Healthcare Providers Acceptability of Breast Milk Donation and Banking, and Factors Influencing Adoption in Rwanda: A Mixed-Methods Study

ABSTRACT Breast milk is essential for optimal neonatal nutrition and survival, particularly among preterm and low-birth-weight infants. When a mothers own milk is unavailable, donor breast milk is the recommended alternative. However, Rwanda currently lacks accredited breast milk donation systems and milk banks, and little is known about healthcare providers perspectives on their potential implementation. The main objective of the study was to assess the acceptability of breast milk donation and explore the potential factors that could influence its adoption among healthcare providers in two Rwandan district hospitals. A convergent parallel design with a qualitative-dominant approach was conducted in the neonatology units of Kirehe District Hospital and Ruhengeri Level-II Teaching Hospital, Rwanda. Quantitative data were collected from 41 healthcare providers using structured questionnaires, including a six-item Likert scale (0=strongly disagree to4=strongly agree) to measure acceptability. Scores[≥]2.4 were interpreted as indicating high acceptability. Qualitative data were obtained through in-depth interviews with 10 healthcare providers and analyzed using inductive thematic analysis. Quantitative data were analyzed using descriptive statistics and non-parametric tests. The overall acceptability of breast milk donation was high, with 82.9% of healthcare providers expressing agreement (mean score: 2.83{+/-}1.10). Most participants (97.6%) perceived donor breast milk as beneficial for neonatal health. Key barriers included cultural resistance, limited maternal awareness, and inadequate infrastructure, while facilitators were staff training, institutional policies, and community engagement. Qualitative findings highlighted that providers were generally familiar with the concept of breast milk donation but noted the absence of formal programs in Rwanda. They emphasized that cultural concerns often stem from limited knowledge rather than entrenched opposition and strongly endorsed the benefits for infant health and maternal wellbeing. Providers stressed that successful implementation would depend on awareness-raising, trust in safety procedures, and institutional support through training and clear guidelines. Breast milk donation is highly acceptable among healthcare providers in Rwanda, with a mean score of 2.83{+/-}1.10 on the 0-4 Likert scale. Providers strongly recognized its benefits for vulnerable infants. Addressing gaps in awareness, infrastructure, and policy frameworks, alongside culturally sensitive community education, will be critical for successful implementation. These findings support the feasibility of introducing breast milk banking in Rwanda and provide evidence to guide policy and program development.