Mothers’ Acceptability of Breast Milk Donation and Banking in Rwanda: A Mixed-Methods Study

For a newborn baby, the first food matters more than almost anything else. Breast milk is not just nourishment; it is a living substance packed with antibodies and nutrients that protect a fragile infant from infection and help their tiny organs grow. When a mother cannot produce enough milk, or when she is too sick to feed her baby, the infant faces a dangerous gap in care. In many parts of the world, the solution has been to turn to formula, a manufactured substitute. However, medical science has long recognized that when a mother's own milk is unavailable, the next best thing is milk from another healthy mother. This concept, known as donor breast milk, involves screening and pasteurizing milk from volunteer mothers to feed vulnerable babies in hospitals. While this practice is well-established in some countries, it remains a new and largely unknown idea in Rwanda, where the infrastructure for storing and distributing such milk does not yet exist.

In a recent study, researchers set out to understand how mothers in Rwanda would react to the idea of breast milk donation and banking. The team, led by scholars from the University of Global Health Equity, wanted to know if mothers would be willing to give their own extra milk to save another baby's life, and if they would trust a hospital to feed their own child with milk from a stranger. They conducted their work in two district hospitals, one in the eastern province and one in the northern province, interviewing hundreds of mothers whose babies were currently receiving care. The goal was not just to count how many people said "yes," but to listen to the stories behind their answers, uncovering the fears, hopes, and cultural beliefs that shape decisions about feeding a newborn.

The researchers found that the idea of donating and receiving breast milk is surprisingly welcome among Rwandan mothers, provided that safety is guaranteed. When asked directly, the vast majority of the 208 mothers surveyed expressed a positive attitude toward the concept. They recognized that donor milk could be a lifeline for premature babies or those whose mothers were ill. In fact, nearly all of the mothers agreed that such a program could help save the lives of infants who have no other source of milk. This high level of acceptance was not limited to a specific group; it was found across different ages, education levels, and economic backgrounds. However, this openness came with a significant caveat: most of these mothers had never heard of breast milk donation before. Only about one in ten had any prior knowledge of the practice, and even fewer knew what a "milk bank" was.

Because the concept was so new to them, the mothers' views were shaped by what they did know about their own culture and their own fears. The study revealed that while the willingness to help was strong, it was often conditional. Many mothers expressed deep concern about safety, worrying that donated milk could carry diseases like HIV or other infections if it was not tested and handled correctly. There was also a strong cultural hesitation. Some mothers feared that if they gave their milk to another family, or if their own baby drank from another woman, it might create confusing family ties or social bonds that their communities did not understand. In some cases, they worried that their husbands or elders would not approve of the practice. One mother described the fear that her own milk might "hurt" her baby if the child had already been fed by someone else, a belief rooted in a lack of information about how milk screening works.

Despite these concerns, the mothers offered clear paths forward. They did not reject the idea; they simply asked for more information and better systems. The study showed that when mothers understood that hospitals could screen donors for diseases and pasteurize the milk to make it safe, their trust increased. They also saw the practical benefits, noting that donor milk could save families from the high cost of buying formula, which many could not afford. The qualitative interviews, which allowed mothers to speak in their own words, highlighted a powerful sense of altruism. Many said they would be happy to donate their extra milk if they knew it would save a life, comparing the act to the familiar concept of blood donation, where one person gives a part of themselves to help another survive.

The researchers also discovered that the location of the hospital mattered. Mothers at one of the two hospitals were significantly more likely to accept the idea of donor milk than those at the other. This difference appeared to be linked to the presence of a peer-support program at that hospital, where experienced mothers helped guide new mothers through breastfeeding challenges. This suggests that when mothers feel supported and educated by their own community and medical staff, they are more confident in trying new solutions. The study concluded that the barriers to starting a milk bank in Rwanda are not a lack of willingness, but rather a lack of awareness and infrastructure. The mothers are ready to participate, but they need a system that is transparent, safe, and culturally sensitive.

Ultimately, this work suggests that introducing a breast milk bank in Rwanda is a feasible and needed step, but it must be done carefully. The path forward involves building trust through education, ensuring that safety protocols are visible and understandable, and engaging community leaders to address cultural concerns. The mothers in the study made it clear that they want to protect their children, and they see donor milk as a way to do that, as long as the process is safe and respectful. The findings offer a hopeful foundation for policymakers and health workers to begin the work of establishing these vital services, turning a novel concept into a life-saving reality for the most vulnerable newborns.