The Role of Work as a Social Determinant of Health in Mother’s Own Milk Feeding Decisions for Preterm Infants: A State of the Science Review

Abstract

In the United States, 10% of infants are born preterm (PT; <37 weeks gestational age) each year and are at higher risk of complications compared to full term infants. The burden of PT birth is borne disproportionately by Black versus non-Black families, with Black mothers significantly more likely to give birth to a PT infant. One proven strategy to improve short- and long-term health outcomes in PT infants is to feed mother’s own milk (MOM; breast milk from the mother). However, mothers must make decisions about work and MOM provision following PT birth, and more time spent in paid work may reduce time spent in unpaid activities, including MOM provision. Non-Black PT infants are substantially more likely than Black PT infants to receive MOM during the birth hospitalization, and this disparity is likely to be influenced by the complex decisions mothers of PT infants make about allocating their time between paid and unpaid work. Work is a social determinant of health that provides a source of income and health insurance coverage, and at the same time, has been shown to create disparities through poorer job quality, lower earnings, and more precarious employment in racial and ethnic minority populations. However, little is known about the relationship between work and disparities in MOM provision by mothers of PT infants. This State of the Science review synthesizes the literature on paid and unpaid work and MOM provision, including: (1) the complex decisions that mothers of PT infants make about returning to work, (2) racial and ethnic disparities in paid and unpaid workloads of mothers, and (3) the relationship between components of job quality and duration of MOM provision. Important gaps in the literature and opportunities for future research are summarized, including the generalizability of findings to other countries.

Where does the time go? Temporal patterns of pumping behaviors in mothers of very preterm infants vary by sociodemographic and clinical factors

“…Taken together, the large variation in pumping behaviors by race/ethnicity and socioeconomic status (payment source as proxy) may contribute to disparity in MOM provision for VPT infants, which supports our previous findings that pumping behaviors mediate differences in MOM provision (35). The reasons underlying these disparities in pumping behaviors are unknown and likely multifactorial, with potential reasons including racial/ethnic differences in return-to-work timing, unpaid workload, lactation-supportive work conditions, maternal health conditions, cultural and familial support for MOM provision, and implicit and explicit biases that may impact mothers in the NICU (33,35,47,(62)(63)(64)(65)(66)(67)(68)(69)(70). Measuring and acknowledging variation in pumping is a first step (71), which highlights the need to further understand barriers to pumping in order to develop appropriate interventions, education and quality improvement efforts.…”

Breastfeeding by Working Mothers: Global Challenges

“…2 Racial and ethnic disparities in paid and unpaid workloads of mothers, and the relationship between components of job quality and duration of mother's own milk provision. 3 However, returning to work, insufficient breast milk, misconceptions about breastfeeding, and interference with social life were the barriers for mothers to breastfeed continuously. 4 Several aspects must be considered to increase the chances of a beneficial effect of interventions: type of intervention, target audience, timing of intervention, actors that can implement it, strategies and methods of intervention, and intensity of intervention.…”