| A. SYSTEM CHALLENGES |
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| “I came along with my mother-in-law. She is in her 60s. |
| Structure | There is no sitting arrangement for her.” (M) |
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| “Sometimes we try to manage activities at our own cost. |
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| There is always a shortage of recurring funds.” (H) |
| Financial Support | “There should be the provision of the separate pool to protect established milk banks through constant funding.” (H) |
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| “Mothers often fail to maintain hygiene which leads to contamination of the donated milk.” (H) |
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| “Every drop of milk is precious for a sick infant. We |
| Operational process | screened all mothers and keep all hygienic practice throughout the process.” (H) |
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| “Mothers post-pregnancy are weak and lethargic. Long waiting period makes them tired. They should be provided some refreshment.” (H) |
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| “During COVID times, families fear the risk of transmission of the virus. We were helpless in lack of any Disaster Management plan and frequently changing guidelines.” (H) |
| Technical Process | “The laboratory should be functional inside mother milk bank with strong monitoring framework to ensure safety and avoid contamination.” (H) |
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| “We filed complaints a couple of times for improper functioning of equipment, but nobody replies.” (H) |
| Quality Maintenance | “Systematic database management is lacking.” (H) |
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| “There is a lack of systematic communication channel for problem-solving.” (H) |
| Human Resources | “It takes few minutes to counsel mother and families about benefits of donated human milk over formula feed. But there is the shortage of staff.” (H) |
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| “To run mother milk bank efficiently, there is need of dedicated staff.” (H) |
| Demand-Supply Ratio | “Donated human milk is a blessing for the child with no mother. We promote and encourage the mother to donate extra milk for orphans and abandoned child.” (H) “Motivating mothers to return for a donation once they leave hospital premises is challenging.” (H) |
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| “I lost my baby. I want to donate milk to help other mothers with less milk, feed her baby properly. It is satisfying and provides peace.” (M) |
| Knowledge about DHM & MMB | “Donating milk is an act of kindness. It will not only help me express more milk but will also help someone else’s baby to get food.” (M) |
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| “Expressed milk should be discarded after few hours as it loses its properties.” (H) |
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| “We promote exclusive breastfeeding as this keeps child thriving and away from infection.” (H) |
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| “If I’m convinced that donating mothers are strictly screened…I don’t have any issue using donated milk for my baby.” (M) |
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| “If no judgment is passed, I will be happy to assist a mother feed her baby.” (M) |
| Attitude (Willingness /Unwillingness to | “My milk is only for my child. It symbolizes my love for my child.” (M) |
| donate /utilize DHM) | “It sounds insane. How can I feed my child with someone else’s milk of other caste or no cultural values? What if my child inherits their values?” (M) |
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| “I wish to donate, but fear my in-laws. They don’t allow me, saying that first feed own child properly instead of donating.” (M) |
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| “My relative donated when she was lactating. She motivated me to do so.” (M) |
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| “One family directly came to us enquiring for donated milk. |
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| We counseled them and gave lactational support to the mother and it had been successful. One should understand |
| Practices (Barriers/ Influencers) | DHM isn’t a replacement of breastfeeding” (H) |
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| “Some communities are rigid. They treat milk banking practices as sin. We need to educate them” (H) |
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| “Some mothers hide their breastfeeding problems. Fear of in-laws is a major contributing factor to this behavior.” (H) |
| B. COMMUNITY-RELATED CHALLENGES |
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| “In our culture, feeding our child with someone else’s milk is a bigger obligation. We can’t bear this loan” (M) |
| Awareness/Motivation | “Donated milk is not safe. It is a combination of milk of various mothers. Who knows if any one of them is infected? |
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| We can’t take chance with our son.” (M) “Public leaders must take this agenda in community and create awareness” (H) |
