Table 1.

Characteristics of the included studies

S. no	Study ID	Study design	Geographic location	Setting	Population	Objective	Outcome
1	Olsson et al. [34]	A prospective, mixed method study (Survey was done through mail)	Sweden	Health facility (two referral university hospital milk banks)	Human milk donors (N = 72) at two Swedish hospitals.	To describe Swedish human milk donor’s experience during the donation process.	The donors wanted to help other infants, and they had more milk than they needed, they knew women whose infants needed donated human milk, and were aware of the importance of human milk for young children.
2	Schafer et al. [21]	An online cross‐sectional survey (Descriptive cross-sectional survey)	USA	Community	206 participants from the USA classified as milk sharing recipient.	To explore factors associated with emotional responses to a parent’s decision to feed their infant with shared human milk.	Receiving strong spousal/partner support for milk sharing (p < .001) and screening donors regarding the health of their nursling(s) (p < .05) were associated with more positive emotional responses. Social stigmatization of milk sharing may negatively influence emotional responses among recipient mothers.
3	Kimani-Murage et al. [13]	Mixed methods study	Kenya	Both the health facility and community levels.	Mothers with children younger than 3 years were interviewed using the structured interviews. How was quantitative data collected?	To establish the perceptions on donating and using DHM and establishing human milk banks (HMBs) as Kenya has not yet established HMBs for provision of safe DHM, which is free from any physical, chemical, microbiological contaminants, or pathogens.	Majority of them had a positive attitude towards donating breast milk to a HMB (80%) and feeding children on DHM (87%). At a personal level, participants were more willing to donate their milk to HMBs (78%) than using DHM for their own children (59%).
4	Wambach et al. [20]	Descriptive cross-sectional study	North America	Community	A convenience sample of 50 women who were current or past milk donors within the last year at a regional milk bank participated.	To describe the personal and social aspects of mothers’ milk donation to a milk bank in the Midwest USA.	Barriers were related to process of expression and donation, dealing with milk donation rules and restrictions. Some fathers had concerns about there being enough milk for their own infant, and some needed information and education about the process and purpose of milk donation.
5	Biggs et al. [32]	Prospective, cross-sectional study (Descriptive cross-sectional survey)	South Africa	Community	Mothers (N = 37) were interviewed using a telephone-administered questionnaire.	To determine why mothers who had committed to donating to a human milk bank in South Africa did not donate their milk.	The major barrier was infrastructure-related, as 62.2% were unaware of the process after discharge. This was followed by practical issues including no transport (21.6%), no freezer for milk storage (18.9%), or working (5.4%).
6	Gribble et al. [28]	Descriptive cross-sectional survey	North America, Europe, Oceania, and Asia	Community	Milk donors (n = 98) and milk recipients (n = 41) who had donated or received breast milk were required to have donated or received breast milk in the previous 6 months in an arrangement that was facilitated via the Internet.	To explore the intersection of peer-to-peer milk sharing and donor milk banks.	One-half of donor recipients could not donate to a milk bank because there were no banks local to them or they did not qualify as donors. Other respondents did not donate to a milk bank because they viewed the process as difficult, had philosophical objections to milk banking, or had a philosophical attraction to peer sharing.
7	McCloskey et al. [29]	Qualitative research (In-depth interviews)	USA and Canada	Community	Mothers (N = 20) in the USA and Canada who were recipients of peer-to-peer human milk sharing.	To examine the experiences of mothers who have received donated human milk from a peer.	Challenges to peer-to-peer human milk sharing were (a) substantial effort required to secure human milk; (b) institutional barriers; (c) milk bank–specific barriers; and (d) lack of societal awareness and acceptance of human milk sharing. Facilitators included (a) informed decision-making and transparency and (b) support from healthcare professionals.
8	Magowan et al. [12•]	A qualitative study (Focus group discussions and in-depth interviews)	Uganda	Health facility	Caregivers (N = 28) (mother, grandmother, or father) of any neonate currently, or recently, admitted in the NNU and in-depth interviews with four of the eight healthcare workers (HCWs) from the NNU.	To show that donor human milk can be acceptable to the caregivers of vulnerable babies in hospital settings in Uganda.	Lack of knowledge of donated human milk emerged with discussants, and the barriers relating to transmission of infection (HIV) and poor hygiene
9	Varer et al. [25]	Mixed methods study (In-depth interviews)	Aydin	Community	Two seventy-one women who were aged over 18 years and had a birth in the last 5 years in Çeştepe, Aydın, were included in the quantitative study. In-depth interviews were conducted with 33 women	To determine the opinions, knowledge, and attitudes of native Turkish and refugee women living in Çeştepe, Aydın, a rural area in Turkey, about HMB	Most (59.7%) of the women were willing to donate breast milk, whereas only 27.7% were willing to use donor milk for their babies. Religious concerns, fear of infectious diseases, and distrust in people they did not know were among the reasons for the negative attitudes of the women
10	Mondkar et al. [3]	Qualitative research (In-depth interviews)	Mumbai	Health facility	Qualitative research was conducted among 56 service recipients including mothers and key influencers and 9 service providers to understand their perceptions and practices.	To understand the perceptions and acceptability of DHM and HMB among service providers, individual mothers availing services and influencers.	Challenges shared were limited supply of DHM because of low awareness on milk donation, shortage of trained staff, and risk of milk contamination. Although most mothers were comfortable in donating milk, few were reluctant to donate milk as they feared shortage of milk for their own babies, or milk expression may cause weakness.
11	Lubbe et al. [33]	Observational study (Focus group discussion)	South Africa	Health facility	In total, eight FGDs were conducted: three with mothers (n = 13), three with grandmothers (n = 17), and two with healthcare professionals (n = 11) working with infants.	To determine attitudes of key stakeholders, including mothers, healthcare workers, and grandmothers, regarding the donation and receipt of human breastmilk.	Barriers included the processes for donating and receiving milk, safety, human immunodeficiency virus (HIV) screening, and cultural beliefs. Mothers’ fears included having insufficient milk for their own infants, changes in the quality of donated milk during pasteurization and transportation, and HIV transmission.
12	Murray et al. [35]	A mixed methods study using a convergent parallel design concurrently collecting qualitative and quantitative data (Individual interviews)	Indonesia	Health facility	Mothers (N = 74) of hospitalized infants and 8 hospital staff (5 nurse managers, 1 doctor, and 2 administrators) Private, individual qualitative interviews with health professionals, mothers of sick infants completed a paper-based questionnaire with assistance from trained data collectors. Facility observation of the neonatal intensive care unit (NICU), special care unit (SCU), and post-natal and pediatrics wards was iteratively undertaken using a paper-based structured rubric.	This study explored the barriers and enablers to exclusive breastfeeding among sick and low birth weight hospitalized infants in Kupang. The attitudes and cultural beliefs of health workers and mothers regarding the use of donor breast milk (DBM) were also explored.	Mothers (39.7%) retrospectively reported exclusively breastfeeding and 37% of mothers expressed breast milk. Most mothers stated that they would not accept milk from a donor and would use formula if they could not breastfeed. Most mothers stated that they would not accept milk from a donor and would use formula if they could not breastfeed.
13	Perrin et al. [22]	A qualitative design using a grounded theory approach (Semistructured telephone interviews)	USA	Community	Women (N = 28)	To explore how lactating women with a surplus of breast milk come to the decision to share their milk with a peer rather than donate to a milk bank.	Participants reported that they received no information about milk exchange options and considerations from healthcare professionals.
14	Osbaldiston et al. [24]	Study design not reported (Telephonic interviews)	Austin	Community	Data were collected via telephonic interview and by sending cover letters and consent forms through mails among 87 mothers.	To create a detailed characterization of human milk donors, including descriptive information about demographics and lifestyle, involvement with the milk bank, reasons for donating, problems encountered while breastfeeding and pumping milk, barriers to donating milk, affective experiences, and personal values.	The reasons for donating milk were significantly correlated with amount of milk donated, namely, “Had too much milk and wanted to donate it”. “Needed to pump milk to stimulate lactation”. A small group of donors reported that they had to pump milk to stimulate lactation. There was a significant negative relationship between age and donation amount such that younger donors donated more milk.
15	Gribble et al. [30]	Descriptive cross-sectional survey design (Closed- and open-ended questions)	Australia [3], Canada [4], Malaysia [2], New Zealand [3], and the USA [28]	Community	Written questionnaire administered to 41 peer milk recipients from five countries.	To examine internet-facilitated peer-to-peer milk sharing, the process by which women came to use peer-shared milk was explored.	Ten respondents considered using peer-shared milk after a friend or relative suggested it; eight had thought about milk sharing prior to needing it; for five respondents, it was viewed as a logical solution or had been suggested by a health worker; for four respondents, online discussions had alerted them to the possibility; three respondents each stated that they had turned to peer-shared milk after failing to obtain banked donor milk or
16	Brown et al. [36]	Mixed methods with thematic analysis (Online questionnaire included both open- and closed-ended questions)	UK	Community	Mothers (N = 107) of baby aged 0–12 months who had received screened DHM from a milk bank were administered a Likert scale and open-ended questionnaire.	To explore how experience of receiving DHM for their baby affected the well-being of parents.	Almost all the 107 participants agreed that receiving DHM had a positive impact upon infant health and development, their own mental and physical health, and their family’s well-being. Receiving DHM helped mothers to process some of their emotions at not being able to breastfeed, in part because knowing their baby was being fed gave them the space to focus on recovery and bonding with their baby.
17	Mantri et al. [31•]	Qualitative study (In-depth interview of key stakeholders)	India	Community	A face-to-face interview was conducted using the in-depth interview (IDI) guide for lactating mothers (n = 30) and healthcare providers (n = 25)	To know the various facets of the challenges in milk banking practices using the Root Cause Analysis framework.	Lack of recurring funds, dedicated lactational counsellors, and trained technicians were the challenges. The community challenges were low acceptance of DHM due to safety concerns, risk of disease transmission, and quality of donated milk. Moreover, the religious stigma and cultural beliefs regarding the transfer of heredity traits and decrease in mother–child affection act as barriers in donating milk.
18	Mizrak Sahin [27]	Descriptive cross-sectional study	Turkey	Health facility	Multipara mothers (N = 250)	To evaluate the attitude, knowledge, and views of mothers about breast milk donation and HMBs.	Mothers (40.8%) indicated that they were against the establishment of HMBs in Turkey. However, only 61 mothers (24.4%) approved of obtaining milk from HMBs. Mothers who did not agree to the establishment of HMBs (77.5%) stated that babies who are fed breast milk from the same mother would be milk siblings, and it would be an ethical problem if they got married to each other.
19	Rosenbaum et al. [23]	Article (Design not reported) Telephonic interview	USA	Health facility	NR	To examine how three hospitals have used pasteurized donor milk successfully despite barriers encountered when incorporating this change in practice.	Common strategies that helped drive success included a strong change agent, a multidisciplinary team, and incorporation of the latest research and guidelines. Barriers encountered included cost, difficulty gaining staff buy-in, and the logistical challenge of creating a milk lab.
20	Gürol [26]	Descriptive cross-sectional study (Open-ended and closed questions)	Turkey	Health facility	Married women aged 15–49 years who had given birth and who were registered with a family health center in Turkey.	To determine the knowledge and views of Eastern Anatolian women towards mother’s milk banking.	Most 90.6% indicated they had not previously heard anything about breast milk banking, 64.0% said that they could donate their milk, 36.3% stated it constituted a problem from a religious aspect, and 28.9% said it leads to social and moral problems.