Racial and socioeconomic disparities in breast milk feedings in US neonatal intensive care units

Patel, Aloka L.; Johnson, Tricia J.; Meier, Paula P.

doi:10.1038/s41390-020-01263-y

Cited by 44 publications

(33 citation statements)

References 138 publications

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“…The AAP recommends effective and efficient double electric breast pumps for mothers of VLBW infants to maximize and maintain milk expression at the hospital and at home [ 9 ]. Policies that more broadly support families, including paid family leave, ensuring a livable wage through universal basic income or raising the minimum wage, and housing and educational support would also help mediate the economic burden associated with the provision of mother’s own milk [ 39 , 48 ]. Similarly, since previously cited concerns regarding the safety of DHM have been adequately addressed, including DHM as a WIC-eligible specialty nutritional product, when medically indicated, would increase access for low-income families, further reducing disparities in DHM availability.…”

Section: Steps To Advance Access To Donor Human Milkmentioning

confidence: 99%

US state policies for Medicaid coverage of donor human milk

et al. 2022

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Donor human milk is recommended by the American Academy of Pediatrics for high-risk infants when mother’s own milk is absent or insufficient in quantity. Several factors may contribute to the inequitable use of or access to donor human milk, including a limited knowledge of its effects, cost, reimbursement, and regulatory barriers. The American Academy of Pediatrics and the United States Surgeon General have called for investigating barriers that prevent use of donor human milk for high-risk infants and for changes to public policy known to improve availability and affordability. We review the current legislative, regulatory, and economic landscape surrounding donor human milk use in the United States, as well as suggest state- and federal-level solutions to increase access to donor human milk.

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Section: Steps To Advance Access To Donor Human Milkmentioning

confidence: 99%

US state policies for Medicaid coverage of donor human milk

et al. 2022

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“…This raises critical questions about structural barriers associated with systemic racism that pose disproportionate impacts on Black mothers’ ability to access quality care, interact and engage with trusted providers including lactation consultants in the NICU, and also initiate and continue pumping MM. Black women, especially those of lower SES, are less likely to initiate breastfeeding [ 32 ] and often need to make difficult trade-offs related to income, time, and travel before devoting finite resources to MM provision [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Maternal Milk Provision in the Neonatal Intensive Care Unit and Mother–Infant Emotional Connection for Preterm Infants

et al. 2022

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Maternal milk (MM) intake during neonatal intensive care unit (NICU) hospitalization is associated with improved neurodevelopment in preterm infants. Underlying mechanisms may include stronger mother–infant emotional connection. This paper examines associations between MM provision in the NICU with maternal connection to her infant using three factors validated in our sample: maternal sensitivity, emotional concern, and positive interaction/engagement. We studied 70 mothers of infants born <1500 g and/or <32 weeks’ gestation. Associations between MM provision and mother–infant connection were modeled using median regression adjusted for clustering. Mothers who provided exclusive MM (i.e., 100% MM, no other milk) reported higher levels of maternal sensitivity by a median score of 2 units (β = 2.00, 95% CI: 0.76, 3.24, p = 0.002) than the mixed group (i.e., MM < 100% days, other milk ≥1 days), as well as greater emotional concern (β = 3.00, 95% CI: −0.002, 6.00, p = 0.05). Among mothers of very preterm infants, greater milk provision was associated with greater maternal sensitivity, but also with greater emotional concern about meeting the infant’s needs. These findings highlight the importance of supporting MM provision and early infant care as an integrated part of lactation support. The findings may also provide insight into links between MM provision in the NICU and infant neurodevelopment.

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“…These results matter because HMBs provide an essential service, in particular to the most vulnerable babies—hospitalized ill and premature newborns, for whom it is both an essential food and lifesaving medicine (Patel et al, 2021 ). It is concerning that during the outbreak of a disease that does not circulate through human milk and has a low likelihood of making infants sick, DHM orders dropped.…”

Section: Discussionmentioning

confidence: 99%

“…Second, our study is limited in its findings. In the United States, there are significant disparities in the use of DHM and breastfeeding, especially along race, ethnicity and economic status (Kair et al, 2020 ; Patel et al, 2021 ; Sigurdson et al, 2019 ; Spatz, 2020 ). No specific trend emerged from the data as to whether the decreases in DHM orders originated from private versus public (or 'safety net') hospitals or rural versus urban versus suburban hospitals.…”

Section: Discussionmentioning

confidence: 99%

The impact of the Covid‐19 pandemic on North American milk banks

Cohen

Cassidy

2021

Maternal & Child Nutrition

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This study aims to understand the impact of the Covid‐19 pandemic on human milk banking services in North America, with a focus on the United States. We triangulated questionnaire data with interviews and text‐based website data. Of the 30 human milk bank services from which data were obtained, the majority faced substantial internal organization change in terms of staffing and protocols and experienced financial hardship in particular because of decreases in donor human milk orders. At the same time, most banks reported an increase in their numbers of donors and in the volume of milk collected. These results show that the pandemic significantly affected the way in which many North American milk banks operate, some lactating mothers donate their milk and, at least during the first few months of the crisis, certain hospitals' donor human milk ordering patterns changed. It suggests in particular that stay‐at‐home orders and the turn to remote work created the potential for a surge in human milk available for donation as a number of parents no longer needed their surplus for their own children. Legal and policy reform should focus on replicating the positive effects of the pandemic on breastfeeding by guaranteeing paid parental leave and flexible work conditions. Initiatives should also aim at counteracting its negative effects by mandating the insurance coverage of donor human milk, supporting milk banks financially and, more generally, integrating lactation and human milk banking services within the health system.

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Racial and socioeconomic disparities in breast milk feedings in US neonatal intensive care units

Cited by 44 publications

References 138 publications

US state policies for Medicaid coverage of donor human milk

US state policies for Medicaid coverage of donor human milk

Maternal Milk Provision in the Neonatal Intensive Care Unit and Mother–Infant Emotional Connection for Preterm Infants

The impact of the Covid‐19 pandemic on North American milk banks

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