Milk kinship is not an obstacle to using donor human milk to feed preterm infants in Muslim countries

A comparative review of human milk banking and national tissue banking programs

This paper explores the legislative and operational commonalities and differences in Medical Products of Human Origin (MPHO) programs, including blood, hematopoietic cells, tissues and reproductive cells and human milk banking. The analysis includes ethical principles in donation and utilization, policies and legislation, public awareness and education, registries, guidelines in donor selection, safety and quality assurance, operational models and funding, infrastructure and human resources and biovigilance and evaluation of outcomes. Unlike other MPHO, the need for donor human milk (DHM) may be greatly reduced, that is, by ensuring optimal support for maternal lactation and breastfeeding. This should not be lost in the drive for wider and improved service provision. Nevertheless, increased overall demand for DHM is expected as a result of forthcoming international recommendations and also its increased use as the first-choice supplement to a mother's own milk both within and beyond preterm, low-birthweight and sick infant populations. Insight into current human milk banking highlights differences and gaps in practices that can benefit from further exploration and harmonization. Strong similarities with the ethical and operational principles underpinning donation and processing of the diverse MPHO suggest that legislating human milk banks within similar MPHO frameworks may bring additional safety and facilitate improved product quality. Moreover, that MPHO-inspired models operating within attainable regulatory requirements may contribute to sustainable human milk banking activity and growth.

Women's perspectives on human milk banking in Ghana: results from a cross-sectional study

Background

Although political and academic interest exists in Ghana to include human milk banks (HMB) into current maternal and child health programs, efforts to establish a HMB have not yet been subjected to any real empirical inspection with the view toward implementation. Furthermore, views toward the establishment of a HMB in Ghana have not been assessed among Ghanaian women. The aims of the current study were to examine Ghanaian women's views about HMB, and to investigate women's willingness to donate to a HMB.

Methods

Quantitative and qualitative responses were received from Ghanaian females (n = 1,270) aged 18+ years. Excluding outliers and missing data (n = 321), a final sample of 949 was retained for final analysis. Chi-square tests and logistic regression analysis were computed on quantitative data; Thematic analysis was performed on the qualitative responses.

Results

In our sample, 64.7% of respondents indicated that Ghana is ready for a HMB. The majority (77.2%) were willing to donate milk, and 69.4% believed that donating to the HMB would favor their child. The main concerns for the unwillingness to donate excess milk included: (i) the idea of HMBs as strange/bizarre (n = 47), (ii) fear of infections (n = 15), (iii) religious beliefs (n = 9), and (iv) insufficient information (n = 24). This study serves as the first step toward the development of a HMB in Ghana.

Conclusions

Overall, Ghanaian women support the building of a HMB to enhance infant nutrition and reduce childhood morbidity and mortality.

Attitudes and Views Concerning Human Milk Banking Among Mothers Residing in a Rural Region of Bangladesh

BACKGROUND

Human milk banks play an essential role by providing human milk to infants who would otherwise not be able to receive mother's milk.

STUDY AIM

To determine the opinions and attitudes among possible donor mothers regarding human milk banks in one rural region in Bangladesh.

METHODS

A prospective, cross-sectional study following a probability type of stratified cluster sampling technique was used. Included in the study (N = 121) were mothers aged 20-49 years, with at least one child, who was currently lactating or had breastfed her child, and who resided in the rural community of Bangladesh where the study was conducted. Data were collected through a 21-item, close-ended questionnaire and a face-to-face interview conducted by the researcher at each participant's home.

RESULTS

Among the participants, 98.3% (n = 119) said that they had not heard about human milk banks before speaking with the researchers. Most participants (71.9%, n = 87) said would obtain human milk from milk banks if necessary, but 28% (n =34) of mothers indicated that they would not receive milk from a milk bank, even if it was necessary for their children. Only 8.3% (n = 10) said human milk banks were not appropriate according to Islam and 99.2% (n = 120) did not know about the acceptance of human milk banking practices in Bangladesh.

CONCLUSIONS

For those with religious concerns, a framework for both the donors and recipients can be established. It can be recommended that health education through healthcare personnel (midwives, nurses, gynecologists, pediatricians, and other health professionals) and religious leaders may strengthen the belief and increase awareness among family members about milk banking practices.

Islamic Beliefs About Milk Kinship and Donor Human Milk in the United States

Milk kinship is an Islamic belief that human milk creates a kinship between the breastfeeding woman and her nonbiological nursing infant (as well as the woman's biological nursing infants) prohibiting future marriages between "milk brothers and sisters." As such, Muslim families in the Western world may be reluctant to use donor human milk from human milk banks given the anonymity and multiplicity of donors. Health care providers for the mother-newborn dyad should be aware of this belief to have respectful, informed conversations with Muslim families and appropriately advocate for healthy newborn feeding. With this article, we outline the basis of milk kinship in Islamic beliefs, explore religious and bioethical interpretations of milk kinship, and provide information for physicians and other health care workers to become more knowledgeable about this practice.

Knowledge and attitudes of Lebanese women towards Baby Friendly Hospital Initiative practices

BACKGROUND

The World Health Organization and United Nations Children's Fund launched the Baby Friendly Hospital Initiative (BFHI) to encourage best infant breastfeeding practices immediately after birth. In Lebanon, few hospitals are currently accredited as Baby Friendly.

AIM

To assess the knowledge of Lebanese women of BFHI steps, and to explore their attitudes towards Baby Friendly Hospitals, Skin-to-Skin Contact and Kangaroo Care practices.

METHODS

A cross-sectional survey of a random sample of healthy pregnant women from Lebanon's six governorates.

RESULTS

The mean (SD) age of the participants (N = 517) was 28.6 (4.7) years. Most participants were unfamiliar with the terms Baby Friendly hospital (93.7%), skin-to-skin contact or kangaroo care (75%), or were inadequately instructed on how to initiate (54.2%) or continue (46.2%) breastfeeding. However, when provided with information about the benefits of BFHI practices, most mothers (> 90%) stated that they would deliver in Baby Friendly hospitals. About 68.4% of mothers refused to give donor human milk to their sick premature infants because of religious beliefs. Knowledge of Baby Friendly hospitals was significantly associated with university education (p = 0.029), higher monthly income (p = 0.042), and previous experiences of skin-to-skin contact (p<0.001), rooming in (p = 0.037), or breastfeeding support (p = 0.036).

CONCLUSION

There is a need for national awareness campaigns that address both the numerous advantages of the BFHI practices and Lebanese women's knowledge gaps about these practices. Such knowledge will help scale up the implementation of BFHI practices in hospitals in Lebanon, thus increasing breastfeeding rates and positively impacting the health of infants and mothers.

Exploring the barriers and facilitators to the acceptability of donor human milk in eastern Uganda - a qualitative study

BACKGROUND

Human milk is the best nutrition for all infants. When the mother's own milk is not available, the World Health Organization recommends the use of donated human milk and milk banking for neonates born prematurely or with medical problems. Donor human milk is rarely available in low-resource settings where both the rates of preterm birth and neonatal mortality are highest. The potential to reduce neonatal mortality through use of donated human milk is one that is yet to be fully explored in the African setting. For the introduction of any new health intervention to be successful, determining the barriers and facilitators to its acceptability is a vital first step. There are limited studies on this in sub-Saharan Africa.

METHODS

This qualitative study used focus group discussions and in-depth interviews to explore the potential barriers and facilitators to utilizing donated human milk for neonates in a hospital setting in eastern Uganda from the perspectives of caregivers (parents, grandparents) and healthcare workers.

RESULTS

Six focus group discussions involving 28 caregivers were conducted in a hospital setting in eastern Uganda. Four in-depth interviews were then also held with healthcare staff. Lack of knowledge of donated human milk emerged with discussants, and the barriers relating to transmission of infection (HIV) and poor hygiene. Common reasons which facilitated its acceptability were; a general knowledge and recognition that human milk is better than formula milk and a strong belief by caregivers in healthcare workers providing knowledgeable and safe care. Healthcare workers were supportive of introducing donor human milk but perceived a need for community and hospital education programs to enable this to be facilitated and scaled up.

CONCLUSIONS

This study shows that donor human milk can be acceptable to the caregivers of vulnerable babies in hospital settings in Uganda. Lack of awareness of donor human milk, its benefits and the methods of screening, acquisition and storage of donor milk are all barriers that could be addressed through improved education. This study advocates for national policies and programs that build capacity for effective and sustainable donor milk banking.

Acceptability of Donor Human Milk in Muslim Populations in Canada

Human milk is considered to be the best nutritional option for newborns. When a mother gives birth prematurely, she may have difficulty providing breast milk for her child. Pasteurized donor human milk (DM) is a better feeding alternative than preterm formula. Human milk banks in North America pool the milk from up to 5 women before distribution, a concept which does not pose a problem for most living in the Western world. Muslim families living in North America may reject the use of DM due to the idea of milk kinship and the anonymity of the donor. This paper aims to provide knowledge to Canadian clinicians on these Islamic religious beliefs relevant to DM and how they may impact their practice. Additionally, this paper provides Canadian clinicians with information to alleviate concerns Muslim families may have regarding the use of DM for their preterm infant.

Informal Breast Milk Sharing in a Muslim Country: The Frequency, Practice, Risk Perception, and Risk Reduction Strategies Used by Mothers

Introduction: Turkey is the first and only Islamic country which has initiated a process to establish a milk bank. However, the effort was abandoned because of religious concerns. Informal breast milk sharing has become a practical alternative to some. Research Aims: To document the religious concerned views and attitudes toward breast milk sharing and to determine risk reduction strategies of mothers in an Islamic country. Materials and Methods: Participants comprised volunteers from relevant forums or members of social media groups on the Internet. The participants (n = 435) were divided into three groups: those who did not share milk (n = 371), donors (n = 48), and receivers (n = 16). A prepared questionnaire was used for each group as a data collection tool. Results: 14.7% of the participants were experienced in informal milk sharing. Seventy-five percent of the recipients and 85.4% of the donors did not enter into a written agreement. Religious rules on milk sharing were reflected in three ways: asking about the infant's gender, limiting the number of sharing parties to 3, and knowing the identity of the donor or recipient. Of the participants, 77.3% believed that it was necessary to establish a milk bank in Turkey. However, 19.5% of the respondents reported that they would not feed their infant with donor milk because of reasons related to the issue of "milk kinship" in Islam. Conclusions: Informal milk sharing is a reality and risks similar to those stated in the literature are undertaken. Milk sharing is frequently performed independent of religious concerns and commercial purposes, Comprehensive measures to minimize disease transmission are not routinely implemented.

Perceptions on donated human milk and human milk banking in Nairobi, Kenya

Donor human milk (DHM) is recomended as the best alternative when use of mothers' own milk is not a feasible option. Kenya has not yet established human milk banks (HMBs) for provision of safe DHM, which is free from any physical, chemical, microbiological contaminants or pathogens. This study aimed to establish the perceptions on donating and using DHM, and establishing HMBs in Kenya. Qualitative data were collected through 17 focus group discussions, 29 key informant interviews, and 25 in‐depth interviews, with women of childbearing age, community members, health workers, and policy makers. Quantitative interviews were conducted with 868 mothers of children younger than 3 years. Descriptive analysis of quantitative data was performed in STATA software, whereas qualitative interviews were coded using NVIVO and analysed thematically. Majority of them had a positive attitude towards donating breast milk to a HMB (80%) and feeding children on DHM (87%). At a personal level, participants were more willing to donate their milk to HMBs (78%) than using DHM for their own children (59%). The main concerns on donation and use of DHM were personal dislikes, fear of transmission of diseases including HIV, and hygiene concerns. Ensuring safety of DHM was considered important in enhancing acceptability of DHM and successful establishment of the HMBs. When establishing HMBs, Kenya must take into consideration communication strategies to address the main concerns raised regarding the quality and safety of the DHM. The findings will contribute to the development of HMB guidelines in Kenya and other African contexts.

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

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 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.

Nutrition for Preterm Infants: 75 Years of History

As technology has advanced, survival rates of preterm infants have improved dramatically. Human milk was the primary source of enteral nutrition during the early days of neonatology, but the HIV/AIDS epidemic resulted in an increased use of preterm formula. More recently, the benefits of human milk were rediscovered, resulting in increased use of donor human milk as well. The awareness that human milk does not contain the amounts of nutrients to meet the high requirements of infants born premature resulted in the development of human milk fortifiers. The development of these fortifiers is still ongoing, as are alternative methods of pasteurization of donor milk. Those initiatives will increase the use of human milk with consequently short- and long-term benefits for preterm infants.

Human Milk-Treatment and Quality of Banked Human Milk

The aim of human milk banks is to deliver safe and high quality donor human milk. Treatment of human milk has to destroy most microorganisms while preserving immunological and nutrient components, which is obtained when using low time low temperature pasteurization. However it destroys bile-simulated lipase, reduces lactoferrin, lysozyme, immunoglobulins, and bactericidal capacity of human milk. New methods are under investigation such as high temperature short time pasteurization, high pressure processing, or ultraviolet irradiation. They have been tested in experimental conditions and there are promising results, but they have to be tested in real conditions in human milk bank.

Ensuring Safety in Donor Human Milk Banking in Neonatal Intensive Care

The provision of donor human milk avoids the risks associated with early infant formula feeding only when maternal milk is unavailable. Donor human milk-banking services (DHMBS) should provide an effective clinical service that causes no harm to donors or recipients. This article aims to begin the process of defining the minimum acceptable standard required for safe donor human milk banking in the neonatal unit. An assessment process is established to consider the potential risks and benefits of milk banking to both recipients and donors. These risks and benefits define the clinical responsibility of DHMBS and their social responsibility.