Journal of Human Lactation http://jhl.sagepub.

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The Human Milk Donation Experience: Motives, Influencing Factors, and Regular Donation
Ana Claire Pimenteira Thomaz, Luiz Victor Maia Loureiro, Tathiane da Silva Oliveira, Norma Caroline de Mendonça Furtado
Montenegro, Eglailson Dantas Almeida Júnior, Cláudio Fernando Rodrigues Soriano and Jairo Calado Cavalcante
J Hum Lact 2008 24: 69
DOI: 10.1177/0890334407310580

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Currents in Human Milk Banking

The Human Milk Donation Experience: Motives, Influencing

Factors, and Regular Donation
Ana Claire Pimenteira Thomaz, MD, Luiz Victor Maia Loureiro, Tathiane da Silva Oliveira,
Norma Caroline de Mendonça Furtado Montenegro, Eglailson Dantas Almeida Júnior,
Cláudio Fernando Rodrigues Soriano, PhD, and Jairo Calado Cavalcante, MPH

Abstract
The aim of this investigation was to identify factors that influenced or motivated women (N =
737) to donate human milk to human milk banks in Alagoas, Brazil. The most common char-
acteristics of a regular donor were having 4 to 7 pregnancies (relative risk [RR] = 1.9285; 95%
confidence interval [CI] = 1.0388-3.5800) and having obtained a higher education level (RR =
2,0625; 95% CI = 1.0097-4.2130). The most commonly reported reasons for donating were
“encouragement of a health professional” (61.3%), followed by “the needs of the babies the
banks serve” (25.3%). Most of the donors (49.9%) were introduced during their stay in the hos-
pital to the human milk bank to which they donated, and 25.8% chose the bank recommended
by a health professional. Health professionals play an indispensable role in motivating mothers
to become human milk donors. J Hum Lact. 24(1):69-76.
Keywords: human milk, human milk bank, human milk donor, breastfeeding, decision-
making, human behavior, donor

Human milk donation has a significant role in chil-
dren’s survival when a mother cannot provide her own
milk for her infant. It is the only way to provide both
Received for review April 13, 2006; Revised manuscript accepted for pub-
lication June 29, 2007.
Ana Claire Pimenteira Thomaz, PhD, is an adjunct professor in the
Department of Obstetric-Gynecology and Pediatrics at the Federal University of
Alagoas, Brazil. Luiz Victor Maia Loureiro is a student graduating with a bach-
elor’s degree in Medicine at the Federal University of Alagoas, Brazil. Tathiane
da Silva Oliveira is a student graduating with a bachelor’s degree in Medicine
at the Federal University of Alagoas, Brazil. Norma Caroline de Mendonça
Furtado Montenegro is a student graduating with a bachelor’s degree in
Medicine in the Federal University of Alagoas, Brazil. Eglailson Dantas
Almeida Júnior is a student graduating with a bachelor’s degree in Medicine in
the Federal University of Alagoas, Brazil. Cláudio Fernando Rodrigues
Soriano, PhD, is an adjunct professor in the Department of Obstetric-
Gynecology and Pediatrics at the Federal University of Alagoas, Brazil. Jairo
Calado Cavalcante, MPH, is an assistant professor in the Department of Public
Health Medicine at the Federal University of Alagoas, Brazil.
Address correspondence to Ana Claire Pimenteira Thomaz, MD, Rua
Juliao Marques 186, Barro Duro–Maceio/Alagoas, Brazil; e-mail:ana.claire
@uol.com.br.
J Hum Lact 24(1), 2008
DOI: 10.1177/0890334407310580
© Copyright 2008 International Lactation Consultant Association
nutritional and immunologic factors necessary for pre-
mature infants; low birth weight infants; and children
with severe infections, allergies, metabolic disorders,
and immunodeficiencies.1-4
Donation depends on a biological environment that
promotes milk production and a social context that
includes the potential donor’s age, education, political
beliefs, culture, and economic circumstances, all of
which can support or interfere with a woman’s motiva-
tion to become a donor and to continue donating over
time.5,6
Today, Brazil has the largest network of donor
human milk banks (HMBs) in the world. There are 181
donor milk banks in the country, located in every state.
In 2003, more than 100,000 preterm infants received
milk from these donor milk banks. The banks collected
more than 70 000 liters of donor milk, from approxi-
mately 65 000 donors registered all over the country.
It has been a challenge for the milk banks to increase
the volume of donations to meet the ever-increasing need
for donor milk. Recruitment of new donors and increas-
ing the volume and frequency of each woman’s donations
has become a priority in most HMBs. To improve the

69
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70
effectiveness of the current recruitment model, the factors
that encourage volunteers to donate and continue express-
ing milk to donate must be identified and appraised.
To date, most publications on donor milk banking
have been on the clinical uses of the milk, the medical
and physiologic factors of the donors,7 and the charac-
teristics of eligible recipients, not on the demographic
characteristics of ideal donors. However, the profiles
of volunteer blood donors and the altruistic nature of
their act have been studied extensively. Blood donation
seems to have greater visibility than human milk (HM)
donation, and potential blood donors are found in larger
numbers than HM donors. Studying blood donors can
possibly provide us suggestions for addressing the chal-
lenge of recruiting new HM donors.
In an attempt to discover new and better strategies
for donor recruitment, this study focused on under-
standing the significance to the donor of donating her
milk and factors that influenced or supported her deci-
sion to donate.
Methodology
Study Design and Participants
A cross-sectional survey study was conducted with
737 HM donors to all the HMBs in the State of Alagoas,
Brazil, from March 2004 to February 2005. The follow-
ing 3 hospitals participated in the study: Maternity
School Hospital Santa Mônica, Federal University of
Alagoas School Hospital Prof. Alberto Antunes, and
Santa Casa de Misericórdia of São Miguel dos Campos.
Data Source
To obtain information regarding demographics and
pregnancy profiles, a questionnaire was administered
to the HM donors at time of donation. If the HM donor
was illiterate, the questionnaire was completed for her
by a staff member of the HMB. The following vari-
ables were collected: age, marital status, educational
level (complete or incomplete), employment status,
number of prenatal visits, number of pregnancies, type
of delivery (preterm, term, postterm), number of chil-
dren, and previous donation experience. Influencing
factors in the decision to donate to a specific HMB
were also collected. In Brazil, each human milk bank
has a special room for HM donors to pump their excess
milk during their stay and return to the hospital. All the
HM donors have a healthy infant and are instructed by
a nurse how to express and store milk at home.8 This
milk is used for every infant in the neonatal unit. Also,
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Pimenteira Thomaz et al J Hum Lact 24(1), 2008
Box 1. Questions About the Reasons for Donating and the
Influencing Factors in the Choice to Be a Donor for a
Specific Human Milk Bank (HMB)
Why did you decide to donate human milk (HM)?
Encouraged by a health professional
Involved in social activities
Have had a child who used donated HM
Knew an infant who needs/needed HM
Was aware of the needs of the babies the banks serve
Encouraged by another donor
What influenced you to choose the HMB where you are donating?
Indication of a health professional
Friends, family members, coworkers’ indication
Means of communication such as TV, radio, posters, or others
Was informed during my stay in the maternity hospital
each HMB has a car or motorcycle for home visit use.
Registered HM donors may call the HMB, and a des-
ignated person will travel to the mother’s home to pick
up human milk for the HMB. At that time, the HMB
representative will encourage the mother again to
express any excess milk to donate.
Group’s Definition
Donors were considered repeat HM donors when
they noted on the questionnaire that they had made
previous HM donations, regardless of frequency. A
total of 65 (8.8%) donors met this criteria. The first-
time (FT) donor group totaled 608 (82.5%) of the vol-
unteers. Sixty-four (8.7%) donors did not answer the
item “previous donation” on the questionnaire.
Statistical Analysis
EPI-INFO 6, version 6.04 (Centers for Disease Control
and Prevention, Atlanta, GA/World Health Organization,
Geneva, Switzerland, 1996), was used to perform the
statistical analysis. Demographic and pregnancy data
were organized into tables, as were reasons for donat-
ing and factors that influenced the decision to donate to
a specific HMB. The chi-square test was used to deter-
mine possible significant differences in demographic
and pregnancy profile variables among reasons for
donating and influencing factors. The chi-square was
used also to compare the 2 donor groups in relation to
demographic and pregnancy profile variables.
The corrected chi-square test of Yates was used
when necessary.
The average age of the mothers in each group was
compared by the ANOVA test. The statistical signifi-
cance was set at an alpha of < .05.
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J Hum Lact 24(1), 2008 The Human Milk Donation Experience
The relative risk (RR) and confidence intervals
(95% CI) were calculated by univariate risk analysis to
evaluate association between the 2 donor groups for
each demographic and pregnancy histories.
For the correlation analysis between the number of
pregnancies and the number of previous donations, a
model of logistics linear regression was applied.
Missing information was excluded from the analysis.
Factors influencing the decision to donate to a specific
HMB were missing in 124 (16.8%) of the questionnaires;
type of delivery in 101 (13.7%) of the questionnaires; rea-
sons for donating in 93 (12.6%) of the questionnaires; and
previous donation information was missing from 73
(8.7%) of the questionnaires. Other variables had < 4%
missing data.
Ethics
The donors agreed to take part in the study and
signed an informed consent form before completing
the questionnaire.
The study was analyzed and approved by the Ethics
Committee in Research of the Federal University of
Alagoas, under resolution 196 of October 10, 1996, of
the National Council of Health.
Results
Reasons for Donating in General
Reasons for donating HM, classified by demo-
graphic and gestational characteristics, are presented
in Table 1. The most commonly reported reasons were
“recommendation of a health professional” (n = 395;
61.3%), followed by “knew the needs of the babies the
banks serve” (n = 163; 25.3%), “involved in social
activities” (n = 56; 8.7%), and “knew an infant who
needs/needed donor HM” (n = 47; 7.3%). The other
motives summed less than 6%. Some donors identified
more than 1 reason for donating (n = 50; 6.8%).
This ranking order held for all demographic and
gestational groups, except for donors with a secondary
or higher level of education and for those who had
donated previously. These 2 groups ranked “knew the
needs of the babies the banks serve” first (50% for
mothers having a higher educational level; 54% for
regular donors), followed by “recommendation of a
health professional” (43.8% for mothers having a
higher educational level; 36.5% regular donors). Some
statistically significant demographic differences (P <
.05) were observed among the various reasons for
donating (Table 1). Those who donated following a
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71
health professional’s recommendation were young
(< 18 years old), illiterate, unemployed, had 1 to 4 pre-
natal visits, delivered a preterm infant, and had never
previously donated HM. Furthermore, among those
who knew the needs of the infants the banks serve, the
majority had a higher educational level, attended more
than 7 prenatal visits, and had previously donated HM.
Influencing Factors in the Decision to Donate to a
Specific HMB
Table 2 describes factors that influenced the decision
to donate to a specific HMB. Most of the donors (49.9%)
obtained information during their stay in the hospital
about the HMB to which they donated. One hundred
fifty-eight (25.8%) of the donors were influenced
primarily by a health professional, followed by family
members and friends (n = 124; 20.2%), and advertising
and/or news broadcasting (n = 45; 7.3%).
The influencing factors varied among the demo-
graphic groups and by number of children the woman
had. Those who chose the HMB during their stay in the
hospital possessed the same demographic characteris-
tics as donors who stated the influence of a health pro-
fessional was their principal reason for donating. This
similarity was significant (P < .05).
Regular and First-Time (FT) Donors’ Profiles
The average age for regular donors was 39.40 ±
6.28 years and for FT donors was 36.69 ± 6.06 years.
There was no significant difference between the
means (P > .05).
The distribution of several demographic and preg-
nancy profile characteristics for the 65 regular donors
and 608 FT donors is shown in Table 3. For those 2
groups, the donors were between 18 and 35 years old,
unmarried, and unemployed; had only a primary edu-
cational level, 1 to 3 pregnancies, almost an equal
number of delivery term and preterm, and up to 3 chil-
dren; and attended more than 7 prenatal visits (for FT
donors) or attended no prenatal visits (for regular
donors).When the statistical differences between the 2
donor groups were analyzed, in relation to demo-
graphic and pregnancy profile characteristics, only the
number of pregnancies was significant (P < .05) for
mothers who had between 1 and 3 or 4 and 7 pregnan-
cies. The univariate risk analysis model (Table 3)
showed a high possibility of becoming a regular donor
among mothers who had 4 to 7 pregnancies (RR =
1.9285; 95% CI: 1,0388-3,5800) and among mothers
who had a higher educational level (RR = 2.0625; 95%
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72 Pimenteira Thomaz et al J Hum Lact 24(1), 2008

Table 1. Reasons to Donate Human Milk (HM) as Seen at the Moment of Donation

Encouraged by Involved in Have Had a Knew an Infant Was Aware of Encouraged

a Health Social Child Who Who Needs/ Needs the Babies by Another
Professional Activities Used Donated HM Needed HM the Banks Serve Donor
n n (%) n (%) n (%) n (%) n (%) n (%)

Totala 395 (61.3) 56 (8.7) 8 (1.2) 47 (7.3) 163 (25.3) 27 (4.2)

Age, y
< 18 134 86 (74.1) 5 (4.3) 2 (1.7) 5 (4.3) 22 (19) 3 (2.6)
18 to 24 304 168 (62) 25 (9.2) 4 (1.5) 20 (7.3) 62 (22.7) 9 (3.3)
25 to 35 270 124 (53.2) 25 (10.7) 2 (0.9) 20 (8.5) 71 (30.3) 14 (6)
> 35 25 15 (68.2) 1 (4.5) — 1 (4.5) 7 (31.8) 1 (4.5)
P value .003 .179 .752 .458 .071 .353
Marital status
Married 247 193 (58) 29 (8.7) 3 (0.9) 26 (7.8) 89 (26.7) 20 (6)
Single 378 139 (63.8) 20 (9.2) 4 (1.8) 15 (6.9) 53 (24.3) 5 (2.3)
Divorced 3 2 (66.7) 1 (33.3) — — 1 (33.3) 1 (33.3)
Widow — — — — — —
Other 77 45 (69.2) 3 (4.6) 1 (1.5) 3 (4.6) 15 (23.1) 1 (1.5)
b b b b
P value .275 .647
Educational level
Primaryc 402 247 (69.2) 22 (6.2) 5 (1.4) 20 (5.6) 70 (19.6) 11 (3.1)
Secondaryc 245 107 (49.5) 24 (11.1) 3 (1.4) 25 (11.6) 69 (31.9) 12 (5.6)
Higherc 39 14 (43.8) 7 (21.9) — 1 (3.1) 16 (50.0) 2 (6.3)
Illiterate 40 26 (81.3) 2 (6.3) — — 4 (12.5) —
P value < .001 .008 .722 .020 < .001 .329
Employment
Yes 188 100 (53.2) 21 (11.2) 3 (1.6) 17 (9.0) 54 (28.7) 11 (5.9)
No 437 285 (65.2) 29 (6.6) 5 (1.1) 28 (6.4) 105 (24) 15 (3.4)
P value .004 .055 .942 .242 .216 .165
Prenatal visitd
1 to 4 185 122 (78.7) 6 (3.9) 2 (1.3) 3 (1.9) 26 (16.8) 2 (1.3)
5 to 7 267 163 (67.1) 17 (7) 3 (1.2) 12 (4.9) 55 (22.6) 9 (3.7)
>7 241 90 (41.7) 31 (14.4) 2 (0.9) 30 (13.9) 79 (36.6) 14 (6.5)
No prenatal visit 23 15 (75) — 1 (5) 1 (5) 2 (10) 1 (5)
P value 0 .009 b
< .001 < .001 b

Number of pregnancies
1 to 3 633 342 (60.9) 50 (8.9) 7 (1.2) 43 (7.7) 144 (25.6) 24 (4.3)
4 to 7 69 39 (68.4) 4 (7) 1 (1.8) 2 (3.5) 12 (21.1) 2 (3.5)
>8 19 12 (75) 1 (6.3) — — 3 (18.8) 1 (6.3)
b b
P value .293 .839 .379 .631
Time of deliveryd
Preterm 300 199 (73.7) 14 (5.2) 4 (1.5) 5 (1.9) 50 (18.5) 7 (2.6)
Term 310 155 (58.1) 30 (11.2) 3 (1.1) 23 (8.6) 72 (27) 14 (5.2)
Postterm 26 10 (41.7) 5 (20.8) — 3 (12.5) 6 (25) —
P value < .001 .004 .988 < .001 .064 .113
Number of children
0 to 3 666 362 (61.5) 50 (8.5) 8 (1.4) 43 (7.3) 149 (25.3) 26 (4.4)
4 to 7 43 25 (71.4) 4 (11.4) — 1 (2.9) 7 (20) 1 (2.9)
>8 9 5 (71.4) — — — 2 (28.6) —
P value .437 .812 .511 .763 .990
Previous donation
Yes 65 23 (36.5) 8 (12.7) 1 (1.6) 7 (11.1) 34 (54) 2 (3.2)
No 608 362 (63.4) 48 (8.4) 7 (1.2) 40 (7) 129 (22.6) 25 (4.4)
P value < .001 .254 b
.354 < .001 .904
a
The sum of the percentages across influencing factors is more than 100% because donors could indicate more than one factor.
b
The chi-square test was not applied because of the small sample number.
c
Complete or incomplete.
d
For the last pregnancy.

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J Hum Lact 24(1), 2008 The Human Milk Donation Experience 73

Table 2. Influencing Factors in the Decision to Donate to a Specific HMB

Encouragement of Friends, Family Means of Communication Informed During

a Health Members, Such as TV, Radio, Stay in the
Total Professional Coworkers’ Indication Posters, or Others Hospital
n n (%) n (%) n (%) n (%)

Totala 613 158 (25.8) 124 (20.2) 45 (7.3) 306 (49.9)

Age, y
< 18 113 27 (23.9) 17 (15) 1 (0.9) 68 (60.2)
18 to 24 259 68 (26.3) 46 (17.8) 18 (6.9) 134 (51.7)
25 to 35 217 55 (25.3) 57 (26.3) 23 (10.6) 94 (43.3)
> 35 20 5 (25) 4 (20) 2 (10) 10 (50)
P value .971 .052 .013 .031
Marital status
Married 321 83 (25.9) 67 (20.9) 34 (10.6) 148 (46.1)
Single 202 56 (27.7) 37 (18.3) 9 (4.5) 105 (52)
Divorced 2 1 (50) 1 (50)
Widow
Other 63 14 (22.2) 14 (22.2) 1 (1.6) 36 (57.1)
P value .978 —b .005 —b
Educational level
Primaryc 340 83 (24.4) 50 (14.7) 13 (3.8) 202 (59.4)
Secondaryc 209 60 (28.7) 61 (29.2) 22 (10.5) 76 (36.4)
Higherc 31 12 (38.7) 8 (25.8) 8 (25.8) 5 (16.1)
Illiterate 28 2 (7.1) 3 (10.7) 23 (82.1)
P value .029 < .001 < .001 < .001
Employment
Yes 182 55 (30.2) 50 (27.5) 19 (10.4) 65 (35.7)
No 415 96 (23.1) 72 (17.3) 26 (6.3) 233 (56.1)
P value .067 .005 .075 < .001
Prenatal visitd
1 to 4 151 36 (23.8) 9 (6) 4 (2.6) 108 (71.5)
5 to 7 228 56 (24.6) 41 (18) 12 (5.3) 121 (53.1)
>7 207 58 (28) 71 (343) 28 (13.5) 61 (29.5)
No prenatal visit 20 6 (30) 2 (10) 1 (5) 12 (60)
P value .752 < .001 < .001 < .001
Number of pregnancies
1 to 3 540 148 (27.4) 110 (20.4) 41 (7.6) 258 (47.8)
4 to 7 53 7 (13.2) 7 (13.2) 4 (7.5) 38 (71.7)
>8 11 1 (9.1) 3 (27.3) 7 (63.6)
P value .035 .379 .795 .003
Time of deliveryd
Preterm 266 77 (28.9) 25 (9.4) 7 (2.6) 162 (60.9)
Term 249 62 (24.9) 65 (26.1) 24 (9.6) 108 (43.4)
Postterm 20 3 (15) 8 (40) 1 (5) 7 (35)
P value .286 < .001 .003 < .001
Number of children
0 to 3 565 153 (27.1) 114 (20.2) 43 (7.6) 273 (48.3)
4 to 7 32 3 (9.4) 5 (15.6) 1 (6.3) 24 (75)
>8 5 1 (20) 4 (80)
P value .026 —b .550 .005
Previous donation
Yes 56 12 (21.4) 15 (26.8) 10 (17.9) 21 (37.5)
No 547 142 (26) 109 (19.9) 35 (6.4) 279 (51)
P value .459 .226 .004 .054
a
The sum of the percentages across influencing factors is more than 100% because donors could indicate more than one factor.
b
The chi-square test was not applied because of the small sample number.
c
Complete or incomplete.
d
For the last pregnancy.

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74 Pimenteira Thomaz et al J Hum Lact 24(1), 2008

Table 3. Univariate Risk Analysis of Regular and First-Time Discussion

Donors Variables
Since the introduction of donor milk banking in Brazil
Regular First-Time
Donors Donors
in the 1940s, the motivation for donating HM has
n (%) n (%) RR 95% CI changed. At first, donation was motivated purely by eco-
nomics: The volunteers and their children were provided
Total 65 (9.7) 608 (90.3)
Age, y with complete medical care by the state; the donors were
< 18 8 (12.3) 108 (17.9) 0.669 0.328-1.364 enticed by the distribution of powdered milk to feed the
18 to 24 25 (38.5) 220 (36.4) 0.868 0.540-1.397 donor’s infant and by medications, and finally, donors
25 to 35 28 (43.1) 255 (42.2) 1.285 0.807-2.046
> 35 4 (6.2) 21 (3.5) 1.689 0.667-4.279
were paid for the milk. Because of the low income of the
Marital status donors, this model of HM commercialization allowed
Married 18 (28.1) 205 (35.3) 0.740 0.440-1.246 donating of HM to become a donor’s livelihood and even
Single 38 (59.4) 315 (54.2) 1.209 0.752-1.942
motivated poor women to have more children.9(p91-113)
Divorced 1 (1.6) 2 (0.3) 3.397 0.674-17.120
Widow The practice of compensating donors was common
Other 7 (10.9) 59 (10.2) 1.077 0.513-2.264 worldwide but gradually disappeared in response to the
Educational level public’s perception that infants were being denied their
Primarya 29 (46.0) 335 (55.7) 0.705 0.440-1.130
Secondarya 24 (38.1) 206 (34.2) 1.164 0.718-1.886 own mother’s milk in order for the milk to be sold and
Highera 7 (11.1) 31 (5.1) 2.062 1.010-4.213 because there was concern that the milk was being
Illiterate 3 (4.8) 30 (5.0) 0.958 0.317-2.892 diluted to increase volume and therefore increase com-
Employment
Yes 24 (37.5) 182 (30.9) 1.302 0.807-2.101
pensation to the donor.10 Because donors no longer
No 40 (62.5) 407 (69.1) receive compensation for their HM, it is important to bet-
Prenatal visitb ter understand the specific reasons women have for mak-
1 to 4 4 (6.2) 17 (2.9) 1.992 0.799-4.966
ing the effort to donate their excess milk. In the present
5 to 7 12 (18.5) 152 (25.6) 0.683 0.375-1.247
>7 21 (32.2) 226 (38.0) 0.796 0.485-1.306 study, donors explained their interest in donation primar-
No prenatal visit 28 (43.1) 199 (33.5) 1.440 0.906-2.290 ily as a response to the recommendation of a health pro-
Number of pregnancies fessional, and secondarily, because they were aware of
1 to 3 51 (79.7) 536 (89.6) 0.501 0.286-0.877
4 to 7 10 (15.6) 48 (8.1) 1.928 1.039-3.580 the needs of the infants the banks serve.
>8 3 (4.7) 14 (2.3) 1.866 0.650-5.355 It is necessary to highlight the involvement of health
Time of deliveryb professionals to encourage the mothers to donate their
Preterm 25 (43.9) 247 (47.0) 0.890 0.542-1.464
Term 32 (56.1) 254 (48.4) 1.325 0.806-2.178
excess milk to an HMB. Our current data show that
Postterm 0 24 (4.6) health professionals play an indispensable role in moti-
Number of children vating HM donation. It is possible that this involve-
0 to 3 57 (89.1) 559 (94.1) 0.555 0.270-1.141
ment came from the perception of the importance of
4 to 7 6 (9.3) 28 (4.7) 1.899 0.882-4.086
>8 1 (1.6) 7 (1.2) 1.290 0.203-8.189 banked HM not only as a nutritional option but also as
a potentially life-saving therapy.4 The World Health
Each result of RR represents calculation of one category in each variable,
in the same direction (line), plus the sum of the other categories of each
Organization and United Nations Children’s Fund rec-
variable (demographic and pregnancies profile). RR = relative risk; 95% ommend that the health system should educate and
CI = 95% confidence interval. support mothers to continue breastfeeding for at least
a
Complete or incomplete.
b
2 years, and as long thereafter as the infant is inter-
For the last pregnancy.
ested, and that prenatal care should include regular
promotion of and instruction about breastfeeding11 as
well as regular instruction about donating excess HM.
CI: 1.0097-4.2130). Mothers with a history of 1 to 3 Furthermore, donors who were young (< 18 years
pregnancies were less likely to become a regular donor old), illiterate, unemployed, and had a preterm infant
(RR = 0.5012; 95% CI: 0.2865-0.8771). There was no were observed to be the most influenced by their health
statistical significance found among the other analyzed care provider’s recommendation to become a donor.
characteristics. Such women require more medical care than usual. It is
The analysis between the number of pregnancies possible that these women therefore received a more
and the number of donations by a linear regression detailed orientation during pregnancy and the puer-
showed weak correlation (r2 = .02). perium period. Studies suggest that increased exposure

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JHL310580.qxd 12/24/2007 10:41 AM Page 75
J Hum Lact 24(1), 2008 The Human Milk Donation Experience
to prenatal care may help teen mothers to breastfeed
successfully.12,13 We propose that the same would occur
with HM donation. Glynn and colleagues, when investi-
gating the reasons for blood donation, determined that
reasons for donating were strongly influenced by altru-
ism and being aware of the needs of the blood bank.14 In
fact, a great number of the milk donors studied here
referred to knowing the needs of the infants the banks
serve as their main motivation to donate. The demo-
graphic characteristics of regular donors seem to be
compatible with such motivation. Women who are over
35 years old, have a higher educational level, are
employed, have had a term infant, and have already had
experience in donating HM are perhaps more easily
aware of the needs of an HMB and thus more often
become regular donors. Also, other studies have investi-
gated the motives that convert possible candidates into
regular donors. Suárez and colleagues observed that the
act of donating has a social and community character or
constitutes a private and anonymous way of helping the
society.15 In fact, the regular donors, more than any other
demographic group, pointed to involvement in social
activities as a reason to donate. This suggests that those
donors have a sense of social responsibility and social
interaction. Friends, family members, and coworkers’
influence, as seen in some studies,16,17 plays an impor-
tant role early in the blood donation process, but in the
donor’s history, those social pressures decrease as time
passes.18 Our data show that friends, family members,
and coworkers were more influential among FT donors.
Therefore, it is reasonable to assume that there is a sense
of satisfaction from helping others by helping the HMB
to increase the donor milk availability and that it would
thus be effective to recruit donors by publicizing the
need for donor milk to potential and current donors.
Recruiting and retaining additional regular donors is
fundamental to maintaining the supply of donor milk.
The typical regular donor’s profile must be understood to
identify the target for campaigns to increase the number
of regular donors and the total amount of milk donated.
In this study, the typical donors were between 25 and 35
years old, with at least a primary education, currently
unemployed, had up to 3 children, had 1 to 3 pregnan-
cies, and attended more than 7 prenatal visits. Some of
these variables can be correlated with both one-time and
repeated donations. These results are comparable to
the study by Azema and Callahan, on the typical
HM donors’ profile in France, which showed that no
employment outside the home and fewer than 3 children
were common characteristics among the donors.19 Plus,
women who are employed full time tend to breastfeed
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75
for shorter duration20; it is possible that employment out-
side the home also reduces a woman’s chance to become
a regular donor.
Similar demographic factors have been studied to
determine possible influences on the frequency of
blood donation. It is widely known that young and less
educated donors18,21 are less likely to become regular
donors. In fact, educational status seems to play an
important role in converting FT to regular donors. This
study found that higher education is a predictor of reg-
ular donation behavior (RR = 2.062; 95% CI: 1.010-
4.213). Simultaneously, a tendency was also found for
those who have had 4 to 7 pregnancies to become reg-
ular donors (RR = 1.928; 95% CI: 1.039-3.580).
This information can be used to develop new strate-
gies for motivating FT donors to become regular donors.
It has been determined that the number of regular dona-
tions is inversely related to the length of time between
the first 2 blood donations.16,18,21 Therefore, new investi-
gations should be conducted to determine the applicabil-
ity of such a relationship for HM donors. Possibly, in
addition to the predictors discussed here, strategies to
encourage the FT donors to donate again as soon as they
can will convert them to regular donors.
Another aspect of this investigation was the evalua-
tion of factors influencing the selection of a particular
HMB. The period of stay in the hospital was signifi-
cant in the choice of the donation location, especially
among the youngest donors (< 18 years old) and those
who were illiterate, unemployed, and had a preterm
infant. This described many of the donors who donated
HM because a health care professional recommended
doing so. Thus, it is clear the roles of the health pro-
fessionals and the hospital are key to recruiting donors
in this age group.
This study was subject to some limitations. First,
the results may not be directly transferable to other
HMBs elsewhere, because local, cultural, or other vari-
ables may influence donors’ attitudes and expectations
and thereby also their reactions and perceptions
regarding the donation of HM. Second, it is important
to consider that some statistical analyses included only
a small number of donors. Thus, new investigations
with a larger number of participants are necessary to
determine the importance of the results obtained in
such analyses. Third, there is currently a lack of pub-
lished studies regarding the motivations of and influ-
ences on human milk donors; thus, it was necessary to
compare HM donors to blood donors.
In summary, we conclude that the amount of donor
milk available can be increased if more specific training
JHL310580.qxd 12/24/2007 10:41 AM Page 76
76 Pimenteira Thomaz et al
for health professionals in human milk donation is insti-
tuted and more discussion of the need for donor milk is
included in prenatal visits. Also there needs to be more
professional involvement and a better relationship with
the pregnant woman, listening more intently to their
problems and being with them when they need care.
Such discussion must include information regarding the
procedures for HM donation and the recipients who need
the milk. Furthermore, inasmuch as we have found that
women are motivated to donate once they understand the
need for the milk and how it is used, such information
should be used in HMB recruitment advertising.
Finally, the only reliable predictors of becoming a reg-
ular donor were higher education and 4 to 7 pregnancies.
The frequent contact with volunteers, the introduction of
collection depots in the communities, increasing the
number of mobile teams to collect milk from the donors’
homes, and encouraging donors to donate again soon
after the first donation are efforts HMBs can establish
internally to convert FT donors to regular donors.
This information should be useful in developing
marketing campaigns to recruit new donors to the
HMBs as well as programs to increase donor retention.
Acknowledgments
The authors thank Professor Jairo Calado Cavalcante,
at the Department of Public Health Medicine of the
Federal University of Alagoas, for the statistical analyses.
We are also very grateful to the staff at all 3 participating
human milk banks. Without their help, this study would
not have been possible.
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Resumen
El objetivo de esta investigación fue identificar fac-
tores que influencian o motivan a las mujeres (n = 737)
para donar leche humana a los bancos de leche en
Alagoas, Brasil. Las características mas comunes de una
donante regular fueron haber tenido entre 4-7 embara-
zos (RR = 1.9285; 95% CI: 1.0388-3.5800) y haber
obtenido un nivel alto de educación (RR = 2.0625; 95%
CI: 1.0097-4.2130). Las razones mas comúnmente
reportadas para donar fueron “recomendación de un
profesional de la salud” (61.3%), seguida por “las
necesidades de los bebes que reciben leche de los ban-
cos” (25.3%). La mayoría de las donantes (49.9%)
conocieron el banco de leche humana durante el periodo
de hospitalización, y 25.8% escogió el banco recomen-
dado por un profesional de la salud. Los profesionales
de la salud juegan un papel indispensable para motivar a
las madres para que sean donantes de leche humana.