Postpartum Women's Knowledge,Attitude And Perception Regarding Human Milk Banks And Milk Donation-a Mixed Method Research

Background: Breast milk contains a large number of nutrients,which can satisfy the needs of the growth and development of the newborns within 6 months.Breast milk is the best natural standard food for infants including preterm infants.What's more,breastfeeding can reduce the incidence of necrotizing enterocolitis and sepsis,and improve the survival rate of preterm infants.However,direct breastfeeding is often impossible for preterm infants due to lactation failure.Donor human milk is recommended as the first alternative when own mothers' milk is not available.China has a large number of preterm infants,and the establishment of human milk banks is of great significance to promote the breastfeeding of preterm infants,reduce the mortality of preterm infants,and improve their survival quality.However,the establishment of human milk banks in China lags far behind the Europe and the US countries and the research on women's knowledge,attitude and practice regarding human milk banks are insufficient.Objectives:(1)Investigate postpartum women's knowledge,attitude and practice associated with human milk banks and milk donation and deeply explore their perception of human milk banks and milk donation;(2)Identify factors influencing postpartum women's knowledge,attitudes and practice regarding human milk banks and milk donation;(3)Explore the motivations and obstacles of postpartum women's milk donation and acceptance of donor human milk,and provide practical advices for the establishment of human milk banks.Method: The current study was a mixed method research combining with quantitative method and qualitative method.In the quantitative part,convenience sampling was used to recruit 1,078 women who returned for postpartum follow-up within six months after delivery at a maternal and child hospital and a tertiary hospital in Wuhan.Questionnaires were used to obtain sociodemographic data and to determine participants' knowledge,attitude and practice regarding human milk banks and milk donation.Statistical analysis was performed using SPSS 25.0 software.Descriptive statistics were used to identify respondents' characteristics;two independent samples t-test and ANOVA analysis were used to compare scores with participants' demographic data;multiple linear regression models were used to examine association between participants' scores regarding human milk banks and milk donation(outcome variables)and women's demographic information(independent variables);and Pearson correlation analysis was used to analyze the correlation between participants' knowledge,attitude and practice regarding human milk banks and milk donation.In the qualitative research part,eight postpartum women who had heard of human milk bank were selected as the interviewees by objective sampling.Face-to-face interviews guided with semi-structured were conducted to explore women's perception of human milk banks and milk donation.Content analysis was used to analyze qualitative data and Nvivo 12.0 software was adopted for topic extraction.Results: Quantitative part: The quantitative results showed that only 216(20%)of participants had heard about human milk banks and milk donation ever and the major source of information was the Internet.For sub-domain of knowledge,the item with the highest correct rate was the benefit of breast milk,and the item with the lowest correct rate was the recipient of donor human milk.As for sub-domain of attitude,811(75.3%)participants held a supportive attitude for the establishment of human milk banks,877(81.3%)participants were supportive for donating breast milk while 412(38.3%)participants were supportive for accepting donor human milk.As for sub-domain of practice,the practice of milk donation was not optimistic,participants lacked the interest in donating breast milk and spreading knowledge of breast milk banks,and only 28.3% of the participants expressed that they would donate breast milk continuously.In addition,the quantitative results showed that there was a significant positive and weak correlation between knowledge and attitude(r=0.446,P<0.001),knowledge and practice(r=0.369,P<0.001),and a significant positive and strong correlation between attitude and practice(r=0.657,P<0.001).Participants' age,education background,the birth weight of the newborn and having heard about human milk banks were promoting factors for women's knowledge,attitude and practice;women's medication using experience during pregnancy or lactation was blocking factors of their knowledge about human milk banks.Qualitative part: Four themes emerged from this interview.The first one theme was perception of human milk banks,including two sub-themes: high expectation;disinterest.The second theme was desires and barriers for women's milk donation,including six sub-themes: Excessive milk production;altruism;strong belief in the value of breast milk and strong desire to breastfeed;family support;inconvenient transportation and time consuming;and concerns about complicated donation processes.The third theme was barriers to the use of donor human milk,including three subthemes: Safety concerns;personal dislikes;and formula using experience during hospitalization.The last theme was practical advices on human milk banks,including three sub-themes: Enhancement of publicization and education;sources,forms and timing of education;and promotion of milk donation.Conclusion: The popularization of human milk bank is not optimistic,only 20% of women have heard of breast milk bank,and the major information source was the Internet.Postpartum women have recognized the benefits of breast milk,which can promote their practice of donating breast milk.However,they lack of knowledge of human milk banks and milk donation,fear of the transmitted diseases via breast milk,which makes them reluctant to accept donor human milk.Education of breastfeeding and training of health care providers should be promoted before the establishment of human milk banks.In the early stage of establishing breast milk bank,the publicization and education of human milk banks should be carried out by health care providers;health education intervention should focus on women who are not older,gain primary educational background,deliver low birth weight infants and never heard of breast milk banks.The content of health education should focus on the selection of donors and the handling and storage process of donated breast milk,so as to reduce mothers' concerns about the safety of donated breast milk.