Mother in hospital bed feeding her newborn baby.

Racial Disparities in Human Milk Consumption Among Very Low Birth Weight Infants

Meg Parker, MD, MPH, Child Health Equity Center Core Faculty, and colleagues recently published findings from a study of nearly 350,000 very low birth weight (VLBW) infants that revealed an 8% increase in provision of human milk at hospital discharge over the 10-year study period; however, gains were smaller and disparities widened among non-Hispanic Black and Native American VLBW infants compared with non-Hispanic White VLBW infants. 

Breastfeeding as Modifiable Factor for Improving VLBW Infant Health Outcomes

In 2021, the American Academy of Pediatrics (AAP) published a clinical report of strategies that promote human milk consumption for VLBW infants treated in the neonatal intensive care unit (NICU). Human milk consumption is associated with several health benefits among VLBW infants including reduced incidences of necrotizing enterocolitis, chronic lung disease, and neurodevelopmental impairment.  Consumption of human milk is a modifiable factor, and thus presents an optimal target for interventions seeking to improve VLBW infant health outcomes. However, despite the increase in human milk use precipitated by AAP’s recommendations, the Surgeon General’s Call to Action to Support Breastfeeding, and the World Health Organization’s Baby-Friendly Hospital Initiative, recent research elucidates persisting racial and ethnic disparities in breastfeeding practices and human milk use for VLBW infants.

Systemic Race-Based Inequities Contribute to Disparities in Human Milk Use

Mothers of VLBWs face a number of challenges with milk production including medical-related complications of their preterm labor and social factors (such as competing caregiving responsibilities, transportation barriers, and the need to return to work) that limit their ability to be at the infant’s NICU bedside. Research from Dr. Parker’s team reveals how these challenges common to NICU mothers may be exacerbated by systemic race-based inequities. Structural racism contributes to racial minorities’ lower socioeconomic status and employer support. Implicit biases of health care providers/staff and lower quality of care provided at hospitals serving predominantly racial minorities contribute to the disparity in human milk use.

Through their research, Dr. Parker and colleagues have highlighted the role of NICU staff and providers in advocating for mothers’ breastfeeding and/or bottle feeding with expressed milk. Bedside nurses and providers, not just lactation consultants, play a critical role in reinforcing education about human milk consumption. 

Effective Strategies Supporting Breastfeeding and Human Milk Consumption

  1. The NICU care team’s post-discharge planning should discuss goals regarding human milk use, including breastfeeding, bottle-feeding with expressed milk and/or formula, and fortification needs. 
  2. Peer programs and support groups may offer mothers sustained education and encouragement. 
  3. Interventions to address social determinants of health, such as providing transportation aid or child care assistance, may enhance the mother’s ability to be at the VLBW infant’s NICU bedside.

 

While the success of clinic and policy-level initiatives to promote breastfeeding is encouraging, evaluations and interventions are needed to address race-based disparities in human milk consumption and the disparities in VLBW infant health outcomes.

Interested in learning more about our efforts to develop interventions that address disparities in neonatal care?

About the Author

Annelise Brochier, MPH, is a Research Project Manager for a number of studies investigating WE CARE, a clinic-based intervention to address unmet basic needs of patients and their families.

Erin Meyer, MD (He/Him)

Assistant Professor of Pediatrics, Attending in Pediatric Emergency Medicine

Dr. Meyer is Assistant Professor of Pediatrics at UMass Chan Medical School and a nocturnist attending in the UMass Pediatric Emergency Room. Dr. Meyer is an early career investigator who is using mixed methods research and implementation science to reduce health inequities for children with acute neurologic conditions such as concussion. Dr. Meyer is also a research leader in the UMass Division of Pediatric Emergency Medicine (PEM) where he directs a research educational curriculum for PEM fellows, supports and mentors PEM fellow research projects, and he serves as the UMass site champion for the nationwide Pediatric Emergency Medicine Collaborative Research Committee.
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Erin Meyer, MD (He/Him)

Assistant Professor of Pediatrics, Attending in Pediatric Emergency Medicine

Dr. Meyer is Assistant Professor of Pediatrics at UMass Chan Medical School and a nocturnist attending in the UMass Pediatric Emergency Room. Dr. Meyer is an early career investigator who is using mixed methods research and implementation science to reduce health inequities for children with acute neurologic conditions such as concussion. Dr. Meyer is also a research leader in the UMass Division of Pediatric Emergency Medicine (PEM) where he directs a research educational curriculum for PEM fellows, supports and mentors PEM fellow research projects, and he serves as the UMass site champion for the nationwide Pediatric Emergency Medicine Collaborative Research Committee.

Nikita S Kalluri, MD MPH (She/Her)

Assistant Professor of Pediatrics/Neonatologist

Nikita Kalluri, MD MPH is an Assistant Professor of Pediatrics at UMass Chan Medical School and an attending neonatologist at UMass Memorial Children’s Medical Center. Dr. Kalluri is a neonatal health services researcher, and her work is centered around perinatal health equity, especially as it pertains to family-provider communication. She has received national research awards from the Academic Pediatric Association and the Society of Pediatric Research, as well as training grants from the American Academy of Pediatrics and Academic Pediatric Association to support her work evaluating disparities in NICU bedside communication. She has also investigated the role of social disparities such as maternal race, ethnicity, and primary language, on neonatal outcomes and family experience.
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Nikita S Kalluri, MD MPH (she/her)

Assistant Professor of Pediatrics/Neonatologist

Nikita Kalluri, MD MPH is an Assistant Professor of Pediatrics at UMass Chan Medical School and an attending neonatologist at UMass Memorial Children’s Medical Center. Dr. Kalluri is a neonatal health services researcher, and her work is centered around perinatal health equity, especially as it pertains to family-provider communication. She has received national research awards from the Academic Pediatric Association and the Society of Pediatric Research, as well as training grants from the American Academy of Pediatrics and Academic Pediatric Association to support her work evaluating disparities in NICU bedside communication. She has also investigated the role of social disparities such as maternal race, ethnicity, and primary language, on neonatal outcomes and family experience.

April Perez-Moore, DO (she/her)

Assistant Professor of Pediatrics

April Perez-Moore, DO is a pediatrician and clinician-scientist who studies the social and relational risks of preterm infant development. She is an Assistant Professor of Pediatrics at UMass Chan Medical School and affiliated faculty member of the Eunice Kennedy Shriver Center. Dr. Perez-Moore also directs the NICU follow-up / SHINE (Supporting Healthy Infant Neurodevelopmental Experiences) Clinic at the UMass Memorial Children’s Medical Center. Her clinical and research work focus on promotion of early relational health for mother-preterm infant dyads and intervention to foster social-emotional development in the high-risk preterm population.
April Perez-Moore

April Perez-Moore, DO (she/her)

Assistant Professor of Pediatrics

April Perez-Moore, DO is a pediatrician and clinician-scientist who studies the social and relational risks of preterm infant development. She is an Assistant Professor of Pediatrics at UMass Chan Medical School and affiliated faculty member of the Eunice Kennedy Shriver Center. Dr. Perez-Moore also directs the NICU follow-up / SHINE (Supporting Healthy Infant Neurodevelopmental Experiences) Clinic at the UMass Memorial Children’s Medical Center. Her clinical and research work focus on promotion of early relational health for mother-preterm infant dyads and intervention to foster social-emotional development in the high-risk preterm population.

Rani Jones, BS (She/Her)

Project Coordinator

Rani Jones is the current Project Coordinator for the Child Health Equity Center. She graduated from Rensselaer Polytechnic Institute (RPI) in 2023 with her B.S. in Biochemistry and Biophysics, and a minor in Behavioral and Cognitive Neuroscience. During her time as an undergraduate, she spent a lot of time volunteering with children in the New York capital region. She is very interested in public health and plans to continue her education at RPI to pursue her Ph.D. in Biochemistry and Biophysics in the Fall.
Rani_headshot

Rani Jones, BS (She/Her)

Project Coordinator

Rani Jones is the current Project Coordinator for the Child Health Equity Center. She graduated from Rensselaer Polytechnic Institute (RPI) in 2023 with her B.S. in Biochemistry and Biophysics, and a minor in Behavioral and Cognitive Neuroscience. During her time as an undergraduate, she spent a lot of time volunteering with children in the New York capital region. She is very interested in public health and plans to continue her education at RPI to pursue her Ph.D. in Biochemistry and Biophysics in the Fall.

Maia Archer, BA (She/Her)

Career path intern

Maia Archer graduated from Boston University with her B.A. in Biology, double minoring in French and Public Health. She is an intern for the Child Health Equity Center primarily assisting with the Pilot Lyft Transportation Program and Food is Medicine Program. Maia will be continuing her academic journey at George Washington University to receive her Masters in Public Health with a concentration in Health Promotion.

Child Health Equity Center

Maia Archer, BA (She/Her)

Career PATH Intern

Maia Archer graduated from Boston University with her B.A. in Biology, double minoring in French and Public Health. She is an intern for the Child Health Equity Center primarily assisting with the Pilot Lyft Transportation Program and Food is Medicine Program. Maia will be continuing her academic journey at George Washington University to receive her Masters in Public Health with a concentration in Health Promotion.

Monick Powell, C-TAGME (She/Her)

Fellowship Coordinator

Monick Powell, C-TAGME, is the Pediatric Training Program Coordinator at UMass Chan Medical School and UMass Memorial Children’s Medical Center. She acts as Coordinator for the Program to Advance Training in Child Health Equity (PATH) Fellowship. She was born in Puerto Rico, grew up in New York, and has been working at UMass since 2004 in various positions in Pediatrics. Ms. Powell established and leads the institutional Training Programs Coordinator Advisory Committee.

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Monick Powell, C-TAGME (She/Her)

Fellowship Coordinator

Monick Powell, C-TAGME, is the Pediatric Training Program Coordinator at UMass Chan Medical School and UMass Memorial Children’s Medical Center. She acts as Coordinator for the Program to Advance Training in Child Health Equity (PATH) Fellowship. She was born in Puerto Rico, grew up in New York, and has been working at UMass since 2004 in various positions in Pediatrics. Ms. Powell established and leads the institutional Training Programs Coordinator Advisory Committee.

Larry Rhein, MD, MPH (He/Him)

Advisor

Larry Rhein, MD, MPH, joined the faculty at UMass Chan Medical School in June 2016. He is an Associate Professor of Pediatrics and Chair of the Department of Pediatrics. Dr. Rhein is board-certified in both pediatric pulmonology and neonatology. He is a health services researcher with a focus on respiratory outcomes of neonatal lung disease and is a national expert on lung disease of prematurity. Dr. Rhein runs a research program focused on optimizing respiratory status in infants with severe lung diseases, particularly infants who are technology- or oxygen-dependent. He has pioneered several protocols for safe outpatient oxygen weaning, which allows infants to be discharged from the neonatal intensive care unit much earlier. Through clinical trials and analysis of physiological data, Dr. Rhein hopes to develop new strategies to prevent and treat neonatal and pediatric lung disease.

Photo of Dr. Larry Rhein, MD, MPH

Larry Rhein, MD, MPH (He/Him)

Advisor

Larry Rhein, MD, MPH, joined the faculty at UMass Chan Medical School in June 2016. He is an Associate Professor of Pediatrics and Chair of the Department of Pediatrics. Dr. Rhein is board-certified in both pediatric pulmonology and neonatology. He is a health services researcher with a focus on respiratory outcomes of neonatal lung disease and is a national expert on lung disease of prematurity. Dr. Rhein runs a research program focused on optimizing respiratory status in infants with severe lung diseases, particularly infants who are technology- or oxygen-dependent. He has pioneered several protocols for safe outpatient oxygen weaning, which allows infants to be discharged from the neonatal intensive care unit much earlier. Through clinical trials and analysis of physiological data, Dr. Rhein hopes to develop new strategies to prevent and treat neonatal and pediatric lung disease.

Michelle Trivedi, MD, MPH (She/Her)

Child Health Equity Center CORE FACULTY

Michelle Trivedi, MD, MPH, is a pediatric pulmonologist and clinician-scientist who studies sustainable community-based interventions that seek to improve asthma health for children. She is an Associate Professor of Pediatrics and Population Quantitative Health Sciences at UMass Chan Medical School. Dr. Trivedi is Principal Investigator on a National Institutes of Health (NIH)-funded clinical trial of Asthma Link, a clinic-school partnership that delivers school-supervised asthma therapy to children with poorly controlled asthma in 52 schools across Massachusetts. 

 

With a focus on sustainable, pragmatic interventions, she has developed a novel methodology for stakeholder engagement, grounded in implementation science, that elicits input from children, parents, pediatricians, community and systems-level stakeholders (payors, legislators, and public health officials) in order to adapt evidence-based interventions to real-world settings. The ultimate goal of this methodology and her work is to develop interventions that produce positive public and population health impact, particularly for historically marginalized populations.

Photo of Dr. Michelle Trivedi

Michelle Trivedi, MD, MPH (She/Her)

Child Health Equity Center CORE FACULTY

Michelle Trivedi, MD, MPH, is a pediatric pulmonologist and clinician-scientist who studies sustainable community-based interventions that seek to improve asthma health for children. She is an Associate Professor of Pediatrics and Population Quantitative Health Sciences at UMass Chan Medical School. Dr. Trivedi is Principal Investigator on a National Institutes of Health (NIH)-funded clinical trial of Asthma Link, a clinic-school partnership that delivers school-supervised asthma therapy to children with poorly controlled asthma in 52 schools across Massachusetts. 

With a focus on sustainable, pragmatic interventions, she has developed a novel methodology for stakeholder engagement, grounded in implementation science, that elicits input from children, parents, pediatricians, community and systems-level stakeholders (payors, legislators, and public health officials) in order to adapt evidence-based interventions to real-world settings. The ultimate goal of this methodology and her work is to develop interventions that produce positive public and population health impact, particularly for historically marginalized populations.

Meg Parker, MD, MPH (She/Her)

Child Health Equity Center CORE FACULTY

Meg Parker, MD, MPH, is an Associate Professor of Pediatrics and Chief of the Division of Neonatology at UMass Chan Medical School and UMass Memorial Children’s Medical Center. Dr. Parker is a neonatal health services researcher and holds several federal and foundation grants in the area of social disparities in preterm birth outcomes; she has a particular interest in safe sleep and breastfeeding. 

Dr. Parker is also an expert in multi-site implementation science and is the Co-Chair of the Neonatal Quality Improvement Collaborative of Massachusetts and an Improvement Advisor from the Institute of Healthcare Improvement. She has led multi-site NICU quality improvements focused on breastfeeding and family engagement. Dr. Parker applies a health equity lens to her local and multisite quality improvement projects.

Photo of Dr. Meg Parker

Meg Parker, MD, MPH (She/Her)

Child Health Equity Center CORE FACULTY

Meg Parker, MD, MPH, is an Associate Professor of Pediatrics and Chief of the Division of Neonatology at UMass Chan Medical School and UMass Memorial Children’s Medical Center. Dr. Parker is a neonatal health services researcher and holds several federal and foundation grants in the area of social disparities in preterm birth outcomes; she has a particular interest in safe sleep and breastfeeding. 

Dr. Parker is also an expert in multi-site implementation science and is the Co-Chair of the Neonatal Quality Improvement Collaborative of Massachusetts and an Improvement Advisor from the Institute of Healthcare Improvement. She has led multi-site NICU quality improvements focused on breastfeeding and family engagement. Dr. Parker applies a health equity lens to her local and multisite quality improvement projects.

Heather Forkey, MD (She/Her)

Child Health Equity Center CORE FACULTY

Heather Forkey, MD, is a pediatrician and a Professor of Pediatrics at the UMass Chan Medical School. She also directs the Child Protection Program and Foster Children Evaluation Service (FaCES) of the UMass Memorial Children’s Medical Center. Dr. Forkey is particularly interested in meeting the health and developmental needs of children who have experienced trauma. In collaboration with colleagues, she has trained thousands of professionals and parents about the impacts of childhood trauma and has developed innovative resources to make that work easier. She published the first textbook on trauma-informed care for pediatrics and presents nationally and internationally on the topic. Dr. Forkey also serves in leadership roles for the National Child Traumatic Stress Network and the American Academy of Pediatrics.

Photo of Dr. Heather Forkey

Heather Forkey, MD (She/Her)

Child Health Equity Center CORE FACULTY

Heather Forkey, MD, is a pediatrician and a Professor of Pediatrics at the UMass Chan Medical School. She also directs the Child Protection Program and Foster Children Evaluation Service (FaCES) of the UMass Memorial Children’s Medical Center. Dr. Forkey is particularly interested in meeting the health and developmental needs of children who have experienced trauma. In collaboration with colleagues, she has trained thousands of professionals and parents about the impacts of childhood trauma and has developed innovative resources to make that work easier. She published the first textbook on trauma-informed care for pediatrics and presents nationally and internationally on the topic. Dr. Forkey also serves in leadership roles for the National Child Traumatic Stress Network and the American Academy of Pediatrics.

Nisha Fahey, DO, MSc (She/Her)

Child Health Equity Center CORE FACULTY

Nisha Fahey, DO, MSc, is an Assistant Professor at UMass Chan Medical School in the Division of General Pediatrics and a faculty member in the Child Health Equity Center with a focus on global health. Dr. Fahey leads an institutional collaboration with an academic tertiary care center in rural western India focused on research capacity building and community engagement to identify and address barriers to care and health inequities in rural community settings. Through this collaboration, she has led the implementation of several research projects in India; recent projects have focused on maternal-child health and social determinants of health. In addition, she is passionate about exploring how digital technologies can be used to reduce health inequities. Her current research focuses on developing ways to promote the practice of Kangaroo Mother Care among mother-neonate dyads across a variety of settings.

Photo of Dr. Nisha Fahey

Nisha Fahey, DO, MSc (She/Her)

Child Health Equity Center CORE FACULTY

Nisha Fahey, DO, MSc, is an Assistant Professor at UMass Chan Medical School in the Division of General Pediatrics and a faculty member in the Child Health Equity Center with a focus on global health. Dr. Fahey leads an institutional collaboration with an academic tertiary care center in rural western India focused on research capacity building and community engagement to identify and address barriers to care and health inequities in rural community settings. Through this collaboration, she has led the implementation of several research projects in India; recent projects have focused on maternal-child health and social determinants of health. In addition, she is passionate about exploring how digital technologies can be used to reduce health inequities. Her current research focuses on developing ways to promote the practice of Kangaroo Mother Care among mother-neonate dyads across a variety of settings.

Sarabeth Broder-Fingert, MD, MPH (She/Her)

Child Health Equity Center CORE FACULTY

Sarabeth Broder-Fingert, MD, MPH, is a pediatrician and implementation scientist who studies early diagnosis and treatment for autistic children and children with other developmental, behavioral, and/or mental health disorders. She is Vice Chair for Clinical Research in Pediatrics and Associate Director for Research at the Eunice Kennedy Shriver Center at UMass Chan Medical School. Dr. Broder-Fingert is Principal Investigator on multiple National Institutes of Health (NIH)-funded awards focused on testing and/or evaluating the implementation of autism interventions. Dr. Broder-Fingert has published more than 60 peer-reviewed manuscripts and serves as an editor for the Autism and Hospital Pediatrics journals.

Photo of Dr. Sarabeth Broder-Fingert

Sarabeth Broder-Fingert, MD, MPH (She/Her)

Child Health Equity Center CORE FACULTY

Sarabeth Broder-Fingert, MD, MPH, is a pediatrician and implementation scientist who studies early diagnosis and treatment for autistic children and children with other developmental, behavioral, and/or mental health disorders. She is Vice Chair for Clinical Research in Pediatrics and Associate Director for Research at the Eunice Kennedy Shriver Center at UMass Chan Medical School. Dr. Broder-Fingert is Principal Investigator on multiple National Institutes of Health (NIH)-funded awards focused on testing and/or evaluating the implementation of autism interventions. Dr. Broder-Fingert has published more than 60 peer-reviewed manuscripts and serves as an editor for the Autism and Hospital Pediatrics journals.

Alison LeBlanc, MS, PMP (She/Her)

Child Health Equity Center EXECUTIVE DIRECTOR

Alison LeBlanc, MS, PMP, is an experienced development strategist and child health equity advocate with over a decade of experience designing and implementing initiatives to address adverse social determinants of health. Ms. LeBlanc subscribes to the philosophy “nothing about us without us.” To this end, she has extensive experience fostering bidirectional community partnerships and coalition building. She also has a strong track record of building sustainable centers of excellence in safety-net healthcare systems. 

As a disability and chronic disease self-advocate, Ms. LeBlanc has spent years redefining what it means to promote inclusivity and belonging and is dedicated to continually raising the bar for herself and her colleagues. Ms. LeBlanc completed her undergraduate degree at Wesleyan University and completed her master’s in communications at the S.I. Newhouse School of Public Communications at Syracuse University.

Headshot of Alison LeBlanc

Alison LeBlanc, MS, PMP (She/Her)

Child Health Equity Center EXECUTIVE DIRECTOR

Alison LeBlanc, MS, PMP, is an experienced development strategist and child health equity advocate with over a decade of experience designing and implementing initiatives to address adverse social determinants of health. Ms. LeBlanc subscribes to the philosophy “nothing about us without us.” To this end, she has extensive experience fostering bidirectional community partnerships and coalition building. She also has a strong track record of building sustainable centers of excellence in safety-net healthcare systems. 

As a disability and chronic disease self-advocate, Ms. LeBlanc has spent years redefining what it means to promote inclusivity and belonging and is dedicated to continually raising the bar for herself and her colleagues. Ms. LeBlanc completed her undergraduate degree at Wesleyan University and completed her master’s in communications at the S.I. Newhouse School of Public Communications at Syracuse University.

Arvin Garg, MD, MPH (He/Him)

Child Health Equity Center FOUNDING DIRECTOR

Arvin Garg, MD, MPH, is a general pediatrician and clinician-scientist who studies addressing unmet social needs through family-centered healthcare system-based interventions. He is the Founding Director of the Child Health Equity Center and the Founding Program Director of the Program to Advance Training in Child Health Equity (PATH) Fellowship. He is currently a Professor of Pediatrics and Vice Chair of Health Equity at UMass Chan Medical School and UMass Memorial Children’s Medical Center. Dr. Garg is also Associate Chief Quality Officer for Health Equity for UMass Memorial Health

Since 2009, Dr. Garg has been continuously funded by the National Institutes of Health (NIH) and has received extramural funding from private foundations. He is Principal Investigator or Co-Investigator on multiple NIH-funded awards focused on testing and/or evaluating the implementation of interventions addressing social needs. He has published over 80 peer-reviewed manuscripts and serves as Associate Editor for the Journal of Developmental & Behavioral Pediatrics. He was recently the Chair of the Health Care Delivery Committee for the Academic Pediatric Association.

Photo of Dr. Arvin Garg

Arvin Garg, MD, MPH (He/Him)

Child Health Equity Center FOUNDING DIRECTOR

Arvin Garg, MD, MPH, is a general pediatrician and clinician-scientist who studies addressing unmet social needs through family-centered healthcare system-based interventions. He is the Founding Director of the Child Health Equity Center and the Founding Program Director of the Program to Advance Training in Child Health Equity (PATH) Fellowship. He is currently a Professor of Pediatrics and Vice Chair of Health Equity at UMass Chan Medical School and UMass Memorial Children’s Medical Center. Dr. Garg is also Associate Chief Quality Officer for Health Equity for UMass Memorial Health. 

Since 2009, Dr. Garg has been continuously funded by the National Institutes of Health (NIH) and has received extramural funding from private foundations. He is Principal Investigator or Co-Investigator on multiple NIH-funded awards focused on testing and/or evaluating the implementation of interventions addressing social needs. He has published over 80 peer-reviewed manuscripts and serves as Associate Editor for the Journal of Developmental & Behavioral Pediatrics. He was recently the Chair of the Health Care Delivery Committee for the Academic Pediatric Association.