In a hospital-based cross-sectional study in Morogoro, Tanzania, researchers found that more than half of surveyed postpartum women were willing to allow their infants to receive donor human milk if medically recommended, despite very low baseline awareness. The investigation surveyed 388 breastfeeding mothers attending maternal and child health clinics to assess their familiarity with milk banking, their perceptions, and the determinants of acceptance. Overall, 53.9 percent of respondents reported willingness to use donor milk if medically indicated when their own milk was insufficient or unavailable, while 46.1 percent were unwilling. However, only 12.1 percent had previously heard of donor human milk banking, and merely 3.9 percent were aware of milk banking initiatives in Tanzania. These results indicate that maternal willingness to receive donor milk can be moderate even where formal awareness remains limited.

Mother’s own milk is the recognized gold standard for infant nutrition during the first six months, providing essential macronutrients, micronutrients, and bioactive elements such as immunoglobulins, lactoferrin, and human milk oligosaccharides that bolster infant immunity and gut maturation. For fragile infants, including preterm, very low birth weight, and sick newborns, alternatives like formula are used to prevent hypoglycemia and malnutrition, but pasteurized donor human milk is recommended as the optimal second-best alternative when maternal milk is unavailable. Evidence from systematic reviews and meta-analyses demonstrates that donor human milk protects against severe neonatal morbidities, notably reducing necrotizing enterocolitis. Furthermore, donor milk feeding supports clinical feeding tolerance, enabling neonates to reach full enteral feeding earlier, thereby lowering late-onset sepsis and shortening hospital stays. However, structured human milk banking is not yet established nationally in Tanzania, leaving a key knowledge gap regarding local maternal acceptability.

To address this gap, the analytical cross-sectional study was carried out between November 2025 and January 2026 at Morogoro Regional Referral Hospital. As a primary regional referral facility, this hospital delivers maternal, neonatal, and child health services to urban, peri-urban, and rural populations in Morogoro Region. The study population comprised reproductive-age women attending maternal and child health clinics who were actively breastfeeding. Sample size calculation utilized Cochran’s formula for a single population proportion, assuming a 95 percent confidence level, a 0.05 margin of error, and an anticipated awareness or willingness proportion of 50 percent due to the lack of prior Tanzanian studies. This yielded a minimum sample size of 385. To account for potential incomplete responses, 388 eligible women were recruited through consecutive sampling. All approached women agreed to participate, yielding a 100 percent response rate, while women who were severely ill or declined consent were excluded.

The socio-demographic characteristics of the 388 participants provided important context regarding the cohort’s background. The mean age of the respondents was 25 years with a standard deviation of 3 years. Most participants resided in urban areas, accounting for 71.4 percent of the sample, while the remainder lived in surrounding rural and peri-urban locations. Furthermore, 79.1 percent of the women were married. Regarding formal educational achievement, secondary education was the most frequent level attained, reported by 40.7 percent of respondents. In terms of employment, self-employment was the single most common category, representing 39.4 percent of the surveyed mothers. Parity assessment showed that more than half of the respondents, or 54.6 percent, were multiparous, having delivered more than one child, while 55.9 percent identified their religious affiliation as Christian. These socio-demographic indicators served as baseline independent variables in evaluating how personal, domestic, and structural factors influence maternal perspectives on donor human milk banking.

Data were gathered using a structured self-administered questionnaire implemented on the KoboToolbox digital platform, enabling real-time validation, automated skip patterns, and minimal entry errors. The tool was developed after reviewing published literature, evaluated by clinical and public health experts for content validity, translated into Kiswahili, back-translated to ensure semantic equivalence, and pretested among 20 breastfeeding women, demonstrating acceptable internal consistency with a Cronbach’s alpha of 0.82 for perception items. The primary outcome was willingness to use donor milk, assessed via a single binary question asking if mothers would allow their infants to receive donor human milk if medically recommended when own milk was unavailable; no undecided option was offered. Knowledge of donor milk safety was measured using three specific items: knowing donor milk is pasteurized, believing pasteurization inactivates viruses including HIV, and trusting hospital screening. An all-or-none scoring threshold classified only participants answering yes to all three items as knowledgeable. SPSS version 26 was used for complete-case statistical analysis.

Descriptive findings revealed that general awareness of donor human milk banking was remarkably low across the sample. Only 47 women, representing 12.1 percent, reported having previously heard of donor human milk banking, while 41 participants, or 10.6 percent, knew that breast milk could be donated. Knowledge regarding domestic initiatives was particularly sparse, with only 15 respondents, or 3.9 percent, aware of any donor human milk banking services in Tanzania. Safety protocol comprehension was similarly limited: only 35 women, or 9.0 percent, knew that donated milk undergoes screening before use, whereas 54.4 percent were unaware and 36.6 percent were uncertain. Regarding clinical indications, the majority of respondents, 57.2 percent, believed that donor milk should primarily be reserved for infants whose mothers had died. When asked about potential advantages, 42.0 percent identified protection against malnutrition and 37.4 percent recognized infection prevention as key benefits of donor human milk feeding.

Participants demonstrated mixed perceptions, combining substantial trust in healthcare facilities with notable misconceptions and cultural reservations. Overall, 67.0 percent of women perceived donor milk as safe for infants, and 71.7 percent considered it healthier than infant formula. Furthermore, 79.1 percent expressed confidence that hospitals could ensure the safety of donated milk, while 55.2 percent believed pasteurization improves safety, though 32.7 percent remained uncertain. Conversely, critical concerns persisted: 75.5 percent of participants believed donor human milk could transmit HIV, and 65.2 percent believed it could interfere with mother-infant bonding. Discomfort with feeding an infant another woman’s milk was reported by 87.1 percent of respondents. In addition, only 18.6 percent considered donor milk banking culturally acceptable, while 41.8 percent were uncertain. Similarly, 43.6 percent were unsure if their religion permitted milk donation, and 46.4 percent believed their families would not support using donor milk.

Bivariable logistic regression identified significant associations between willingness and residence, religion, parity, milk production difficulties, perception, awareness, and safety knowledge. Variables with a p-value below 0.20 in bivariable testing and literature-based predictors were entered into a multivariable logistic regression model. After adjusting for confounding, three variables remained independently associated with willingness to receive donor human milk. Urban residence was associated with significantly lower willingness compared to rural residence, yielding an adjusted odds ratio of 0.41 with a 95 percent confidence interval of 0.18 to 0.93 and a p-value of 0.032. Conversely, women who reported experiencing difficulties with breast milk production had more than twice the odds of expressing willingness compared to those without difficulties, with an adjusted odds ratio of 2.19, a 95 percent confidence interval of 1.11 to 4.29, and a p-value of 0.023. Positive perception toward donor human milk banking proved to be the strongest predictor, conferring nearly twenty-fold higher odds of willingness, with an adjusted odds ratio of 19.51, a 95 percent confidence interval of 10.07 to 37.81, and a p-value below 0.001.

In contrast to perception, awareness of donor human milk banking was not independently associated with willingness after multivariable adjustment, showing an adjusted odds ratio of 0.21, a 95 percent confidence interval of 0.04 to 1.09, and a p-value of 0.063. Similarly, formal safety knowledge, religion, parity, and employment were not statistically significant in the final model. The authors noted that the lower willingness observed among urban women contrasts with some literature but may reflect greater availability of commercial formula or distinct local norms. The heightened willingness among women with previous lactation difficulties aligns with behavioral logic, as personal challenges increase recognition of alternative feeding needs. These findings parallel studies in Kenya, Ethiopia, Uganda, and Nigeria, where mothers similarly recognized nutritional benefits but maintained concerns over infectious transmission and milk handling, differing from nations like South Africa or Brazil where institutional milk banking is deeply integrated into routine health services.

Several methodological limitations must be considered when evaluating these conclusions. The cross-sectional design cannot establish causality or determine the direction of the relationship between perception and willingness, and the authors cautioned that conceptual overlap between perception items and willingness may have inflated the very large odds ratio. Consecutive recruitment at a single regional referral hospital may limit generalizability to lower-tier facilities or women outside facility-based healthcare. Additionally, the study required participants to be actively breastfeeding, under-representing women unable to breastfeed or facing acute milk production failure at recruitment, who represent the primary beneficiaries of donor milk. Willingness was also evaluated using a hypothetical scenario with a forced binary choice lacking an undecided option, and safety knowledge was assessed via an unvalidated three-item measure. To support future implementation in Tanzania, the authors emphasized integrating comprehensive education into routine antenatal and neonatal services, addressing HIV transmission fears, and engaging community and religious leaders.

Subject of Research: Postpartum maternal awareness, perceptions, and willingness regarding donor human milk banking in Tanzania

Article Title: Awareness and perceptions of donor human milk banking, willingness to receive donor human milk, and associated factors among women in Morogoro, Tanzania

Article References: Mlelwa, D., Gaisha, G., Chuwa, L., Emmanuel, Z., Gabriel, M., Augustino, W., Musa, K., & Edward, M. (2026). Awareness and perceptions of donor human milk banking, willingness to receive donor human milk, and associated factors among women in Morogoro, Tanzania. Discover Public Health, 23(1), Article 1775. https://doi.org/10.1186/s12982-026-03296-w

Image Credits: AI Generated

DOI: 10.1186/s12982-026-03296-w

Keywords: donor human milk, milk banking, infant nutrition, maternal health, public health, Tanzania, breastfeeding, neonatal care, Awareness, perceptions, donor, human