Donor human milk practices in India: an analysis of health system barriers and facilitators

Background: In India, donor human milk (DHM) is increasingly recognizedas essential for the survival of vulnerable infants, particularly premature or criticallyill ones. Despite national guidelines advocating for the establishment of a lactationmanagement center (LMC), challenges persist in the availability, accessibility, quality,and safety of DHM services. Understanding the health system barriers and facilitatorsis crucial for improving DHM practices and outcomes.Objectives: The study aims to: (1) describe the current status and challengesof DHM practices in India; (2) identify and analyze health system factors affectingthe availability and accessibility of DHM services; and (3) identify and analyzehealth system factors affecting the quality and safety of DHM services.Methods: A documentary review of DHM practices in India was conducted,analyzing literature, reports, and documentary evidence from databases and websites,including PubMed, ScienceDirect, Scopus, and government and NGO websites. Theliterature (n=15) was screened based on predefined criteria and analyzed following thePRISMA framework.Findings: The review identified several key health system barriers and facilitatorsimpacting DHM practices in India. Barriers included inconsistent staffing andtraining, variations in infection control measures, and gaps in data management. Manyhuman milk banks (HMBs) faced challenges with demand exceeding supply and struggled with financial sustainability due to reliance on external funding. Additionally, inconsistentadherence to national guidelines further compromised service quality. Onthe other hand, facilitators included the growing establishment of LMCs in alignmentwith national guidelines, standardized pasteurization methods, adherence to guidelinesin some HMBs, and trained staff in select facilities. These facilitators have positivelyinfluenced the quality, safety, and accessibility of DHM services.Conclusion: Addressing health system challenges is essential to improvingIndia’s DHM service availability, quality, and safety. Greater government involvement,standardized practices, and sustainable funding are needed for the long-term success ofHuman milk banking.