ORIGINAL

Niger J Paed 2015; 42 (3):223 –227

Abhulimhen-Iyoha BI

Okonkwo IR

Ideh RC

Mothers’ perception of the use of

banked human milk for feeding of

the infants

Okolo AA

DOI:http://dx.doi.org/10.4314/njp.v42i3.10

Accepted: 18th May 2015

4

6.5% having some form of terti-

Abstract: Background: Human

breast milk is the most healthful

form of milk for human babies.

Every infant deserves the best

possible start in life in terms of

nutrition by breastfeeding or re-

ceiving donated human milk.

Breast milk is very important for

the infant’s growth and well-being

that the non-availability of the

mother should not deprive the

infant from its benefits. To en-

hance the availability and use of

human breast milk for hospital-

ized babies whose mothers may

not have enough milk, there is the

need to embark on human milk

banking.

ary education and 48.5% having

secondary education. Only 51

(25.8%) of them had heard of

breast milk banking; source of

information being mainly from

health workers (43.1%) and from

friends (27.5%). Majority 168

(

)

Abhulimhen-Iyoha BI

Okonkwo IR, Ideh RC, Okolo AA

Department of Child Health,

University of Benin Teaching Hospital,

Benin City, Nigeria.

Email: drblessing4ever@yahoo.com

(

84.8%) of the mothers would not

give their babies human milk do-

nated by another nursing mother

mainly because of fear of trans-

mission of infections/diseases.

Most 105 (53.0%) were also un-

willing to donate breast milk to be

used for other babies due to the

fact that they disliked the idea

(

51.4%) and because of fear of not

having enough for their own ba-

bies (16.1%). However, most

Objective: To determine the per-

ception of mothers towards breast

milk banking in Benin City, Nige-

ria.

(

59.1%) strongly agreed that hu-

man milk banking would help as-

sist mothers in need, orphans and

abandoned babies.

Conclusion/Recommendation: The

awareness of human milk banking

and its acceptance among mothers

in Benin City is poor. The current

findings strongly justify the need

for public enlightenment on human

milk banking and its benefits.

Subjects and Methods: The study

subjects included 198 mothers

who brought their babies to Well

Baby/Immunization Clinic of the

University of Benin Teaching

Hospital (UBTH), Benin City,

Nigeria. A structured researcher-

administered questionnaire was

used to assess their biodata,

awareness and perception of

breast milk banking.

Key words: Breast milk banking,

mothers, Perception

Results: The mean age of the

mothers was 29.8 ± 5.5 years with

Introduction

some mothers are desperately trying to breastfeed their

babies with limited success due to physical ailments,

surgery or chronic illnesses. To enhance the availability

and use of breast milk for all babies, there is the need to

embark on human milk banking. A human milk bank is

a service which collects, screens, processes, and dis-

penses by prescription human milk donated by nursing

mothers who are not biologically related to the recipient

Every infant deserves the best possible start in life in

terms of nutrition by breastfeeding or receiving donated

human milk. Human breast milk is the most healthful

form of milk for human babies. There is scientific evi-

dence that breast milk and donor human milk is the opti-

mal nutrition of choice for the most fragile and vulner-

2

able infants in the Neonatal Intensive Care Unit (NICU)

infant . Donor milk banking involves the recruitment of

1

.

Breast milk is very important for the infant’s growth

appropriately screened donors and the collection, screen-

ing, storage, processing and distribution of their donated

and well-being that the non-availability of the mother

should not deprive the infant from its benefits. Some

infants cannot ingest formulas without undue stress, pain

and gastric upset from exposure to formula feeds while

3

breastmilk .

The World Health Organization (WHO) recommends

2

24

that for infants who cannot receive breast milk from

their own mothers, the next preferred option is donated

breast milk (human donor milk) . Human donor milk is

cation (Table 1). Only 51 (25.8%) of them had heard of

breast milk banking; source of information being mainly

from health workers (43.1%) and from friends (27.5%).

Other sources of information included the print (13.7%)

and electronic (11.8%) media. Majority 168 (84.8%) of

the mothers would not give their babies human milk

donated by another nursing mother largely because of

fear of transmission of infections/diseases (39.9%) and

preference of infant formula (17.9%). It is worth noting

that custom/tradition (7.7%) was not a major reason for

refusal to use donated human milk (Table 2). Whereas

26 (13.1%) respondents said they would give their ba-

bies donated human milk, four (2.0%) of them said they

do not know whether or not they would (Table 2). Most

105 (53.0%) were also unwilling to donate breast milk

to be used for other babies due to the fact that they dis-

liked the idea (51.4%) and because of fear of not having

enough for their own babies (16.2%). While 79 (39.9%)

mothers were willing to donate breast milk for other

babies’ use, 14 (7.1%) were not sure of what they would

do (Table 2). However, most (59.1%) strongly agreed

that human milk banking would help assist working

mothers, sick mothers, orphans and abandoned babies.

4

not exactly equal to fresh mother’s milk, owing to some

loss of micronutrients and anti-infective factors during

pasteurization, decomposition over time, and normal

variations in the makeup of breast milk. Even then, suf-

ficient bioactivity and immunological properties persist

to guarantee that (especially when the gestational age of

the donor’s infant can be matched with that of the recipi-

5

ent infant) donated breast milk is superior to formula .

Prior to the introduction of a new health intervention,

determining the acceptability of such intervention within

the would-be recipient community is a crucial first step.

This is particularly so with one involving sensitive bod-

ily fluids and in locales of high HIV prevalence, where

various infant feeding choices are often stigmatized or

6

dreaded because of their associations with HIV . Unfor-

tunately, these communities with high HIV prevalence

are the same ones (with huge burden of at-risk infants

with low birth weights and high infant mortality rate)

that donated breast milk is most needed.

Developing countries lag behind the rest of the world in

establishing and promoting human milk banks. For in-

stance, there is no human milk bank in Nigeria and the

West African sub-region in general and little is known

concerning mothers' perceptions of using human milk

banks in Nigeria.

Table 1: Socio-demographic Characteristics of Mothers

Variable

Frequency Percent (%)

Age group in years

≤

20

6

3.0

2

3

>

1 – 30

1 – 40

40

113

72

7

57.1

36.4

3.5

Parity

Subjects and methods

1

2

3

4

≥

Level of Education

None

66

55

38

18

21

33.3

27.8

19.2

9.1

This descriptive and cross-sectional study involved

mothers of apparently healthy babies who were brought

to the Well Baby/Immunization Clinic of the University

of Benin Teaching Hospital (UBTH), Benin City, Nige-

5

10.6

3

1.5

th

ria; seen between 20 September and 10 October 2014.

A structured researcher-administered questionnaire was

used to assess their biodata, and as potential donors,

their awareness and perception of human milk banking

to inform decision on such activity. Ethical approval

was obtained from the Ethics Committee of UBTH and

informed consent was obtained from each participant.

Data collected were entered into the IBM Statistical

Package for Scientific Solutions (SPSS) version 20.0

spreadsheet and analyzed. The results obtained were

cross tabulated as frequency and contingency tables.

Means, standard deviations and ranges were used as

appropriate to describe continuous variables while cate-

gorical data were analyzed using Chi square and

Fisher’s exact tests. For all statistical tests, p<0.05 was

considered to be significant.

Primary

Secondary

Tertiary

7

96

92

3.5

48.5

46.5

Among the mothers who gave definite responses as to

willingness to use donated human milk (194), 97

(82.2%) of those aged ≤30years said no while 71

(93.4%) of those aged^≥³¹^y^e^a^r^s^s^aⁱ^dⁿ^o^.^T^hⁱ^s^w^a^s^s^t^a^-

tistically significant (p = 0.030) (Table 3). As for will-

ingness to donate own milk, 57 (50.4) mothers in the age

group ≤30yearsand 22 (31.0) in those belonging to the

group ^≥³¹^y^e^a^r^s^w^e^r^e^wⁱ^l^lⁱⁿ^g^.^T^hⁱ^s^w^a^s^a^l^s^o^s^t^a^tⁱ^s^tⁱ^c^a^l^l^y

significant (p = 0.010) (Table 3).

Results

A total of 198 mothers were interviewed. Their mean

age was 29.8 ± 5.5 years with 46.5% having some form

of tertiary education and 48.5% having secondary edu-

2

25

Table 2: Mothers’ acceptance or refusal of use of human banked milk

Discussion

(HBM) with reasons

Variables

Frequency Percent (%)

The use of donor human milk is not generally accepted

in many developing countries. In our study locale, most

Acceptance of use of human banked milk

7

(n=198)

No

168

26

84.8

13.1

mothers would not give their babies human milk do-

nated by another nursing mother similar to the findings

Yes

7

8

in Jos and in Lagos both in Nigeria where majority of

the mothers would not accept donated breast milk for

their babies. The major reason given for this decision in

the cur₇r_,₈ent study as well as the two aforementioned

studies is the fear of transfer of diseases. The human

donor milk must, therefore, be made safe and secure. In

Brazil, for example, donors are tested for HIV even₉

though pasteurisation is sufficient to kill the HIV virus.

The finding that tradition was not a major reason for

unwillingness of mothers to use donated human milk

could possibly be explained by the fact that wet nursing

is not new to most traditions in Nigeria and it is ac-

cepted by the major religions of Islam and Christian-

Don’t know

Reasons for willingness to use HBM (n=26)

Breast milk is the best source of food for baby

Doctor’s advice

4

2.0

20

4

76.9

15.4

Expensive Infant Formula

2

7.7

Reasons for refusal to use HBM (n=168)

Fear of transmission of infections/diseases to

baby

67

39.9

Preference of infant formula

Unhygienic

30

28

13

4

17.9

16.7

7.7

Custom/ tradition forbid it

Fear of Spouse and in-laws

2.4

Others

Willingness to donate breastmilk

26

15.5

10

No

Yes

105

79

14

53.0

39.9

7.1

ity. Furthermore, the advent of HIV and the effective

awareness campaign on the possible modes of mother to

child transmission including through breast milk has led

to the decline of such practices. The marketing and

availability of breast milk substitutes provides a ready

alternative for feeding the infant in situations that hith-

erto qualified for wet nursing. Co₁ntrary to the current

Not sure

Reasons for willingness to donate breast milk

Satisfaction that I can help a child in need

29

36.7

To support the promotion of health of children

A good idea

26

11

32.9

13.9

To support other mothers

If family members accept

10

3

12.7

3.8

1

study, however, Mackenzie et al in South Australia

Reasons for unwillingness to donate breast milk

recorded that breastfeeding mothers unanimously sup-

ported donating their breast milk to a human milk bank,

provided it would be easy and not overly time consum-

ing; and mothers of preterm or sick infants would use a

human milk bank if they were assured the milk was safe

and appropriate for their babies. Their study was, how-

ever, carried out among mothers who were breastfeeding

and/or had preterm or sick babies. Most of the partici-

pants in the present study would rather not donate their

own milk a finding similar to the findings of Ighogboja

Do not like the idea

5

1

4

7

51.4

16.2

Fear of not having enough breast milk for own

baby

Against traditions / customs

1

3

2

9

0

9.5

2.9

1.9

8.6

Spouse and family may not like it

Fear of transmission of diseases

Breast sagging

Others

Table 3: Maternal characteristics and willingness to use or

donate human milk

7

et al . The majority of the women not willing to donate

Willingness to use donated human milk

simply did not like the idea. The strangeness of human

breast milk banking in this part of the world could be a

plausible reason for this. The fear that donating their

breast milk could shorten the ration for their own babies

only emphasizes the fact that awareness need to be in-

creased on the physiology of breast milk production. Of

note, however, is the fact that the mothers were more

willing to donate than to use Human donor milk. Mater-

nal protective instinct can explain this; fear of infecting

their babies with disease discourages their willingness to

use, while the satisfaction that they can help another

baby in need makes them willing to donate their milk.

Given that only a few of the participants were aware of

breast milk donation, the initial resistance expressed by

them is not surprising. It is more than reasonable to ex-

pect that some prior knowledge of, or experience with

an intervention would be a necessary prerequisite for

accepting it. The importance of having familiarity and

ideally experience with breast milk donation was clearly

Characteristics

Frequency (%)

p-value*

Yes

No

Mothers’ age (n=194)

<

20 – 30

21 (17.8)

5 (6.6)

97 (82.2)

71 (93.4)

0.030*

0.147

31 - >40

Mothers level of education

No formal/ Primary

3(33.3)

6 (66.7)

85(89.5)

77 (85.6)

Secondary

10 (10.5)

13 (14.4)

Tertiary

Mothers parity (n=194)

1

2

3

7 (10.6)

6 (10.9)

7 (18.9)

6 (16.7)

59 (89.4)

49 (89.1)

30 (81.1)

30 (83.3)

0.564

≥

4

Willingness to donate own milk

Mothers’ age (n=184)

<

20 – 30

57 (50.4)

22 (31.0)

56 (49.6)

49 (69.0)

0.010*

0.518

31 - >40

Mothers level of education

No formal/ Primary

5 (50.0)

Secondary

34 (38.6)

40 (46.5)

54 (61.4)

46 (53.5)

12

Tertiary

illustrated in the study of Coustsouds is et al by the fact

that those participants who had been exposed to the

practice were generally more convinced of its value and

efficacy.

Mothers’ parity (n=184)

1

2

3

34 (55.7)

20 (39.2)

11 (31.4)

14 (37.8)

27 (44.3)

31 (60.8)

24 (68.6)

23 (62.2)

0.084

Human donor milk fulfills an important role in keeping

≥

4

2

26

babies healthy and thriving. It is life-saving and is the

optimal choice for preterm and sick infants when the

mother's own milk is not available. For instance, human

unconnected with the lack of awareness as it concerns

human donor milk. Perhaps a comparison of the level of

acceptance between both tissue usages among mothers

may be worth evaluating in the future. Coutsoudis et

3

milk banking in Brazil has contributed to a fall in infant

9

12

mortality. Mothers who are aware of the importance of

al demonstrated in their study that mothers were more

breast milk to their babies but are having difficulty

breastfeeding them are relieved when they are provided₁

the donated breast milk that is needed for their infants.

The support these mothers get helps nourish their infants

as well as assists them to continue their efforts in getting

their breast milk supply to successfully increase for their

babies. A small number of children whose mothers died

in childbirth or shortly thereafter as well as adopted chil-

dren also stand to benefit.

comfortable with blood transfusion than with the use of

donor milk. The participants in their study claimed that

blood transfusion is generally a short-term intervention

that may be completed within a few hours, where as the

use of donor milk is more sustained over days or months

and they would need to ponder over the use of this inter-

vention. This suggests a certain degree of sensitivity

with breast milk that is pe₂rhaps absent with blood. The

1

study of Coutsoudis et al also showed that the obsta-

cles to the acceptability of donor milk were mainly

stemming from lack of awareness/familiarity with the

processes around donor breast milk and that these could

be readily addressed through health education; and the

more psychological concerns would also likely be

Mothers need to be educated on the importance of hav-

ing a breast milk bank as obtains in developed countries.

The cultural myth in some parts of our society that ne-

gates the use of another nursing mother’s milk for a

baby requires correction. It is important to note that in

some parts of the country, wet nursing is carried out

especially by relatives but close neighbours may be

called upon to help suckle a child in the event that the

baby’s mother is not available (for instance in case of

reduced over time as these educational efforts progress.

Conclusion

13

maternal mortality). Some mothers give their milk di-

rectly to the parents of ba₄bies in need, an exchange

In conclusion, the awareness of human milk banking

and its acceptance among mothers in Benin City is poor.

There is a strong need for public enlightenment on hu-

man milk banking and its benefits. All countries need to

include donor human milk banking as part of the total

maternal and child health policy, so that it is done safely

and consi₅stently and is accessible to infants and children

1

known as casual sharing. The intent behind casual

sharing is wonderful – it’s a caring act of sisterhood. It

is, however, important to go the extra mile to have the

milk tested in a laboratory to ensure that it is safe for the

baby.

1

A sizable proportion(74.2%) of mothers interviewed

were unaware of milk banking. Milk banking is a form

of tissue banking just like blood banking. Its awareness

among mothers would likely increase its acceptance as

has occurred with blood banking services. Generally,

blood banking services are acceptable among our people

and is believed to be life-saving. Many mothers felt

more comfortable with blood transfusion than with the

use of human donor milk for infants. This may not be

in need. It is incumbent on every nation to start donor

milk banks and for those who already have to protect the

ones they have, not close them. In supporting donor hu-

man milk banking we will truly be fostering a child

friendly world.

Conflict of interest: None

Funding: None

References

1

.

About Mothers’ Milk Bank. Avail-

5.

Bertino E, Giuliani F, Occhi L,

8. Egri-Okwaji MTC, Bamisaiye A,

Ahmed I. Setting up a Brest-milk

Bank: Some Socio-Psychological

and Organisational considerations.

Niger J Paediatr 1984; 11: 23-27.

9. A Snapshot of Milk Banking in

Other Countries. LEAVEN 2000;

36: 22-23.

10. Moran L, Gilad J. From Folklore to

Scientific Evidence: Breast-

Feeding and Wet-Nursing in Islam

and the Case of Non-Puerperal

Lactation. Int J Biomed Sci. 2007;

3: 251–257.

able at http://mothersmilk.org/

Coscia A, Tonetto P, Marchino F:

Benefits of donor human milk for

preterm infants: current evidence.

Early Hum Dev 2009, 85:S9-S10.

th

Accessed 19 October, 2014.

2

.

Human milk bank. Wikipedia, the

free encyclopedia. Availa_t_hble at

http://www. Accessed 19 Octo-

ber, 2014.

6. Thairu L, Pelto GH, Rollins NC,

Bland RM, Ntshangase N: So-

ciocultural influences on infant

feeding decisions among HIV-

infected women in rural KwaZulu-

Natal, South Africa. Matern Child

Nutr 2005, 1:2-10.

7. Ighogboja IS, Olarewaju RS,

Odumodu CU, Okuonghae HO.

Mothers' attitudes towards donated

breastmilk in Jos, Nigeria. J Hum

Lact. 1995; 11:93-6.

3

4

.

International Milk Banking Initia-

tive (IMBI). Available at http://

www.internationalmilkbanking.or

th

g/ Accessed 19 October, 2014.

WHO: Infant and Young Child

Feeding: Model Chapter for Text-

books for Medical Students and

Allied Health Professionals Ge-

neva, Switzerland: World Health

Organization; 2009.

11. Mackenzie C, Javanparast S, New-

man L. Mothers' knowledge of and

attitudes toward human milk bank-

ing in South Australia: a qualita-

tive study. J Hum Lact. 2013;

2

9:222-9.

2

27

1

2. Coutsoudis I, Petrites A, Cout-

soudis A. Acceptability of donated

breast milk in a resource limited

South African setting. Interna-

tional Breastfeeding Journal 2011,

13. Ransome- Kuti O. Milk and Lacta-

tion. Mod Probl Paediat 1975;

15:117-24

15. Donor Human Milk Essential Re-

source For High Needs Infants

Human Milk Banking Threatened

in Canada? Available at http://

14. Why Bank Milk? Human Milk

Banking Association of North

America. Available at https://

www.infactcanada.ca/sumdhm.htm

th

6

:3 http://www.international

4 December, 2014.

th

breastfeedingjournal.com/

content/6/1/3 Accessed 12th Janu-

ary 2015.

www.hmbana.org/ Accessed 19

October, 2014.