Exploring barriers to human milk banking acceptability among nursing mothers in Iran using social cognitive perspectives.

Abstract

Background: Despite extensive global research on mothers' intentions regarding human milk banking (HMB), its acceptability remains underexplored in non-Western contexts, particularly in Muslim-majority countries. This study investigates barriers to HMB acceptability among nursing mothers in Iran through the lens of Social Cognitive Theory (SCT), emphasizing how cultural, religious, and contextual factors intersect with maternal decision-making.

Methods: A qualitative study was conducted in Tehran, Iran, between August and October 2024. Semi-structured interviews were held with twelve nursing mothers of premature infants unable to breastfeed. Data were analyzed thematically using Braun and Clarke's six-step approach, guided by SCT to capture the interplay between personal, behavioral, and environmental influences on mothers' decision-making regarding HMB. Rigorous strategies, including iterative coding and peer debriefing, were employed to ensure trustworthiness of the analysis.

Results: Three overarching themes emerged. Personal factors included emotional states, risk perceptions, self-efficacy, outcome expectations, and religious beliefs and ethics. Behavioral factors comprised trust-based decision-making and past behavioral patterns, which shaped willingness to engage with HMB. Environmental factors involved institutional accessibility, social support systems, authoritative influence, and cultural norms. Findings revealed that mothers experienced emotional conflict, mistrust in milk safety, and religious concerns about milk kinship and halal practices. Institutional and logistical barriers, coupled with lack of family and community support, further reduced HMB acceptability. Nevertheless, participants emphasized that religious endorsements, transparent regulations, health professional guidance, and improved service accessibility could enhance trust and participation.

Conclusions: This study highlights how reciprocal interactions among personal beliefs, behavioral patterns, and environmental contexts shape the acceptability of HMB among Iranian mothers. To improve uptake, culturally sensitive interventions are essential particularly those involving religious authorities, healthcare professionals, and awareness campaigns to address misconceptions and build trust. Strengthening institutional accessibility and transparency can further promote HMB as a viable feeding option. Future research should also examine the roles of socioeconomic status, healthcare access, and generational differences to broaden the evidence base for culturally adapted HMB policies in Muslim-majority contexts.