Racial Disparities in Donor Human Milk Feedings: A Study Using Electronic Medical Records

Abstract

Introduction: The aim of this study was to evaluate differences in the use of pasteurized donor human milk (PDHM) by maternal race–ethnicity during postpartum hospitalization using electronic medical records (EMRs). Materials and Methods: A retrospective cohort study of all live-born infants at our academic research institution from July 1, 2014, to June 30, 2016, was conducted. EMR data were used to determine whether each infant received mother's own milk (MOM), PDHM, or formula. These data were stratified based on whether the infant received treatment in the Neonatal Critical Care Center. Generalized estimating equation models were used to calculate the odds of receiving PDHM by maternal race–ethnicity, adjusting for gestational age, birth weight, insurance, preferred language, nulliparity, and mode of delivery. Results: Infant feeding data were available for 7097 infants, of whom 49% were fed only MOM during their postpartum hospitalization. Among the 15.9% of infants admitted to neonatal critical care, infants of non-Hispanic Black (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.31–0.72), Hispanic (OR 0.65, 95% CI 0.36–1019), and Other (OR 0.63, 95% CI 0.32–1.26) mothers had lower rates of PDHM feedings than infants of non-Hispanic White mothers in the adjusted models. Among well infants, the use of PDHM was lower among non-Hispanic Black and Hispanic mothers (OR 0.25, 95% CI 0.18–0.36, and OR 0.38, 95% CI 0.26–0.56) compared with non-Hispanic White mothers. Conclusions: Inequities in exclusive human milk feeding and use of PDHM by maternal race–ethnicity were identified. Antiracist interventions are needed to promote equitable access to skilled lactation support and counseling for PDHM use.

Lactation Support as a Proxy Measure of Family-Centered Care Quality in Neonates with Life-Limiting Conditions—A Comparative Study

“…Furthermore, similar to previous findings, we identified non-English language as a barrier to breastmilk utilization in our cohorts [15,16]. Finally, contrary to previous studies demonstrating FCC and lactation healthcare disparities in the NICU for mothers of racial, ethnic, and socioeconomic differences, we did not identify race, ethnicity, or socioeconomic differences as a barrier to lactation support in the NICU in our cohort analysis [17][18][19][20][21][22][23][24].…”

Inequities Among Hospital Donor Human Milk Access

“…Of note, there are racial trends in NEC, with some data indicating that Hispanic infants are at greater risk [28]. Although much of the prior research discusses the racial and ethnic inequities in DHM use [1,17], this research indicates there may be more structural barriers by inequities in access. Further, hospitals with more uninsured patients are also less likely to have DHM available for NICU patients.…”

“…While California has covered the use of DHM through MediCAL since 1998, it is only is speci c situations and there are still additional costs associated with providing DHM that the hospital incurs such as milk storage, preparation time, and licensing [30]. Many reports indicate that the use of DHM lowers overall medical costs in the long run [10,11,17,20,29,31]. However, nancially constrained institutions might feel required to respond to short-term direct costs rather than longterm cost savings [32].…”

“…Black VLBW infants receive less MOM compared to non-Black VLBW infants [1]. Similarly, DHM use is lower among infants born to Black and Hispanic mothers compared to infants born to non-Hispanic White mothers [17]. Much of the current literature examines human milk inequities at the time of discharge [18,19]; however, not much is known about inequities that may exist around access to DHM at the hospital level.…”

Forming the Perception of WIC Infant Feeding Recommendations: A Qualitative Study

“…Since healthcare provider support is a well-established predictor of breastfeeding success [ 24 ], WIC should invest more time and resources in communicating WIC’s role in breastfeeding promotion and support to healthcare providers to align messaging and services. For mothers from racial and ethnic minority groups, racism has also been documented through experiences of being discriminated against or stereotyped during postpartum hospitalization, contributing to racialized disparities in who receives lactation support and/or human donor milk versus formula supplementation [ 25 , 26 , 27 ]. The WIC program should work collaboratively with major medical organizations to improve equal access to evidence-based maternity practices, such as those advanced by the Baby-Friendly Hospital Initiative, both in and outside the hospital setting [ 28 , 29 ].…”