Knowledge, perceptions, and support for human milk banking among Saudi mothers: a cross-sectional study

Donor Human Milk (DHM) is recommended for preterm infants when a mother's own milk is unavailable. This study explored Saudi mothers' knowledge, attitudes, and concerns regarding human milk banking (HMB) and donation, to identify barriers to acceptance and to inform future implementation.

A cross-sectional survey of 835 mothers across Saudi regions assessed support for HMB and its association with sociodemographic factors, feeding practices, breastfeeding duration, and knowledge of the benefits of breast milk. Attitudes toward religious permissibility and willingness to accept or donate DHM were also evaluated.

Among 835 surveyed mothers, 37.7% supported HMB while 62.3% did not. Support was significantly higher among mothers aged 21-30 years (45.6% vs. 28.4% aged >40; p = 0.002) and those with one child (47.4% vs. 27.0% with >4 children; p < 0.001). Education and region showed no significant association with support (p > 0.05). Religious milk kinship concerns were the primary barrier, cited by 91.2% of non-supporters of HMB (p < 0.001); however, among participants who considered HMB permissible if the donor was known, 50.0% supported HMB. Furthermore, among participants who indicated that their stance could change after learning more about HMB and the benefits of human milk for preterm infants, 83.6% supported HMB, while 71.5% of those who would consider donating or receiving donor milk if breastfeeding were documented on a government platform supported HMB (p < 0.001). Logistic regression revealed that religious concerns about milk kinship (OR = 0.014; p < 0.001) and uncertainty about HMB legality (OR = 0.186; p = 0.033) were significant predictors of non-support.

Overall, a considerable proportion of Saudi mothers demonstrated support for human milk banking (HMB) and willingness to accept or donate breast milk. However, religious concerns regarding milk kinship remain the primary barrier to wider acceptance. Successful HMB implementation requires three key strategies: (1) collaboration with religious scholars to establish secure donor-recipient registries addressing milk kinship concerns; (2) public education on safety and screening protocols; and (3) integration into national neonatal guidelines for preterm infants. The positive response to education and government-documented breastfeeding platforms suggests that culturally responsive, religiously informed approaches can significantly enhance HMB adoption and improve neonatal outcomes in Saudi Arabia.