The correlation between maternal knowledge of breastfeeding, self-efficacy of breastfeeding and knowledge and attitudes towards donated human milk: a cross-sectional study

BACKGROUND: The World Health Organization (WHO) endorses breast milk as the optimal nutritional source for infants. When maternal lactation is insufficient due to multifactorial causes or breastfeeding is contraindicated by maternal illness, donated human milk (DHM) is recommended as the preferred alternative feeding strategy. This study aims to investigate correlations between maternal breastfeeding knowledge, breastfeeding self-efficacy, and DHM-related knowledge/attitudes, and to identify factors influencing maternal DHM knowledge and attitudes. Findings will inform targeted strategies to optimize human milk donation practices. METHODS: A cross-sectional study was conducted among postpartum women attending 42-day postnatal check-ups between January and June 2025. Participants completed a sociodemographic questionnaire and three validated instruments: the Questionnaire for the Knowledge, Attitudes, and Practices of Human Milk Donation in Hospital Puerperants, Breastfeeding Knowledge Questionnaire (BKQ), and Short Form of the Breastfeeding Self-Efficacy Scale (BSES-SF). Multiple linear regression analyses were performed to identify significant predictors of DHM-related knowledge and attitudes. RESULTS: Of 188 valid responses, mothers demonstrated moderate-to-high DHM knowledge (mean ± SD: 8.42 ± 2.78) and positive DHM attitudes (mean ± SD: 40.21 ± 5.03). Multiple linear regression revealed that BKQ scores were significantly associated with DHM knowledge scores (p < 0.05). Additionally, longer maternity leave duration, higher BKQ scores, and higher BSES-SF scores were independently associated with more favorable DHM attitudes (p < 0.05 for all). CONCLUSIONS: Postpartum women with longer maternity leave duration represent key target groups for DHM promotion. Healthcare providers should prioritize interventions to enhance postpartum women's breastfeeding knowledge and self-efficacy, as these factors may significantly improve maternal engagement in breast milk donation. TRIAL REGISTRATION: The study was registered at the Chinese Clinical Trial Registry (registration number: ChiCTR2500098424; date of first registration: 07/03/2025).