Table 2 Participants’ perceptions on the use of donated breast milk

Positive perceptions

Nutritious

• Its human milk

• Has all nutrients the baby needs

• “Donated milk is from humans and the one receiving it is a human. It will definitely have nutrients that are better than tinned milk.” (Participant 4, FGD fathers, Nsambya hospital).

• Breast milk contains everything, the white blood cells that prevent a baby from acquiring infections. It can easily be digested. You won’t have a baby with diarrhoea because of it. Baby won’t vomit it, ok, it’s just healthy. It’s part of the human body. The way you see its importance I would recommend it to my own child. (KII, Nurse, Nsambya Hospital).

• “Breast milk can’t be substituted in terms of nutrients. It is what God created and is the best for babies.” (KII, Mother of premature ever used DBM, Nsambya hospital).

• Breastfed babies are healthy

• “The truth is, milk that comes from mothers is the kind of milk where a baby is in good health and fully cared for. Whenever a baby is not given this breast milk and you prefer going to work and the baby doesn’t breastfeed that is where we find malnourished babies because you have not cared enough for this baby.” (Participant 3, FGD grandmothers, Naguru hospital).

• The right balance of nutrients.

• Properly measured

• DBM has all the nutrients. It’s not that you’re going to give NAN, sometimes those mothers that give NAN, they don’t know the right mls to give, and they don’t know how to mix it. Sometimes if you leave the baby with a maid, they give the baby, for example they haven’t boiled the water very well, and the baby will get other things that lead to complications. But if the breast milk is got, at least I know it has everything in its correct amount. (KII, Midwife, Nsambya Hospital).

• “Tined milk may not have directions from the doctor yet this one definitely has directions from the doctor and is properly measured. But for tined milk you can buy and just mix without knowing the right measures to us.” (Participant 1, FGD fathers, Naguru hospital).

Help babies that would not get breast milk

• Help babies & mothers in need

• Baby gets a taste of breast milk

• “It is going to help mothers who don’t have breast milk and also children who have lost their mothers, they can get the taste of breast milk because it is the best.” (KII, Midwife, Naguru hospital).

• “It helps, some parents immediately after giving birth she dies. It helps the baby to at least get breast milk.” (Participant 2, FGD Lactating mothers, Naguru Hospital).

Opportunity to avoid feeding babies formula or cow milk

• Saved from cow’s milk

• Less use of formula milk

• Go for human than animal milk

• “Me, I have no problem with it because the baby receives milk that is right, natural and saved from using cow’s milk.” (Participant 2, FGD Grandmothers, Naguru hospital).

• “If we can get a breast milk bank, the formula would lose the market, no worries of a baby over feeding or mixing water, worrying of adding too much water or too much formula. It is just standard.” (KII, Mother of premature ever used DBM, Nsambya hospital).

• “Hmmm, instead of me buying cow’s milk when there’s human milk, I rather go for human milk. Not milk from animals.” (Participant 2, FGD fathers, Nsambya hospital).

Same as blood donation

• Like donating blood to someone

• Blood transfusion

• Need of blood

• “The thing is ok. It’s like donating blood to someone.” (KII, Nurse, Nsambya Hospital).

• “I think it’s good because, just like how we can use blood transfusion and you are trying to save a life and for preterm they require to get breast milk, it is the best option for them.” (KII, paediatrician, Nsambya hospital).

• Now, it’s like bringing a patient to the hospital, and they tell you this person needs blood. So if this milk is also prepared properly and carefully, and there is an emergency, there is no problem as long as it helps improve the health of this person. (Participant 5, FGD fathers, Nsambya hospital).

Negative perceptions

Disgusting

• Feel disgusted

• “Another woman’s milk is disgusting.” (Participant 6, FGD pregnant mothers, Nsambya hospital).

• “Hmmm, some mothers will take it like, forgive me for using this word “ekyenyinyarwa” (disgusting). Because this milk is mixed from different donors.” (Participant 3, FGD fathers, Naguru hospital).

• “I even feel disgusted about it. I like when it is mother to baby not in a bottle. Some mothers are unhygienic they are disgusting (benyinyaza).” (KII, midwives, Naguru hospital).

Inheriting genes & negative traits of the donor

• Mixed a lot of different blood

• Transfer bad traits/ character/ lifestyle

• Habits of theft

• “Hmmm, this milk isn’t bad, but it has mixed a lot of different blood.” (Participant 3, FGD fathers, Naguru hospital).

• The problem that comes with the mixing of blood from different people, is what I look at as a problem. For instance, you may not be cannibalistic, but these different kinds of blood that a child has breastfed on! That is what am worried about because it is donated by people of different blood. (Participant 3, FGD grandmothers, Naguru hospital).

• Every clan has its own stuff. You don’t know this person’s blood group. You don’t know whether this clan behaves like this, whether they have sickle cells which make you refuse this milk. On this side they are thieves, on the other, they are cannibals, and you wouldn’t want your baby to become a thief just because she breastfeeds on another person’s breast milk. (KII, mother of preterm, Naguru Hospital).

• Mixing/transfer genes

• Behave like the donor

• “…genes might be transmitted through donor milk like habits of theft.” (KII, midwives, Naguru hospital).

• “Genes are very important and those traits cannot be ruled out by the health worker. The child might end up behaving like the donor or having habits of a donor.” (Participant 2, FGD grandmothers, Nsambya hospital).

• Taboo to feed baby another woman’s breast milk

• “There those who feel its taboo for you to give another woman’s breast milk to your baby and will obviously not accept.” (KII, paediatrician, Naguru hospital).

• Change child’s DNA

• “If they take the baby for DNA test won’t the baby be connected to the donor. What if she steals my child and they check her blood, won’t they find when she is connected to the donor.” (Participant 4, FGD Lactating mothers, Naguru hospital).

Safety and quality concerns towards DBM

• Concern for allergies

• “It might not connect with the baby, and he or she reacts by vomiting or constipation.” (Participant 1, FGD lactating mothers, Naguru hospital).

• Risk of infections & diseases

• “The donor is available but has either HIV or hepatitis or syphilis, any kind of disease.” (KII, Mother of premature ever used DBM, Nsambya hospital).

• “infections that are acquired such as HIV.” (KII, Nurse, Nsambya hospital).

• Risk of feeding baby contaminated milk

• “What might scare me are the preservatives and other things added which are different from the real milk.” (Participant 4, FGD fathers, Naguru hospital).

• Naturally we know that breast milk will eventually go bad if you keep it. But now when you preserve it for a long time, it means there are some preservatives added which in a long run won’t be good for the baby health-wise. (Participant 3, FGD fathers, Nsambya hospital).

• “Contamination, external in terms of handling during expression and storage.” (KII, Mother of premature ever used DBM, Nsambya hospital).

• Not stored appropriately

• Over stayed/ expired milk

• Mix old & new batch

• With donated breast milk, just a small error can cause my child to have different kind of diseases because at times it can be stored poorly. The baby can be in an emergency, you might find the milk was checked properly and donor screened well before storage, but then it takes long in the fridge or expires. By the time they give it to the child you find it’s not of the right standard. During that time when a child is in need, we might not have that time to recheck or ascertain the standard of that milk. So you give this milk to the baby, hmmm, “kumbe” (yet), anything can happen. (Participant 1, FGD Lactating mothers, Nsambya Hospital).

• “You might find it wasn’t stored appropriately or they mixed old with new batch yet some has over stayed. So a lot can happen.” (Participant 2, FGD Lactating mothers, Nsambya Hospital).

• Unhygienic

• Poor hygiene

• Transportation condition

• “Unhygienic person to feed my baby, may contaminate it and infect my baby” (Participant 1, FGD pregnant mothers, Nsambya hospital).

• “Hygiene of the donor and also the transportation condition from the donor to the bank.” (Participant 2, FGD fathers, Nsambya hospital).

• “Hygiene, how the milk is handled. Do they give all the tips on how to handle that milk?” (Participant 1, FGD Lactating mothers, Naguru Hospital).

• Feeding of the donor

• Cannot reach the standard for feeding babies.

• “Can’t know the feeding of the donor.” (Participant 5, FGD fathers, Nsambya hospital).

• I can’t trust donated breast milk to reach the standard to which I would feed my baby. And also because I don’t keep it myself. You see even cow’s milk you have to first check if it’s not yet spoilt or dairy milk. But with donated breast milk remember even people who bring it or administer it know a lot. You can’t just tell them you want to first check if the milk is fine. All in all, hmmmm, I wouldn’t trust donated breast milk very well. (Participant 2, FGD lactating mothers, Nsambya hospital).

• Distrust in the health condition of the donor

• Distrust in screening procedures & health workers

• False test results

• “If she is not screened when she has diseases that might affect the baby.” (Participant 3, FGD Lactating mothers, Naguru Hospital).

• “You might find the donor has HIV but consistently taking drugs and tests negative for HIV test.” (Participant 1, FGD lactating mothers, Nsambya hospital).

• “…telling the truth, I can have that doubt that the doctors might not tell the truth. What if someone bribes them or they screen and results are different from the reality.” (Participant 2, FGD lactating mothers, Naguru hospital).

Fear it could be expensive

• Free/ sold

• Expensive

• Hard to access the milk

• Will it be for free? Hmm!! I don’t think it will be for free and if a mother can’t sustain herself to eat well and get breast milk, I don’t think she can buy that milk. Unless it’s going to be for free but if it’s for buying it will be difficult. (KII, Nurse, Naguru hospital).

• That practice! Hmmmm, it’s not bad but though expensive. If you find someone who even let me say, fights hard to get at least two thousand shillings; and your telling this person we need only that milk. I don’t think a donor is going to give it to us free of charge, not the hospital. Because the two hospitals have so far heard where it is, I don’t think they are very cheap. Me myself I don’t think they are very cheap because I think you have to pay the donor. So there am not yet sure whether you pay the donor or the institution and how. Because, and how many mls are you going to pay per donor? Are you going to pay per day or a contract of six months? (KII, Midwife, Nsambya hospital).

• “Me, I can only fear that it could be expensive. We don’t know whether it will be for free or sold.” (Participant 3, FGD grandmothers, Nsambya hospital).

• “…a lot of logistic hurdles might be needed to access the milk…” (KII, paediatrician, Naguru hospital).

Affect mother to child bond

• Miss bonding

• Mother’s love goes away

• Neglect of babies

• “That feeling stays in me that my baby will get love distant from mine, and she misses that bond between me and her as her mother.” (Participant 1, FGD lactating mothers, Naguru hospital).

• “It has a negative effect on our mothers, they will now neglect…doesn’t mind because there is that milk.” (Participant 6, FGD fathers, Naguru hospital).