644 - A Pre-Implementation Qualitative Exploration of Provider and Family Views on Donor Human Milk Use in Ethiopia

Publication Number: 3624.644

Sharla Rent, Duke University School of Medicine, Chapel Hill, NC, United States; Merhawit Abadi, Saint Paul's Hospital Millennium Medical College, ADDIS ABABA, Adis Abeba, Ethiopia; Gregory C. Valentine, University of Washington School of Medicine, Tacoma, WA, United States; Krystle Perez, University of Washington School of Medicine, Snohomish, WA, United States; Elizabeth Gebre. Woldesenbet, St Paulos Millennium Medical College, Addis Ababa, Adis Abeba, Ethiopia; Olivia C. Brandon, University of Washington School of Medicine, Seattle, WA, United States; Gal Barbut, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Redeat Workneh, St paul's Hospital Mellenium Medica college, Addis Ababa, Adis Abeba, Ethiopia; Mahlet Abayneh. Gizaw, St Paul's Hospital Millenium Medical College, Addis Ababa, Adis Abeba, Ethiopia

Background: Ethiopia faces one of the world's highest neonatal mortality rates. Ensuring that small and/or sick newborns (SSNBs) receive human milk early and exclusively is among the most effective and affordable strategies to improve survival. Although a mother's own milk is ideal, many mothers are unable to provide it due to illness, death, or delayed lactation. Donor human milk (DHM) offers a lifesaving alternative widely implemented in high-income countries, yet only 7 out of 54 African countries have established such programs.

Objective: We describe the beliefs and preferences of Ethiopian mothers and Neonatal Intensive Care Unit (NICU) providers regarding the use of DHM to nourish SSNBs. This study is part of a pre-implementation assessment for establishing a DHM program within a tertiary referral hospital in in Ethiopia.

Design/Methods: Semi-structured focus groups of NICU providers, NICU mothers, and mothers from the community were held in Feb-March 2025. Thematic saturation was reached after 9 focus groups - 3 from each participant category. A research assistant fluent in Amharic led discussions on breastfeeding, personal experience with informal human milk sharing, knowledge of DHM programs, and questions/concerns about implementing a DHM program within the NICU. Focus groups were audio recorded, transcribed and translated into English for analysis. Focus group data were thematically coded using a directed content analysis combining a priori codes derived from relevant literature and inductive coding.

Results: 16 providers, 15 NICU Mothers, and 16 community mothers participated (Table 1). Half of providers were parents. All mothers and all female providers with children had experience breastfeeding. Amongst mothers, 64.5% (n=20) would be willing to use DHM and 93.6% (n=29) would donate their milk. A slight majority, 54.8% (n=17) would prefer DHM over formula if given the choice.(Figure 1) Qualitative analysis revealed three core themes 1) a cultural willingness to donate and accept milk to support newborn growth and development, especially in the NICU, 2) prioritization of DHM safety, and 3) recognition of the need for provider, family, and community education on DHM to support effective implementation.(Figure 2)

Conclusion(s): Mothers and NICU providers in Ethiopia are supportive of implementing a DHM bank, recognize the positive impact such an initiative could have on SSNBs. The future implementation of a facility-specific DHM bank must target gaps in baseline knowledge about DHM, address safety concerns, and provide culturally attuned educational materials.

Table 1: Demographic Information from Focus Groups


Figure 1: Cultural Preferences Amongst Ethiopian Mothers Regarding Supplemental Feeding of their Infant.
Community mothers were more willing to accept informal breastmilk from a friend or family member, compared to NICU mothers (Panel A), whereas NICU mothers were more willing to accept pasteurized donor milk (Panel B) and expressed a stronger preference for donor milk over formula (Panel C). Quotes justifying support or caution around DHM are shown in Panel D.

Figure 2: Descriptive Quotes from NICU Providers, NICU Mothers, and Community Mothers.
Participants expressed an overall willingness to provide and use donor milk, with uncertainty expressed primarily by community mothers. Participants in all groups noted the need for safety procedures around DHM use and education for providers and families. Together, qualitative results reveal that a lack of knowledge of the benefits of DHM is a leading reason for maternal hesitancy in supporting DHM, highlighting the importance of community education on DHM during the implementation phase.