Turkish Women’s Beliefs Concerning Human Milk Banking

Abstract

French

Background:

A donor milk bank provides an alternative source of human milk for mothers who cannot breastfeed or provide their own milk. Although wet-nursing is a common practice, there is currently no donor milk bank in Turkey.

Research Aims:

The aims of our study were (1) to determine the knowledge and opinions of Turkish women in regard to donor milk banking; and (2) to raise awareness of donor milk banking.

Methods:

This was a prospective cross-sectional descriptive study, in which the data were collected with an online survey consisting of 22 questions. The link to the online survey was distributed through the social media accounts of the researchers, with a statement inviting women aged 18–64, who were literate and actively using social media, to participate in the survey. There were 648 female participants.

Results:

Of those who responded to the questionnaire, 54.1% had not previously given birth, and 54.2% had heard about donor milk banks before. The implementation of donor milk banks in Turkey was desired by 56.4% of the participants, and 50.8% of the participants considered donating their milk. It was determined that the reasons why the women did not want to benefit from donor milk banks were the risk of disease transmission to the baby and the possibility of their child marrying his or her milk sibling in the future.

Conclusion:

It appears that Turkish women lack information about donor milk banking. We recommend public awareness activities to be organized concerning donor milk banking.

Keywords

breastfeeding donor milk banking human milk milk bank milk banking Muslim survey Turkey

Key messages

Women’s views about donor milk banking in Turkey are largely unknown.

We discovered the reasons why our participants did not want to benefit from donor milk banks were lack of information about donor milk banks, fear of infection risk, and religious objections.

Education level was a determining factor in forming the opinions of the participants about donor milk banking, and solutions should be offered to hesitations about milk banking, considering sociocultural values and attitudes.

Background

Approximately 2.4 million infants die each year in the first 4 weeks of their lives worldwide (World Health Organization [WHO], 2019a), with about three-quarters of these deaths occurring within the 1st week of birth (United Nations Children’s Fund [UNICEF], 2020). Human milk and breastfeeding have an important effect in preventing infant mortality (Victora et al., 2016). The WHO (2020) has stated that in the first 6 months, infants should be given only human milk without any additional food, including water, and recommends starting additional liquid and solid foods after 6 months and continuing human milk until at least 2 years of age, in addition to these complementary foods. Fresh human milk should always be the first choice for newborn infants (Kair et al., 2020). However, not all newborns have the same rate of access to their mother’s own milk in the 1st hour after birth and in the early neonatal period. Common causes of this condition include the mother’s absence due to illness, death, or abandonment; some medications; and inability to breastfeed due to adoption or prematurity (Centers for Disease Control and Prevention [CDC], 2019). This situation might cause infants to be deprived of this miraculous nutrient.

The WHO (2019b) and the American Academy of Pediatrics (American Academy of Pediatrics Committee on Nutrition, 2017) have highlighted that pasteurized donor human milk is the best option in the absence of the mother’s own milk. Researchers have shown that premature and low-birth-weight infants who were fed with milk from donor milk banks are protected from many diseases, and their immune systems are stronger than formula-fed infants (Kantorowska et al., 2019). Additionally, for premature infants born to mothers with transferable infections, including cytomegalovirus, some researchers have recommended pasteurization of the mother’s own milk (Prendergast et al., 2019). Regarding the use of pasteurized donor milk, priority should be given to sick or preterm newborns (Mansen et al., 2021).

A donor milk bank is a service established to recruit human milk donors, collect donated milk, and then process, screen, store, and distribute the milk to meet infants’ specific needs for optimal health. The mission of a donor milk bank is to promote and support breastfeeding by providing safe, high-quality donor milk to fill a gap for those who need mother’s milk but are not able to receive it. The first donor milk bank was established in 1909 in Vienna, Austria, followed by those established later in the United States, Germany, and the United Kingdom. In 1985, the modern Human Milk Banking Association (HMBANA) was created in North America with an effort to establish the necessary standards for safe and efficient milk banking (Jang et al., 2016). Additionally, the European Milk Bank Association (EMBA) was established in Italy in 2010 to encourage milk banking in Europe and international collaboration among the donor milk banks of European countries (EMBA, 2021). The number of milk banks is increasing worldwide. In many countries, donor milk banking is protected, encouraged, and supported as an extension of national breastfeeding policies by being included in child healthcare policy (Demarchis et al., 2017).

Donor milk banking is a common practice in European society. In Turkey, although preparations had started for the opening of a donor milk bank in 2013, differences in opinions emerged. Milk kinship and the possibility of milk siblings marrying in the future caused great controversy. For this reason, the bank was never opened. The authorities stated that the opening was postponed until legal regulations had been established (Ergin & Uzun, 2018). Currently, there is no active donor milk bank in Turkey. It is a common opinion that this situation is negatively affecting the lives of sick and premature infants (Fonseca et al., 2021).

The support of healthcare staff and families is extremely important in establishing a donor milk bank (Doshmangir et al., 2019; Meneses et al., 2017). It is thought that the knowledge of individuals and their views on the topic are important in the establishment and provision of the beneficial services of these milk banks. The aims of our study were (1) to determine the knowledge and opinions of women in regard to donor milk banking; and (2) to raise awareness about donor milk banking.

Methods

Research Design

This was a prospective cross-sectional descriptive study, in which the data were collected with an online survey consisting of 22 questions. The rationale for the choice of this design was that it provides fast, easy data collection at a low cost, and it was suitable for studying the variables of interest, including beliefs and opinions (Zangirolami-Raimundo & Oliveira, 2018). Ethical approval for the study was obtained (GOKAEK-2020/5.02 2020/86) and the study was conducted in accordance with the principles of the Declaration of Helsinki.

Setting and Relevant Context

Approximately half of the population in Turkey is women (49.8%; Turkish Statistical Institute, 2019). The Breastfeeding Promotion and Baby-Friendly Health Facilities Program, whose main purpose is to sustain, encourage, and support breastfeeding, has been operating in Turkey since 1991 (Ministry of Health, 2017). According to this program, midwives and other health professionals who deal with women and their infants provide free education and consultancy about breastfeeding and human milk during the pregnancy and postpartum period at public hospitals. Families can receive special education and counseling about breastfeeding and human milk from midwives by paying a fee if they desire.

Although breastfeeding is common in Turkey, breastfeeding rates are still not at a desired level. Although currently 71% of infants under the age of 2 are breastfed within 1 hr of birth and 86% are breastfed within 1 day of birth, only 41% are exclusively breastfed in the first 6 months, and 42% receive pre-lacteal food. Additionally, contrary to the suggestion that infants who are under the age of 6 months should be fed only human milk, 23% receive milk other than human milk including cow or goat milk, 15% receive human milk and water, 12% receive human milk and supplementary food, and 2% receive liquids including fruit juice and broth. Moreover, 7% of infants in general are not breastfed (TNSA; Turkey Demographic and Health Survey, 2018).

Sample

The target population included women who were 18–64 years of age and actively using social media in Turkey. In the calculation of the sample size, the rate of women in Turkey hearing about donor milk banks (22.9%) was used based on the information provided in a study by Ergin and Uzun (2018). The sample size was calculated using the sample formula of unknown population (n = t²pq/d²; α = 0.05; t = 1.96; p = .229; q = 0.771; d = 0.05 with a design effect of 1.5). The adequate minimum sample size was found to be 407.

All volunteering women who were 18 and older, literate, and spoke Turkish, were included in the study. The language of the survey form was Turkish. Potential participants who did not respond to all questions were excluded from the study. The exclusion criteria were women who were older than 64 and younger than 18, illiterate, did not accept the consent text, and did not complete the questionnaire fully. We had 650 participants who responded to the questionnaire. Two participants who did not meet the inclusion criteria were excluded from the study. Eventually, 648 eligible participants were included in the sample.

Measurement

The questionnaire was created based on the clinical experience of the researchers and the issues highlighted by researchers in previous studies and assessed by professionals in the field (AlHreashy, 2018; Alnakshabandi & Fiester, 2016; Demarchis et al., 2017; Ekşioğlu et al., 2015; Ergin & Uzun, 2018; Kul Uçtu & Özerdoğan, 2017; Ozdemir et al., 2015). The questionnaire (see Supplemental Material) consisted of 22 questions including eight closed-ended questions examining sociodemographic and obstetric characteristics including age, educational status, delivery type, and the infant’s need for intensive care in the postpartum period; eight closed-ended questions examining the women’s beliefs and attitudes about wet-nursing and donor milk banking; and six statements about donor milk banking, requiring the marking of one of the options of true, false, or indecisive.

Data Collection

The data were collected between 18 November and 15 December 2019 using an online questionnaire form. The original questionnaire is included in the supplementary material of this article. The link to the online questionnaire was distributed through the researchers’ social media accounts (WhatsApp, Instagram, Facebook, etc.). An online information text was shared with the participants about the purpose of the study, assurance that their personal information would be kept confidential, and that there were no questions requiring identifying information. Participants who agreed to participate in the study after opening the online survey link, confirming the informed consent text, and declaring that they were women in the gender option, could access the survey questions. The research data were stored on an encrypted computer.

Data Analysis

The responses were analyzed using SPSS (Version 20.0). Descriptive statistics, including mean (M) and standard deviation (SD) were used to describe “age” which was one of the sociodemographic variables. Other responses to all questions are reported as frequencies and percentages. Pearson’s chi-squared test was used to test the relationships between the sociodemographic variables and the women’s beliefs and attitudes about wet-nursing and donor milk banking and statements about donor milk banking. p ≤ .05 was accepted as statistically significant.

Results

The sociodemographic and obstetric characteristics of the participants are given in Table 1. The age range was 18–58, and the mean age of the participants was 28.13 (SD = 7.90). Just under half of the participants had children. Almost all participants had had their latest birth between 37 and 42 weeks of gestation (n = 275, 92.5%), and their infants did not need intensive care (n = 272, 91.5%), and 22 participants (7.5%) gave birth between 26–36 weeks of gestation. Over half of the participants had previously heard about donor milk banks and had wanted the presence of donor milk banks in Turkey (Table 2). While a few of the participants who had given birth before the survey stated that they had been a wet nurse before and that their infants were breastfed by a wet nurse, more than half of the participants stated that they were thinking of donating their milk, and approximately one third stated that they would like to benefit from a donor milk bank if there was a situation that prevented them from breastfeeding (Table 2). The reasons why the participants did not want to benefit from a donor milk bank were the risk of infection to their infant, finding it religiously objectionable, and the possibility of their child marrying his/her milk sibling in the future.

Table 1.

Sociodemographic and Obstetric Characteristics of the Participants (N = 648).

Characteristic	n (%)
Educational Status
Primary School	37 (5.8)
High School	120 (18.5)
University	491 (75.7)
Working Status
Yes	272 (42.0)
No	376 (58.0)
Family Type
Nuclear family	539 (83.1)
Extended family	109 (16.9)
Delivery before the survey
Yes	297 (45.8)
No	351 (54.2)
Form of delivery
Normal vaginal delivery	105 (16.2)
Cesarean delivery	180 (27.8)
Both normal vaginal delivery and cesarean delivery	12 (1.9)
Never given birth	351 (54.1)

Note. Nuclear family = a family consisting of mother, father, and unmarried children; extended family = the broader form of the nuclear family, usually organized around a one-sided lineage group, consisting of close relatives including grandfather, grandmother, uncle, aunt.

Table 2.

Beliefs and Attitudes of Participants about Donor Milk Banking (N = 648).

Beliefs and Attitudes	n (%)
Previously heard about donor milk banks
Yes	351 (54.2)
No	297 (45.8)
Requesting donor milk bank implementation in Turkey
Yes	366 (56.4)
No	84 (13.0)
Undecided	198 (30.6)
Wet-nursing status of women who previously gave birth
Yes	32 (10.8)
No	265 (89.2)
Mothers with breastfeeding problems prior to survey
Yes	124 (41.8)
No	173 (58.2)
Mothers supported by a wet-nurse due to breastfeeding problems
Yes	27 (9.1)
No	270 (90.9)
Women’s opinion about donation of their milk
Considering donation	329 (50.8)
Not considering donation	129 (19.9)
Undecided	190 (29.3)
Women’s opinion on personal use of donor milk bank
Yes	257 (39.7)
No	157 (24.2)
Undecided	234 (36.1)
Reasons for not willing to benefit from donor milk banking^a
Risk of infection to their infants	275 (42.4)
Religious objections	130 (20.1)
Possibility of future marriage of milk siblings	105 (16.2)
Not knowing the identity of the donor	101 (15.6)
Not knowing the storage conditions of milk	64 (9.9)
Other	32 (4.9)

Note. Participants were allowed to select multiple reasons; therefore, frequencies are not mutually exclusive; Other = not allowed by partner, not considered necessary, thinking that own milk will be enough.

The responses of the participants to the statements about donor milk banks are presented in Table 3. The participants mostly thought that Statement 5 was true, Statement 6 was false, and they were undecided about Statement 4. Additionally, the relationships between the education levels of the participants and other sociodemographic and obstetric variables are summarized in Table 4. Accordingly, the education level of the participants who had not given birth before was higher. It was found that the participants with a university-level education had higher rates of having heard about donor milk banks before and were considering using donor milk bank in the case of obstacles to their breastfeeding. These data are summarized in Table 5.

Table 3.

Participants’ Response to Statements About Donor Milk Banks (N = 648).

Statements	Truen (%)	Falsen (%)	Undeterminedn (%)
1. The risk of infection is high in babies who are fed milk from a donor milk bank.	163 (25.1)	147 (22.7)	338 (52.2)
2. The risk of developing infection is higher in babies who are given formula than those who are given donor bank milk.	200 (30.8)	108 (16.7)	340 (52.5)
3. Contagious diseases can be transmitted to babies from milk taken from donor milk banks.	260 (40.1)	99 (15.3)	289 (44.6)
4. Milk taken from a donor milk bank is safe.	124 (19.2)	67 (10.3)	457 (70.5)
5. Nutritional value of milk taken from donor milk bank is higher than formula.	409 (63.1)	25 (3.9)	214 (33.0)
6. The benefits of milk from a donor milk bank are less than that of formula.	35 (5.4)	378 (58.4)	235 (36.2)

Table 4.

Comparison of Sociodemographic and Obstetric Characteristics Grouped by Educational Status (N = 648).

Characteristic	Educational status
Characteristic	Primary schooln (%)	High schooln (%)	Universityn (%)	X ²	p
Working status
Yes	10 (3.7)	48 (17.6)	214 (78.7)	4.109	.128
No	27 (7.2)	72 (19.1)	277 (73.7)	4.109	.128
Family type
Nuclear family	29 (5.4)	95 (17.6)	415 (77.0)	2.623	.269
Extended family	8 (7.3)	25 (22.9)	76 (69.8)	2.623	.269
Delivery before the survey
Yes	34 (11.4)	91 (30.7)	172 (57.9)	98.198	<.001
No	3 (0.9)	29 (8.2)	319 (90.9)	98.198	<.001
Type of delivery
Normal vaginal delivery	14 (13.3)	32 (30.5)	59 (56.2)	112.317	<.001
Cesarean section delivery	17 (9.4)	52 (28.9)	111 (61.7)
Both normal vaginal delivery and cesarean delivery	3 (25.0)	7 (58.3)	2 (16.7)
Not given birth	3 (0.9)	29 (8.2)	319 (90.9)

Note. p < .05 is the level of significance.

Table 5.

Comparison of Participants’ Sociodemographic Characteristics Grouped by Their Beliefs About Donor Milk Banks (N = 648).

Characteristic	Heard about the donor milk bank		Requesting donor milk bank implementation in Turkey			Opinion about donation of their milk			Opinion about use of donor milk bank when obstacles to BF
Characteristic	Yesn (%)	Non (%)	Yesn (%)	Non (%)	Undetermined n (%)	Yesn (%)	Non (%)	Undetermined n (%)	Yesn (%)	Non (%)	Undeterminedn (%)
Educational status
Primary school	15 (4.3)	22 (7.4)	17 (4.6)	6 (7.2)	14 (7.1)	12 (3.6)	15 (11.6)	10 (5.3)	11 (4.3)	14 (8.9)	12 (5.1)
High school	59 (16.8)	61 (20.5)	65 (17.8)	17 (20.2)	38 (19.2)	54 (16.4)	28 (21.7)	38 (20.0)	36 (14.0)	40 (25.5)	44 (18.8)
University	277 (78.9)	214 (72.1)	284 (77.6)	61 (72.6)	146 (73.7)	263 (80.0)	86 (66.7)	142 (77.7)	210 (81.7)	103 (65.6)	178 (76.1)
X²	4.976			2.347			14.342			14.168
p	.083			.670			.007			.007
Working status
Working	152 (43.3)	120 (40.4)	159 (43.4)	38 (45.2)	75 (37.9)	143 (43.5)	57 (44.2)	72 (37.9)	109 (42.4)	68 (43.3)	95 (40.6)
Not working	199 (56.7)	177 (59.6)	207 (56.6)	46 (54.8)	123 (62.1)	186 (56.5)	72 (55.8)	118 (62.1)	148 (57.6)	89 (56.7)	139 (59.4)
X²	0.556			2.055			1.858			0.318
p	.456			.351			.402			.857
Family type
Nuclear family	293 (83.5)	246 (82.8)	307 (83.9)	65 (77.4)	167 (84.3)	279 (84.8)	103 (79.8)	157 (82.6)	218 (84.8)	131 (83.4)	190 (81.2)
Extended family	58 (16.5)	51 (17.2)	59 (16.1)	19 (22.6)	31 (15.7)	50 (15.2)	26 (20.2)	33 (17.4)	39 (15.2)	26 (16.6)	44 (18.8)
X²	0.048			2.339			1.685			1.162
p	.826			.316			.436			.576
Delivery before the survey
Yes	147 (41.9)	150 (50.5)	164 (44.8)	39 (46.4)	94 (47.5)	144 (43.8)	71 (55.0)	82 (43.2)	93 (36.2)	98 (62.4)	106 (45.3)
No	204 (58.1)	147 (49.5)	202 (55.2)	45 (53.6)	104 (52.5)	185 (56.2)	58 (45.0)	108 (56.8)	164 (63.8)	59 (37.6)	128 (54.7)
X²	4.820			0.382			5.516			27.059
p	.028			.826			.063			<.001
Form of delivery
NSVD	52 (14.8)	53 (17.8)	62 (16.9)	13 (15.5)	30 (15.2)	53 (16.1)	20 (15.5)	32 (16.8)	36 (14.0)	28 (17.8)	41 (17.5)
Cesarean section	90 (25.7)	90 (30.3)	96 (26.3)	23 (27.3)	61 (30.8)	89 (27.1)	45 (34.9)	46 (24.2)	55 (21.4)	62 (39.5)	63 (26.9)
Both NSVD & cesarean delivery	5 (1.4)	7 (2.4)	6 (1.6)	3 (3.6)	3 (1.5)	2 (0.6)	6 (4.7)	4 (2.1)	2 (0.8)	8 (5.1)	2 (0.9)
Not given birth	204 (58.1)	147 (49.5)	202 (55.2)	45 (53.6)	104 (52.5)	185 (56.2)	58 (45.0)	108 (56.8)	164 (63.8)	59 (37.6)	128 (54.7)
X²	5.135			2.987			14.168			37.029
p	.162			.822			.028			<.001

Note. NSVD = normal spontaneous vaginal delivery; BF = breastfeeding. p < .05. The relationship is significant at the level of significance.

Discussion

In this study, we aimed to determine the knowledge and beliefs of women about donor milk banking. In 2018, a similar study was conducted with 240 women from a semi-rural area (Denizli) in Turkey, and the researchers showed that 62.5% of their participants had heard about donor milk banking (Ergin & Uzun, 2018). Researchers of other studies conducted in Turkey (in İzmir and Çankırı) have obtained similar results (Ekşioğlu et al., 2015; Pekyiğit et al., 2019). One of the strong and unique features of this study was that it also included the views of women who had no children; the participants in previous studies consisted of only mothers.

In a study conducted by Ekşioğlu et al. (2015), the researchers showed that 71.3% of the participants were willing to have the practice of donor milk banking in Turkey. There is no active donor milk bank in Turkey. Discussions about donor milk banks in Turkey continue and are not settled mostly due to the risk of “milk kinship,” which is a religious concern (Religious Affairs Supreme Council Presidency, 2020).

In Muslim societies, wet-nursing is a well-established practice in feeding newborn infants (Kul Uçtu & Özerdoğan, 2017). Wet-nursing is also a practice, especially in rural areas in Turkey, when the mother cannot breastfeed for any reason (Yılmaz et al., 2018). However, due to the increase in formula use, there has been a decrease in the rate of wet nursing (AlHreashy, 2018). In studies in various provinces of Turkey, researchers have shown that the incidence of wet-nursing of infants was 5.2%–12.5% (Ekşioğlu et al., 2015; Ergin & Uzun, 2018; Yılmaz et al., 2018). Our study, having quite a large sample, was similar to other studies in terms of the data we collected. In our study, about one in every 10 mothers who had given birth had been a wet nurse before, and the same number had been supported by a wet nurse, due to their own breastfeeding problems. In fact, the rate of wet-nursing has not changed in the last 10 years.

In the study conducted by Ergin and Uzun (2018), the researchers showed that most participants (78.3%) agreed with being a wet nurse or sharing their milk if necessary, but only one fifth (19.1%) would donate their milk to a donor milk bank. Ekşioğlu et al. (2015) reported that only 26.7% of mothers wanted to benefit from a donor milk bank if there was a situation that prevented them breastfeeding. In previous studies, researchers have shown that there is no problem in sharing human milk, but the problem stems from the issue of getting it from a milk bank or sharing it with a milk bank.

In our study, it was determined that the reasons for the participants not wanting to benefit from a donor milk bank were the risk of infection to their baby, finding the issue religiously objectionable, and the possibility of their child marrying their milk sibling in the future. The results of our study were similar to the results of other studies conducted in Turkey (Ergin & Uzun, 2018; Pekyiğit et al., 2019). The most critical demand for human milk is for the most vulnerable newborns who are either premature or in need of neonatal intensive care (Quitadamo et al., 2018). Additionally, if the mother is ill, or experiencing excessive stress for her baby at the intensive care unit, she might not be able to provide enough milk for her baby (Coşkun & Günay, 2020). In our study, it was seen that most of the women did not know that the milk obtained from a donor milk bank is safe in terms of infection risk, and they were undecided about this issue. It may be thought that an institutional structure as a donor milk bank can eliminate the risk of infection and be reliable by following strict policies and procedures regarding the screening, careful collection and use of milk, as well as the pasteurization and culturing of milk with serological tests. However, the majority of the participants agreed that the statement “Nutritional value of milk taken from donor milk banks is higher than formula” was correct. Nevertheless, it is controversial that the nutritional value of milk taken from a donor milk bank is higher than formula (Brownell et al., 2018; McGee et al., 2020; Soares et al., 2019). Furthermore, finding the issue religiously objectionable and the possibility of the child marrying their milk sibling in the future, which we discussed under two different options in our study, were also important issues. According to Islamic sources, the marriage of people sharing the same human milk with each other raises concerns (Alnakshabandi & Fiester, 2016; Onat & Karakoç, 2019; Özdemir et al., 2015). In a study conducted by religious officials in Turkey, the researchers reported that 63.3% of the participants were in favor of donor human milk, 71.3% would approve the establishment of milk banks if only a limited number of recipients benefit from the donor milk bank (1–3 milk donors in each pool, provided that the donor and the recipients know each other’s identity), and only 1.7% of them leaned towards a western type of donor milk bank (Özdemir et al., 2015). In fact, it is thought that women do not have enough information on these issues. Before the establishment of donor milk banks, the concerns and anxieties of the society must first be resolved. In addition to the criteria of donor milk banks operating in the rest of Europe, there are several recommendations for donor milk banks to provide services in Turkey. These recommendations are a regular control mechanism that can prevent issues (e.g., mutual knowledge regarding the identities of the donor and the recipient) that Islam does not approve (e.g., marrying recipients to their milk siblings in the future; Kabasakal & Bozkurt, 2019; Onat & Karakoç, 2019; Clifford et al., 2020; Subudhi et al., 2021). In this context, women should be informed that donor milk banks are safe in terms of infectious disease risk, and that milk obtained from a donor milk bank is more effective than formula in cases where their mother’s milk is not available for premature and sick newborns. Additionally, if the concept of milk kinship is taken into account with appropriate legal regulations, it is assumed that milk banks will find support in Turkey.

One of the surprising results of this study was that the participants who knew more about donor milk banks and were willing to use donor milk were more frequently the women who had not given birth before. This situation is thought to be due to the higher education level of the women who had not given birth. Another surprising result was that the participants who were university graduates and had not given birth before were considering donating their milk and using donor milk banks in the case of obstacles to breastfeeding. In line with these results, it may be considered that education level was a determining factor in forming the opinions of the participants about donor milk banking. Therefore, more detailed studies are needed to examine how education level affects women’s beliefs about donor milk banking.

Limitations

We did not count the total number of people the online link of the questionnaire reached. This may have created a bias whereby the questionnaire was answered by women who were interested in the topic of donor milk banks. At the same time, sharing the data form via social media may have caused the questionnaire to be answered according to the ability of the women to use the internet. The questionnaire was created by the researchers and therefore was not externally validated. In general, closed-ended questions were used in the questionnaire, but if there had been open-ended questions, the participants’ views could have been understood more clearly. Additionally, regional differences (rural, industrial area, urban, or suburban districts) were not taken into account in the study. Therefore, other researchers could increase the sample size by taking into account regional differences in future studies.

Conclusions

Donor milk banks are particularly important for sick and premature infants whose mothers cannot breastfeed them or do not have enough milk. Breastfeeding is an informal kinship system that still prevails in Turkish society. Most women are welcome to donate human milk. It is seen that the obstacle stems from the risk of disease transmission, finding the issue religiously objectionable, and the possibility of the child marrying their milk sibling in the future. It may be thought that the reason for this is that women do not have enough information about the subject. Especially, it can be thought that women’s views can change positively if adequate restriction and identification requirements are applied to donors who donate human milk to a donor milk bank as well as to the recipients. In order to inform people about this issue, which is vital for the health of premature newborns, first of all midwives, neonatal physicians and nurses, pediatricians and pediatric nurses, and clergy should organize public awareness meetings and campaigns through social media and the press.

Supplemental Material

sj-docx-1-jhl-10.1177_08903344211037989 – Supplemental material for Turkish Women’s Beliefs Concerning Human Milk Banking

Supplemental material, sj-docx-1-jhl-10.1177_08903344211037989 for Turkish Women’s Beliefs Concerning Human Milk Banking by Suzi Özdemir, Sena Dilek Aksoy and Gaye Soyaslan Akdağ in Journal of Human Lactation

Footnotes

Disclosures and Conflicts of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Suzi Özdemir

Supplementary Material

Supplementary Material may be found in the “Supplemental material” tab in the online version of this article.

References

American Academy of Pediatrics Committee on Nutrition. (2017). Donor human milk for the high-risk infant: Preparation, safety, and usage options in the United States. Pediatrics, 139(1). https://doi.org/10.1542/peds.2016-3440

AlHreashy

(2018). Non-maternal nursing in the muslim community: A health perspective review. Journal of Clinical Neonatology, 7(4), 191. https://doi.org/10.4103/jcn.jcn_55_18

Alnakshabandi

Fiester

(2016). Creating religiously compliant milk banks in the Muslim world: A commentary. Paediatrics and International Child Health, 36(1), 4–6. https://doi.org/10.1080/20469047.2015.1110336

Brownell

E. A.

Matson

A. P.

Smith

K. C.

Moore

J. E.

Esposito

P. A.

Lussier

M. M.

Lerer

T. J.

Hagadorn

J. I.

(2018). Dose-response relationship between donor human milk, mother’s own milk, preterm formula, and neonatal growth outcomes. Journal of Pediatric Gastroenterology and Nutrition, 67(1), 90–96. https://doi.org/10.1097/MPG.0000000000001959.

Centers for Disease Control and Prevention. (2019). Contraindications to breastfeeding or feeding expressed breast milk to infants. https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/contraindications-to-breastfeeding.html

Clifford

Sulfaro

Lee

Pink

Hoad

(2020). Development and evaluation of formal guidelines for donor selection for human milk banks. Journal of Paediatrics and Child Health, 56, 1242–1248. https://doi.org/10.1111/jpc.14909

Coşkun

Günay

(2020). The effects of kangaroo care applied by Turkish mothers who have premature infants and cannot breastfeed on their stress levels and amount of milk production. Journal of Pediatric Nursing, 50, e26–e32. https://doi.org/10.1016/j.pedn.2019.09.028

Demarchis

Mansen

K. A.

Engmann

(2017). Establishing an integrated human milk banking approach to strengthen newborn care. Journal of Perinatology, 37, 469–474. https://doi.org/10.1038/jp.2016.198

Doshmangir

Naghshi

Khabiri

(2019). Factors influencing donations to human milk bank: A systematic review of facilitators and barriers. Breastfeeding Medicine, 14(5), 298–306. https://doi.org/10.1089/bfm.2019.0002

10.

Ekşioğlu

Yeşil

Çeber Turfan

(2015). Annelerin süt bankası hakkındaki görüşleri: İzmir örneği [Mothers’ views of milk banking: Example of İzmir]. Türk Pediatri Arşivi [Turkish Archives of Pediatrics], 50, 83–89. https://doi.org/10.5152/tpa.2015.2406

11.

European Milk Bank Association. (2021). About EMBA. https://europeanmilkbanking.com/

12.

Ergin

Uzun

S. U.

(2018). Turkish women’s knowledge, attitudes, and behaviors on wet-nursing, milk sharing and human milk banking. Maternal and Child Health Journal, 22(4), 454–460. https://doi.org/10.1007/s10995-018-2433-1

13.

Fonseca

R. M. S.

Milagres

L. C.

Franceschini

S. D. C. C.

Henriques

B. D.

(2021). The role of human milk banks in promoting maternal and infant health: A systematic review. Cien Saude Colet, 26(1), 309–318. https://doi.org/10.1590/1413-81232020261.24362018.

14.

Jang

H. L.

Cho

J. Y.

Kim

E. J.

Park

E. Y.

Park

S. A.

Kim

I. Y.

Choi

Bae

Chung

(2016). The experience of human milk banking for 8 years: Korean perspective. Journal of Korean Medical Science, 31, 1775–1783. https://doi.org/10.3346/jkms.2016.31.11.1775

15.

Kabasakal

Bozkurt

. (2019). Türkiye’de anne sütü merkezi girişimlerinin değerlendirilmesi ve sistem önerisi [Evaluation of breast milk centers initiative in Turkey and system recommendation]. Journal of Contemporary Medicine, 9(4), 417–423. https://doi.org/10.16899/jcm.563568

16.

Kair

L. R.

Nidey

N. L.

Marks

J. E.

Hanrahan

Femino

Fernandez

Garcia

Ryckman

Wood

K. E.

(2020). Disparities in donor human milk supplementation among well newborns. Journal of Human Lactation, 36(1), 74–80. https://doi.org/10.1177/0890334419888163

17.

Kantorowska

Wei

J. C.

Cohen

R. S.

Ruth

(2019). Impact of donor milk availability on breast milk use and necrotizing enterocolitis rates. Pediatrics, 137(3), e20153123. https://doi.org/10.1542/peds.2015-3123

18.

Kul Uçtu

Özerdoğan

. (2017). Anne sütü bankası [Human milk bank]. Manisa Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi [Manisa Celal Bayar University Journal of Institute of Health Science], 4(2), 593–596. https://dergipark.org.tr/tr/pub/cbusbed/issue/30032/324253

19.

Mansen

Nguyen

T. T.

Nguyen

N. Q.

C. T.

Tran

H. T.

Nguyen

N. T.

Mathisen

Nguyen

V. D.

Ngo

Y. T. K.

Israel-Ballard

. (2021). Strengthening newborn nutrition through establishment of the first human milk bank in Vietnam. Journal of Human Lactation, 37(1), 76–86. https://doi.org/10.1177/0890334420948448

20.

McGee

Unger

Hamilton

Birken

C. S.

Pausova

Kiss

Bando

O’Connor

D. L.

(2020). Adiposity and fat-free mass of children born with very low birth weight do not differ in children fed supplemental donor milk compared with those fed preterm formula. The Journal of Nutrition, 150(2), 331–339. https://doi.org/10.1093/jn/nxz234

21.

Meneses

T. M.

X. de, Oliveira

M. I. C. de

de Boccolini

C. S.

(2017). Prevalence and factors associated with breast. milk donation in banks that receive human milk in primary health care units. Jornal de Pediatria, 93(4), 382–388. https://doi.org/10.1016/j.jped.2016.09.004

22.

Ministry of Health (Turkey). (2017). Anne Sütünün Teşviki ve Bebek Dostu Sağlık Kuruluşları Programı [Breastfeeding Promotion and Baby-Friendly Health Facilities Program]. https://hsgm.saglik.gov.tr/tr/cocukergen-bp-liste/anne-sütünün-teşviki-ve-bebek-dostu-sağlık-kuruluşları-programı.html

23.

Onat

Karakoç

(2019). Informal breast milk sharing in a Muslim country: The frequency, practice, risk perception, and risk reduction strategies used by mothers. Breastfeeding Medicine, 14(8), 597–602. https://doi.org/10.1089/bfm.2019.0027

24.

Ozdemir

Karatas

Ozer

Dogan

D. G.

Karadag

(2015). Human milk banking and milk kinship: Perspectives of religious officers in a Muslim country. Journal of Perinatology, 35, 137–141. https://doi.org/10.1038/jp.2014.177

25.

Pekyiğit

Yıldız

Eren Fidancı

Çalık

Dehmen

Ö.

Koçak

Altıntaş

(2019). Annelerin donör süt ve süt bankalarına ilişkin görüşleri [Mothers’ views on donor milk and human milk banks]. Güncel Pediatri [The Journal of Current Pediatrics], 17(3), 325–336. https://dergipark.org.tr/tr/pub/pediatri/issue/50216/647108

26.

Prendergast

A. J.

Goga

A. E.

Waitt

Gessain

Taylor

G. P.

Rollins

Abrams

E. J.

Lyall

E. H.

de Perre

P. V.

(2019). Transmission of CMV, HTLV-1, and HIV through breastmilk. The Lancet Child and Adolescent Health, 3(4), 264–273. https://doi.org/10.1016/S2352-4642(19)30024-0

27.

Religious Affairs Supreme Council Presidency. (2020). Süt Akrabalığı [Milk Kinship]. https://kurul.diyanet.gov.tr/Konu-Cevap-Ara/169/sut-akrabaligi

28.

Soares

F. V. M.

Abranches

A. D.

Méio

M. D. B. B.

Gomes

S. C. J.

Villela

L. D.

Moreira

M. E. L.

(2019). Differences in energy expenditure in human donor milk versus formula milk in preterm newborns: A crossover study. Nutrition, 66,1–4. https://doi.org/10.1016/j.nut.2019.04.002.

29.

Subudhi

Sriraman

(2021). Islamic beliefs about milk kinship and donor human milk in the United States. Pediatrics, 147(2), e20200441. https://doi.org/10.1542/peds.2020-0441

30.

Quitadamo

P. A.

Palumbo

Cianti

Napolitano

M. L.

Coviello

Lurdo

Copetti

Gentile

M. A.

Cristalli

(2018). Might the mothers of premature babies feed them and devote some milk to the milk bank? International Journal of Pediatrics, 1–7. https://doi.org/10.1155/2018/3628952

31.

Turkish Statistical Institute. (2019). Adrese Dayalı Nüfus Kayıt Sistemi Sonuçları [Address Based Population Registration System Results]. https://data.tuik.gov.tr/Bulten/Index?p=Adrese-Dayalı-Nüfus-Kayıt-Sistemi-Sonuçları-2019-33705&dil=1

32.

United Nations Children’s Fund. (2020). Neonatal mortality. https://data.unicef.org/topic/child-survival/neonatal-mortality/#:~:text=The neonatal period is the most vulnerable time for a child&text=Children face the highest risk,deaths per 1%2C000 in 1990.

33.

Victora

C. G.

Bahl

Barros

A. J. D.

França

G. V. A.

Horton

Krasevec

Murch

Sankar

M. J.

Walker

(2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475–490. https://doi.org/10.1016/S0140-6736(15)01024-7

34.

World Health Organization. (2019a). Donor human milk for low-birth-weight infants. https://www.who.int/elena/titles/donormilk_infants/en/

35.

World Health Organization. (2019b). Newborns: Improving survival and well-being. https://www.who.int/news-room/fact-sheets/detail/newborns-reducing-mortality#:~:text=Neonates,upfrom40%25in1990.

36.

World Health Organization. (2020). Infant and young child feeding. https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding

37.

Yılmaz

Aykut

Şahin

Ongan

Balcı

Gün

İ.

Öztürk

(2018). Knowledge, attitude, and practices about wet-nursing and human milk banking in Kayseri, Turkey. Erciyes Medical Journal, 40(4), 204–209. https://doi.org/10.5152/etd.2018.18080

38.

Zangirolami-raimundo

Oliveira

J. De

. (2018). Research methodology topics: Cross-sectional studies. Journal of Human Growth and Development, 28(3), 356–360. https://doi.org/10.7322/jhgd.152198

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB