Acceptability and Determinants of Breast Milk Donation and Banking Among Mothers and Healthcare Providers in Two Rwandan hospitals: A Mixed Methods Study

Background: Breast milk donation and banking are globally endorsed strategies to ensure optimal nutrition and survival for medically vulnerable newborns. Donor breast milk is the preferred alternative when maternal milk is unavailable; however, its acceptance is shaped by sociocultural factors. InRwanda, breast milk donation is a novel concept, with limited evidence on community perceptions or readiness to engage with milk banking initiatives. Understanding maternal and healthcare provider attitudes, cultural beliefs, perceived benefits, and barriers is essential for guiding policy development and implementing culturally responsive programs. This study assessed the acceptability of breast milk donation and identified factors influencing willingness to donate among postpartum mothers and healthcare providers in two Rwandan hospitals.

Methods: A mixed-method cross-sectional design provided a comprehensive assessment of perceptions toward breast milk donation. The quantitative component included 208 mothers with infants admitted to neonatal departments and 41 healthcare providers (HCPs) from Ruhengeri Level 2Teaching Hospital and Kirehe District Hospital. Structured questionnaires measured acceptability, willingness to donate, awareness, cultural beliefs, perceived benefits, and barriers using a six-itemLikert scale. Non-parametric tests, including Mann–Whitney U, Kruskal–Wallis, and chi-square analyses, examined associations. Qualitative data from semi-structured interviews were analyzed using inductive thematic analysis, with saturation confirmed at both code and analytical levels.

Results: Awareness of breast milk donation was low among mothers (11.1%), with information primarily provided by healthcare providers (HCPs), while 78% of HCPs reported prior familiarity. Mothers’ perceptions were influenced by individual perceptions, with 63% associating milk sharing with familial ties and 40.8% expressing concerns about disease transmission. HCPs similarly identified belief-driven resistance as a key challenge (75.6%).
Both mothers and HCPs acknowledged the benefits of breast milk donation, including improved infant nutrition (mothers 96.2%, HCPs 87.8%), reduced neonatal mortality (mothers 85.1%, HCPs75.6%), and lower infection risk (mothers 72.1%, HCPs 70.7%). Reported barriers among mothers included lack of awareness (93.3%), cultural beliefs (81.7%), and safety concerns (80.3%), whileHCPs highlighted cultural resistance (80%) and limited infrastructure (77.5%). Key facilitators included education and awareness programs (mothers 91.3%, HCPs 100%) and strong healthcare provider support (mothers 84.5%, HCPs 90.2%).
Overall acceptability was high among both mothers (84.6%) and HCPs (82.9%), with willingness to donate (88%) exceeding willingness to accept donor milk (77.4%) among mothers. Qualitative findings reinforced the quantitative results, highlighting conditional maternal acceptability based on safety assurances, infant need, and family approval, as well as the importance of education, institutional support, and community engagement.

Conclusion: This study provides foundational evidence for implementing breast milk donation and banking programs in Rwanda. High acceptability suggests potential for successful adoption, but targeted education, community engagement, and active healthcare provider involvement are critical to address cultural concerns, knowledge gaps, and logistical challenges. These insights can guide maternal and neonatal health policy and national strategies to reduce neonatal morbidity and mortality through evidence-based feeding interventions.