Sir,

Mother\'s milk is the best food for growth and development of an infant. Every mother should breastfeed her infant. However, if, under certain circumstances, she is unable to feed her infant directly, her breast milk should be expressed and fed to the infant, particularly in preterm and other high-risk infants. At times, when mother\'s own milk in any form (direct or expressed) is not available or is insufficient, then pasteurized donor human milk is the next best alternative as feeding the babies with breastmilk can significantly reduce the risk of infection, especially necrotizing enterocolitis.\[[@ref1][@ref2]\] It is reported that the babies who were never breastfed faced extra visits to doctors, extra days of hospitalization, and extra prescriptions in the 1^st^ year of life as compared to those exclusively breastfed.\[[@ref3]\] As per 2013 Census, India has the highest number of low birth weight babies and neonatal mortality rate, where 28 deaths/1000 live births were reported. Reducing neonatal mortality rate is the key goals of the National Health Mission, Government of India.\[[@ref4]\] Donor mother\'s milk fed through human milk bank can have great impact on reducing the neonatal mortality rate.\[[@ref5]\]

In India, although nearly 14 human milk banks are in service to society, the growth is very slow. The main reasons are lack of awareness among community people and the lack of promotion in the industry too.\[[@ref6]\]

A nonexperimental cross-sectional study design was used to assess the knowledge and attitude of parous women toward human milk banking. The study was carried out in rural and urban community health centers of Patiala district, Punjab, India. Data from parous women visiting community health centers were collected. The study was carried out on 200 parous women selected by purposive sampling technique. Women who were parous or given birth to a child and who had breastfed or presently breastfeeding their child/children were included. The study was approved by the institutional ethical review board and informed consent was obtained from all the respondents. Data were collected through interview technique using two tools; a self-designed knowledge questionnaire to assess knowledge designed in a multiple choice format consisted of 14 questions covering the basic structure, functions, and processes involved in human milk banking; a 3-point Likert scale with 16 items was used to assess the attitude toward human milk banking.

Results revealed that majority of the women (63%) were in the age category of 30--40 years, only 3% were in the age group of 20--30 years, 78% of the women breastfed their children, and none of them fed their children formula milk. Neither of the women had any previous source of information related to human milk banking, nor they had any previous experience as human milk donor or recipient \[[Table 1](#T1){ref-type="table"}\].

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Demographic characteristics of parous women (*n*=200)

  Demographic characteristics        Frequency (%)
  ---------------------------------- ---------------
  Age                                
   20-30                             6 (3)
   30-40                             126 (63)
   40-50                             60 (30)
   \>50                              8 (4)
  Education                          
   Illiterate                        37 (18.5)
   Middle                            84 (42)
   Matric                            54 (27)
   Higher secondary                  18 (9)
   Graduate and above                7 (3.5)
  Occupation                         
   Homemaker                         120 (60)
   Government service                11 (5.5)
   Private service                   28 (14)
   Self-employed                     41 (20.5)
  Residence                          
   Urban                             100 (50)
   Rural                             100 (50)
  Religion                           
   Hindu                             95 (47.5)
   Sikh                              105 (52.5)
   Muslim                            0 (0)
   Any other                         0 (0)
  Income/month (INR)                 
   ≤10,000                           88 (44)
   10,001-20,000                     79 (39.5)
   20,001-30,000                     28 (14)
   ≥30,000                           5 (2.5)
  Parity                             
   Primiparous                       106 (53)
   Multiparous                       94 (47)
  Type of feed                       
   Breastfeed                        156 (78)
   Cow's feed                        44 (22)
   Formula feed                      0 (0)
  Any source of information          
   Yes                               0 (0)
   No                                200 (100)
  Any previous experience as donor   
   Yes                               0 (0)
   No                                200 (100)

It was found that majority of the participants (56.5%) had inadequate knowledge and only 43.5% of respondents had adequate knowledge (*P* = 0.000). Majority of the participants (66.5%) had neutral attitude. The overall mean score of attitude (28.8 ± 5.87) indicates overall neutral attitude of the respondents toward human milk banking since this concept was altogether new to them.

There was no significant difference in the mean knowledge scores of women based on their residence (*t* = 0.425; *P* \> 0.05), whereas the mean attitude scores in rural and urban areas differed significantly (*t* = 3.65; *P* = 0.000). It was found that the attitude of women in an urban area (mean attitude scores = 30.3 ± 5.36) was better than those in a rural area (mean attitude scores = 27.4 ± 6.01). There was a significantly positive correlation between knowledge and attitude (*r* = 0.334, *P* = 0.000), where the nature of correlation was mild \[[Table 2](#T2){ref-type="table"}\].

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Knowledge and attitude of parous women related to human milk banking according to their residence status (*n*=200)

  Variable    Residence   *F*         Mean scores±SD   *t*     *P*
  ----------- ----------- ----------- ---------------- ------- -----------
  Knowledge   Urban       100         6.8±3.57         0.425   0.67 (NS)
  Rural       100         6.6±3.41                             
  Attitude    Urban       100         30.3±5.36        3.65    0.000\*
  Rural       100         27.4±6.01                            

\*Significant at *P*\<0.05. SD: Standard deviation, NS: Not significance

The results revealed that the level of knowledge was not associated with age, education, occupation, religion, income, and type of feed. There was a significant association of attitude with education (χ^2^ = 22.7, *P* = 0.005), where majority of respondents were educated till middle level (84%) followed by matric (54%), and in relation to either of these education categories, most of the respondents were bearing neutral attitude.

In general, like other developing countries, India has a high rate of premature and low birth weight births and infant mortalities. The major contributing factor is suboptimal breastfeeding. Establishing pasteurized human milk banks will scale up the breastfeeding rate and reduce the infant mortality rate. Therefore, to improve the knowledge level of community at large toward. Therefore, to improve the knowledge level and attitude of community at large, HMB must be intergarted into newborn care systems. Breast feeding policies with HMB as an important component should be formulated and communicated to all the health care providers. Healthcare providers must advocate and raise the awareness regarding HMB and exclusive breastfeeding among general public.

Financial support and sponsorship {#sec2-1}
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Nil.

Conflicts of interest {#sec2-2}
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There are no conflicts of interest.
