Human Milk Donation and Human Milk Banking from the Perspective of Fathers: A Qualitative Study

Study Design

This study was conducted using a qualitative research approach with inductive thematic analysis. The study was conducted in accordance with the Standards for Reporting Qualitative Research (SRQR; O’Brien et al., 2014; Supplementary File S1).

Setting and Sample

The study population consisted of fathers who brought their children for examination at a state hospital between August and December 2024. A purposive sampling strategy was used to recruit fathers who met the inclusion criteria and agreed to participate verbally and in writing. The study sample included fathers who were knowledgeable about human milk banking, spoke Turkish as their native language, were literate, were over 18 years of age, had no communication barriers, and had no psychiatric disorders. During recruitment, fathers were asked whether they had previously heard about human milk banking, and only those reporting prior awareness of the concept were included in the study. Fathers who wished to withdraw from the study during the research process were excluded.

In qualitative research, sample size is determined by considering the purpose of the study, the research questions, and data saturation. In this study, interviews with participants continued until similar concepts began to recur and no new expressions emerged. Data collection was terminated when data saturation was reached (Baltacı, 2018; Bradshaw et al., 2017; Saunders et al., 2018). The data collection process was completed with 20 fathers included in the study using purposive sampling.

Data Collection Methods

The data of the study were collected using a “Father Descriptive Information Form” and a “Semi-Structured Interview Form.”

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Table 1.

Semi-Structured Interview Questions.

1. What are your views (both positive and negative) regarding human milk banking? 2. Would you use donor human milk obtained from a human milk bank to feed your infant? Could you explain your thoughts on this? 3. What is your perspective on human milk donation to human milk banks, and what are your thoughts on this process? 4. Would you allow your spouse to donate human milk to a human milk bank? What are your views on this? 5. Currently, there is no human milk bank in our country. If a human milk bank were to be established, what would your opinion on this be?

Researcher Characteristics and Reflexivity

The research team consisted of three academics with backgrounds in maternal health: two nurse researchers specializing in maternity nursing and one midwife researcher. To minimize potential bias, the researcher involved in data collection did not participate in the analysis process. The qualitative data analysis was conducted independently by the two nurse researchers with expertise in maternity nursing and experience in qualitative research, after which codes and themes were compared and consensus was reached. In addition, the researchers engaged in regular reflexive discussions to ensure that their knowledge and perspectives on human milk banking did not influence the coding or theme development. There was no prior professional relationship between the researchers and participants. Participants were informed that their participation was voluntary, their responses would not affect the healthcare their children received, and all information would be kept confidential. This ensured that participants could freely express their views.

Data Collection

The research data were collected between August and December 2024 in the pediatric outpatient clinics of a state hospital. During the data collection process, initial contact with fathers was established in the waiting areas of the outpatient clinics. Those who met the inclusion criteria and voluntarily agreed to participate were invited to the study. Prior to the interviews, fathers were informed that audio recordings would be taken, and written informed consent was obtained. The data collection process was carried out through face-to-face, semi-structured interviews. To ensure that participants felt comfortable and could respond openly and independently from their spouses, interviews were conducted in a private, quiet room within the hospital waiting area. The duration ranged from 10 to 30 minutes; although some interviews were relatively short, all key topics were covered, and data collection continued until saturation was reached, ensuring sufficient depth and richness of information.

Data Analysis

Inductive thematic analysis was used to analyze the data in this study. Thematic analysis enables qualitative data to be systematically coded and structured into meaningful themes (Braun & Clarke, 2006). The data set of the study consisted of statements obtained from semi-structured interviews conducted with fathers regarding human milk banking. The audio recordings were transcribed into written form with careful attention to preserving meaning integrity and content accuracy. Thus, a reliable and analyzable data set was obtained for the purposes of the study (Halcomb & Davidson, 2006). The data set was then uploaded to MAXQDA Analytics PRO (2024), a widely used software program in qualitative data analysis. During the analysis process, tools provided by the software, such as coding, the development of subthemes, thematic mapping, and visualization were utilized. MAXQDA provides substantial support to researchers by ensuring systematic organization, traceability, and ease of data management in data-driven analysis (Kuckartz & Rädiker, 2019).

Coding and theme development were carried out independently by two researchers. Using the tools offered by the software, coding was performed, and frequency tables, subtheme-theme diagrams, and various graphical representations were generated to visualize the findings. The researchers then discussed their analyses and reached consensus on the final codes and themes. The coding process followed an inductive (data-driven) approach. Participant statements were examined in detail, and recurring meaningful expressions were identified as codes. The identified codes were grouped based on conceptual similarity and contextual relevance, and then classified under higher-level themes and subthemes (Nowell et al., 2017). Direct quotations from fathers were included in the findings. Fathers were cited as “Father,” and each father was assigned a number (e.g., Father 1; F1) at the end of the quotations.

Trustworthiness and Rigor

To ensure the rigor of the data analysis, the criteria of credibility, dependability, confirmability, and transferability proposed by Guba and Lincoln were followed (Lincoln & Guba, 1986). To establish credibility, interview transcripts were carefully examined, and participant statements were analyzed using an inductive approach. Coding and theme development were conducted independently by two researchers and finalized through consensus. Direct quotations from fathers were included in the findings to support the interpretations. To enhance dependability, the interview questions were developed based on expert feedback, and the coding process was systematically planned. Inter-researcher consistency was maintained, and the analysis process was supported through the use of MAXQDA software to ensure traceability. For confirmability, transcripts were reviewed thoroughly and the analysis process was re-evaluated, with coding conducted systematically. The findings were supported with frequency tables, thematic diagrams, and visual representations. To ensure transferability, data were collected until saturation was reached, increasing the representativeness of the context. Presenting participant characteristics directly in the text enabled readers to better understand the study context. The study was reported in accordance with the Standards for Reporting Qualitative Research (SRQR) to ensure transparency and methodological rigor.

Theme 1: Fathers’ Views on Human Milk Banking

This theme consists of two subthemes: “Views Focused on Benefits” and “Views Considering it Objectionable.” In the subtheme “Views Focused on Benefits,” fathers emphasized that human milk banking can provide important advantages in terms of infant nutrition, growth, immune support, accessibility, and preventing the need for formula use. Fathers highlighted that human milk is unique and irreplaceable, and therefore, human milk banks may serve as an essential source of nutrition for infants who cannot receive milk from their own mothers.

An infant who is fed with human milk has a stronger immune system and becomes healthier, and they start life in a more positive way. (F 6)

I looked for human milk, but I could not find it. We had to express the milk using a breast pump. (F 3)

In the subtheme “Views Considering It Objectionable,” fathers expressed that the use of donor human milk may pose risks in terms of health, hygiene, religious concerns, emotional factors, record-keeping, and legal issues.

From a religious perspective, there is the issue of milk kinship. We may donate to the milk bank, but to whom will it go? Without knowing, it could lead to a marriage between milk siblings. In this sense, it has disadvantages, and this is a matter of debate in my opinion. (F 4)

Will the laboratory be able to maintain the quality of that milk? This may create problems. There needs to be a clear and reliable record of which mother the milk is obtained from (F 19)

I don’t think it would be hygienic, so I do not find the storage of milk appropriate. For this reason, I would not want milk banks. (F 17)

Theme 2: The Use of Donor Human Milk for One’s Own Infant’s Nutrition

Under the theme of benefiting from human milk banks, two subthemes were identified: “Conditional Use in Necessary Situations” and “Factors Limiting Use.”

In the subtheme “Conditional Use in Necessary Situations,” Fathers stated they might use donor milk for their infants if medically necessary and hygiene, storage, donor identity, and supervision were ensured.

I would use it, especially if it is hygienic and under government supervision. (F 3)

If it is clear which mother the milk comes from, then it can be used, but if it is not known, I find its use objectionable. (F 6)

Under normal circumstances, I would not use it, but if I were in a situation where I had no choice and could not find human milk, then I would. (F 14)

In the subtheme “Factors Limiting Use,” fathers expressed reluctance to use human milk banks due to concerns about milk kinship, hygiene, disease risk, donor lifestyle, and the belief that infants should be fed their own mother’s milk.

For example, from a religious standpoint, I do not find it appropriate to give my child milk from someone I do not know. (F 11)

No, I would never use it. The mother who donates the milk might have an illness, and I cannot know how clean it is. Maybe formula is even more harmful, but still, I would prefer formula. (F 17)

What is the donor mother’s diet like? Could a genetic disorder be passed from the donor mother to my child? Because I would have such concerns, I would not prefer it. (F 19)

We want everything for our baby to belong to us as the mother and father. The child should grow up with their own mother’s milk. (F 5)

Theme 3: Perspectives on Donating to a Human Milk Bank

Under this theme, two subthemes were identified: “A Paternalistic Perspective” and “An Opposing Perspective Shaped by Faith.” Some fathers viewed milk donation as a meaningful, altruistic act, while others opposed it due to religious and cultural beliefs. Selected statements illustrating fathers’ perspectives are presented below.

I would want my wife to donate her milk. All mothers should do this. Because, inevitably, situations like war can happen. (F 9)

Having a human milk bank is just like having a blood bank, it is a very good thing. (F 12)

Some babies lose their mothers right after birth. When a woman donates her milk, it becomes life for a baby whose mother has passed away. (F 9)

Since our religion, customs, and traditions come to the forefront, human milk donation remains secondary for me. (F 4)

Theme 4: Fathers’ Attitudes on Allowing Their Wives to Donate to Human Milk Banks

Within this theme, findings were gathered under a single subtheme titled “Attitudes Toward Human Milk Donation.” It was determined that 15 fathers stated they would allow their wives to donate human milk, while five fathers reported that they would not permit such donation.

Yes, I would allow it. Rather than my wife’s milk going to waste, it makes more sense to me that it reaches someone in need. (F 1)

I would definitely allow it. Human milk is important for raising healthy individuals, so I would fully support my wife in this, as long as she wants it. (F 8)

To put it clearly, I would not allow it. (F 2)

It could be possible if the necessary conditions are met. If our own child does not need the milk and another child does, then I would allow my wife to donate. (F 18)

Theme 5: Fathers’ Views on the Establishment of Human Milk Banks in Türkiye

Fathers’ views on the establishment of human milk banks in Türkiye were categorized into three subthemes: “Acceptance,” “Conditional Acceptance,” and “Rejection.”

Fathers who expressed acceptance of the establishment of human milk banks in Türkiye demonstrated a positive and supportive attitude, indicating that they were willing to fulfill any responsibilities required of them in this process.

It would be good for mothers who do not have milk or who lack the means, so that their infants could receive nutritional support from a human milk bank. I would like it to be established in our country. (F 7)

As a man, I am a bit distant from such matters, but I see it similar to blood donation. I believe that having it in our country would be beneficial. (F 15)

I think it should exist in our country. Because unfortunately, some mothers do not produce milk. In such cases, milk can be obtained. Artificial formulas are not as beneficial as human milk. Human milk is very important for strengthening the infant’s immune system. (F 13)

Fathers in the “Conditional Acceptance” category stated that milk donation would be acceptable if records, religious and health requirements, and sterile handling and storage were ensured.

It can be done if both the donor mother and the recipient are recorded in detail. (F 16)

It depends on how thoroughly the milk is tested and how sterile the storage conditions are. (F 12)

If everything aligns with religious requirements, I would support it. (F 4)

Fathers who rejected the establishment of human milk banks in Türkiye viewed human milk donation as culturally and religiously inappropriate and believed that such a practice would not be implemented effectively in the country.

I do not believe it would work well in our country. That is why I think differently. (F 20)

If it is established, there is nothing I can do, but I do not think it is right. If it were established, I would not use it myself and would not recommend it to others. Our religious beliefs shape our way of life as a society. (F 11)

The frequency distribution of the identified codes reflecting fathers’ views on human milk banks and human milk donation was visualized in the form of a code cloud. Codes that appeared more frequently in the data are represented in larger font size, while less frequent codes appear in smaller size (Figure 2).

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Figure 2.

Code cloud.

Strengths and Limitations

The study’s strength lies in its ability to address fathers’ perspectives within their sociocultural contexts, filling a significant gap in the literature, and making an original contribution to the field. Conducted in a country where Islam is prevalent, this study provides data that will contribute to a better understanding of fathers’ perspectives on human milk banking and human milk donation processes for policymakers and practitioners. Because the study employed a qualitative research design, the results cannot be generalized to all fathers. Additionally, because the study was conducted at a single hospital and the majority of participants were college graduates working in the public sector, the sample is homogeneous. There is a possibility that fathers may have tended to provide socially acceptable responses during the interviews (social desirability bias). Since the study was conducted in a hospital setting, the environment may have influenced participants’ responses. The short duration of some interviews is another limitation.