in a resource limited South African
among infants in Dhaka slums. Pediatrics 2001;108:E67. setting. Int Breastfeed J 2011;6:3.
7. Pineau MG. Liquid Gold: Breast Milk Banking in the 27. Machado RS, Campos-Calderón C, Montoya-Juarez R,
United States. Los Angeles, CA: University of California, et al. Experiences of human milk donation in Andalucı́a-
2012. Spain: a qualitative study [in Spanish]. Enfermer Glob
8. Brownell EA, Lussier MM, Herson VC, et al. Donor human 2015;14:114–124.
milk bank data collection in North America: An assessment 28. Martı́nez-Sabater A, Siles-González J, Escrivá-Aparisi MV,
of current status and future needs. J Hum Lact 2014;30: et al. Review of the characteristics of mothers donor milk
47–53. banks. Am J Nurs Res 2014;2:1–6.
9. Picaud JC. VIII. Human milk banks: How to organize the 29. Senol DK, Aslan E. Women’s opinions about human milk
collection of human milk to feed preterm infants. J Pediatr donation and human milk banking. Biomed Res India 2017;
Gastroenterol Nutr 2015;61:S10–S12. 28:6866–6871.
 306 DOSHMANGIR ET AL.

30. Eksxioğlu A, Yes

xil Y, Turfan ECx. Mothers’ views of milk 40. Perrin MT, Goodell LS, Allen JC, Fogleman A. A mixed-
_
banking: Sample of Izmir. Türk Pediatri Arsx 2015;50:83. methods observational study of human milk sharing com-
31. Gürol A, Ozkan H, Celebioğlu A. Turkish women’s munities on Facebook. Breastfeed Med 2014;9:128–134.
knowledge and views regarding mother’s milk banking. 41. Cole JCM, Schwarz J, Farmer MC, et al. Facilitating milk
Collegian 2014;21:239–244. donation in the context of perinatal palliative care. J Obstet
32. Karadag A, Ozdemir R, Ak M, et al. Human milk banking Gynecol Neonatal Nurs 2018;47:564–570.
and milk kinship: Perspectives of mothers in a Muslim 42. Arnold LD. Global health policies that support the use of
country. J Trop Pediatr 2015;61:188–196. banked donor human milk: a human rights issue. Int
33. Ergin A, Uzun SU. Turkish women’s knowledge, attitudes, Breastfeed J 2006;1:26.
and behaviors on wet-nursing, milk sharing and human 43. Iloh KK, Osuorah CD, Ndu IK, et al. Perception of donor
milk banking. Matern Child Health J 2018;22:454–460. breast milk and determinants of its acceptability among moth-
34. Katke RD, Saraogi MR. Socio-economic factors influenc- ers in a developing community: A cross-sectional multi-center
ing milk donation in milk banks in India: An institutional study in south-east Nigeria. Int Breastfeed J 2018;13:47.
study. Int J Reprod Contracept Obstet Gynecol 2014;3: 44. Gibbins S, Wong SE, Unger S, O’Connor D. Donor human
389–393. milk for preterm infants: Practice considerations. J Neo-
35. Gelano TF, Bacha YD, Assefa N, et al. Acceptability of natal Nurs 2013;19:175–181.
donor breast milk banking, its use for feeding infants, and 45. Williams T, Nair H, Simpson J, Embleton N. Use of donor
associated factors among mothers in eastern Ethiopia. Int human milk and maternal breastfeeding rates: a systematic
Breastfeed J 2018;13:23. review. J Hum Lact 2016;32:212–220.
36. Jahan S. Human development report 2016: Human devel- 46. Carroll KE, Lenne BS, McEgan K, et al. Breast milk do-
Downloaded by [Link] from [Link] at 04/10/20. For personal use only.

opment for everyone. New York, NY: United Nations nation after neonatal death in Australia: A report. Int
Development Programme (UNDP), 2016. Breastfeed J 2014;9:23.
37. Candelaria LM, Spatz DL, Giordano N. Experiences of
women who donated human milk. J Obstet Gynecol Neo- Address correspondence to:
natal Nurs 2018;47:556–563. Leila Doshmangir, PhD
38. Bonn S, Domellof M, Ewald U. Guidelines for use of hu- Department of Health Services Management
man milk and milk handling in Sweden. Milknet, version 2, School of Management and Medical Informatics
2011. Available at [Link] Tabriz University of Medical Sciences
content/uploads/sites/14/2014/03/Guidelines-2017-English Daneshgah Street
.pdf (accessed March 13, 2019). Tabriz 5165665811
39. Zhou Q, Li M, Wang X, et al. Immune-related microRNAs Iran
are abundant in breast milk exosomes. Int J Biol Sci 2012;
8:118–123. E-mail: doshmangirl@[Link]

View publication stats