Donor Breast Milk and Human Milk Banking: Awareness, Acceptance and Determinants among Mothers in Owerri, Nigeria: A Cross-sectional Study

Abstract Background: Donor human milk (DHM) is the recommended alternative when mothers own milk is unavailable, particularly for vulnerable infants who are unable to be breastfed; especially where safe and affordable milk-banking facilities are available or can be established. Human milk banking (HMB) facilitates safe DHM provision but remains nascent in Nigeria. This study assessed the knowledge, acceptance, and determinants of willingness to engage with DHM and HMB among mothers in . Methods: A hospital based descriptive cross-sectional study was conducted from March to June, 2025 at the immunization clinic of a Federal Tertiary . A total of 303 mother/infant dyads were consecutively enrolled. Data on sociodemographics, knowledge of DHM/HMB and acceptance were collected using a pretested structured paper-based questionnaire. Data were analyzed using descriptive statistics, Chi-square/Fisher’s exact tests, and multivariable logistic regression to identify factors independently associated with willingness to donate, recommend, and volunteer for milk banking. Results: A total of 303 mothers were assessed, of whom 95 (31.4%) were between 26 and 30 years. Most mothers 207 (68.3%), had tertiary education and 142 (46.9%) were of the upper socioeconomic class. The median infant age was 5 months (IQR: 3-9). While 186 (61.4%) mothers had heard of DHM, awareness of a formal donor milk policy was low, reported by 57 (18.8%) participants. Although 214(70.6%) mothers knew they could donate milk, only 124(40.9%) were willing to donate and a mere 45 (14.9%) respondents would accept DHM for their own infant. Key barriers to acceptance were hygiene concerns reported by 112 (29.9%) mothers and fear of disease transmission by 88 (23.5%) mothers. A strong preference for breast milk from relatives persisted demonstrated by 220 (72.6%) mothers. In multivariable analysis, higher socioeconomic status (AOR=6.05, 95% CI: 1.63–22.41), prior awareness of milk donation (AOR=5.91, 95% CI: 2.79–12.51), were independently associated with willingness to donate breast milk. Prior awareness of HMBs was the strongest independent predictor for willingness to volunteer for a milk banking association (AOR=7.73, 95% CI: 3.50–17.07). Conclusion: Despite reasonable knowledge, practical acceptance of donor milk and willingness to donate are low, driven by safety concerns and cultural norms. Educational interventions addressing safety protocols, spousal engagement and community advocacy are critical precursors to the successful establishment of human milk banking programs in Nigeria. The cross-sectional design and self-reported data might not represent the real weight of the knowledge practice gap in the study population.