Breastfeeding Mothers' and Nurses' Perceptions of Breast Milk Sharing and Donation for Research in Bhutan: A...

Breast milk is globally recognized as the optimal source of infant nutrition due to its immunological and neurodevelopmental benefits. In low-and middle-income countries like Bhutan, limited availability of donor milk and absence of milk banking infrastructure hinder neonatal nutrition. While breast milk sharing for feeding has been explored elsewhere, little is known about maternal and nursing perspectives of milk donation for research use within Bhutanese sociocultural context.

To explore breastfeeding mothers' perceptions of breast milk sharing and donation for both nutritional and research purposes, emphasizing the facilitating role of nurses.

A qualitative exploratory design was used. Fifty-nine participants, 44 breastfeeding mothers and 15 neonatal intensive care unit nurses, from Jigme Dorji Wangchuck National Referral Hospital, Thimphu Bhutan, were recruited through purposive sampling. In-depth semistructured interviews were held between March and May 2022. Data was thematically analyzed following Braun and Clarke's six-phase framework using NVivo 12 software.

Four themes emerged: (1) Breast milk sharing nutrition; breastfeeding mothers (- CHDM 13) expressed altruism but feared diseases transmission and cultural restriction; (2) Breast milk donation for research; breastfeeding mothers (NICUN 11) perceived potential societal benefits yet cited infrastructural gaps and religious hesitancy; (3) Nurses as facilitators on breast milk nutrition; neonatal nurses (NICUN 2 & 4) promoted breastfeeding and informal sharing despite lacking standard operating procedures (SOPs); and (4) Nurses' role in research; nurse (- NICUN 4) viewed research as transformative but faced capacity and resource constraints.

Support for breast milk sharing in Bhutan is conditional, shaped by altruism, cultural norms, safety concerns, and system readiness. Strengthening nurse training, developing SOPs, and culturally sensitive community engagement are essential for promoting safe, ethical milk sharing and research participation.