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
- 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.
- Peer programs and support groups may offer mothers sustained education and encouragement.
- 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.
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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.