Healthcare Providers Acceptability of Breast Milk Donation and Banking, and Factors Influencing Adoption in Rwanda: A Mixed-Methods Study
This mixed-methods study conducted in Rwanda reveals that healthcare providers highly accept breast milk donation and banking due to recognized neonatal benefits, though successful implementation requires addressing barriers such as cultural resistance, limited awareness, and infrastructure gaps through targeted training, policy development, and community engagement.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of a preprint that has not been peer-reviewed. It is not medical advice. Do not make health decisions based on this content. Read full disclaimer
For the first six months of life, the best food for a baby is the milk from their own mother. This is a universal recommendation from health organizations worldwide, supported by decades of evidence showing that breast milk provides perfect nutrition and powerful protection against illness. However, life does not always follow the ideal path. Sometimes a mother is too sick to feed her baby, she passes away, or her own milk supply is not enough. In these critical moments, especially for premature infants born too small to fight off infections, the next best option is milk from another mother. This is known as donor breast milk. When collected, screened, and stored safely, it acts as a lifeline, offering the same protective benefits as a mother's own milk. Yet, in many parts of the world, including Rwanda, this resource remains largely untapped. There are no formal systems to collect and distribute it, leaving hospitals without a reliable alternative when a mother cannot feed her child.
A team of researchers set out to understand why this gap exists and whether the people who care for these babies would be willing to change that. They focused on healthcare providers—the doctors, nurses, and support staff working in neonatal units in two Rwandan district hospitals. The researchers wanted to know if these professionals believed in the value of breast milk donation, what they thought would make it work, and what fears or obstacles might stand in the way. By listening to their stories and asking specific questions, the team aimed to map the path toward establishing the first milk banks in the country.
The study took place in the neonatal wards of Kirehe District Hospital and Ruhengeri Level II Teaching Hospital. These facilities serve rural communities where resources are often limited. The researchers spoke with forty-one healthcare workers, a group that included doctors, nurses, midwives, and "expert mothers"—experienced mothers trained to support other families with newborns. They used a two-part approach: a written survey to measure general attitudes and in-depth interviews to explore the reasons behind those attitudes. The goal was to see if the idea of donating and using breast milk was acceptable to the people who would have to manage it every day.
The results were encouraging. When asked directly, more than eighty percent of the healthcare providers expressed a positive view of breast milk donation. On a scale measuring how much they agreed with the concept, the average score was high, indicating strong support. Nearly all of the staff believed that donor milk would be beneficial for newborns, particularly for those who are premature or very small. They understood that this milk could help babies grow stronger and survive infections that formula cannot prevent. The staff did not see the idea as strange or wrong; instead, they saw it as a practical solution to a difficult problem.
Despite this high level of support, the providers were clear about the hurdles that would need to be cleared before a milk bank could open. The biggest concerns were not about the idea itself, but about the practicalities of making it safe and trusted. Many staff members noted that there is currently no formal program in Rwanda, so they had no experience with how to collect, store, or test the milk. They worried about the lack of equipment, such as special refrigerators needed to keep the milk safe, and the absence of clear rules on how to handle it. There was also a fear that families might be hesitant to accept milk from another woman due to cultural beliefs or a lack of understanding about safety.
The interviews revealed that these cultural hesitations often stem from a lack of information rather than deep-seated opposition. When the researchers asked about community attitudes, the healthcare workers explained that people might be unsure because they have never been taught how donor milk works. They suggested that if families were educated on the safety measures—such as how the milk is screened for viruses and pasteurized to kill germs—trust would grow. The staff emphasized that they themselves needed training to feel confident in managing a donation program. They wanted clear guidelines, proper equipment, and the knowledge to explain the benefits to worried parents.
The study found that the willingness of healthcare providers to support a milk bank was closely tied to their belief that the hospital could do it safely. If the staff felt they had the right tools and the right training, their enthusiasm was high. They saw the potential for donor milk to save lives and reduce the financial burden on families who might otherwise have to buy expensive formula. One of the most significant findings was that the providers did not view this as a radical change, but as a necessary step forward. They recognized that while the current system relies on mothers feeding their own babies, a safety net of donor milk is essential for the most vulnerable infants when that is not possible.
This research suggests that the foundation for a breast milk banking system in Rwanda is already present in the hearts and minds of the healthcare workers. The barrier is not a lack of interest or a refusal to accept a new idea, but rather the absence of the infrastructure and policies needed to make it a reality. The study concludes that with the right support—specifically training, equipment, and community education—these hospitals could successfully launch programs to collect and distribute breast milk. The path forward involves building trust through education and ensuring that every step, from collection to feeding, is handled with the highest standards of safety. By addressing these practical needs, Rwanda could provide a vital resource that ensures no baby goes hungry when their mother cannot feed them.
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