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Racial Disparities in Donor Human Milk Feedings: A Study Using Electronic Medical Records
Aunchalee E L Palmquist1,2, Ifeyinwa V Asiodu3, Christine Tucker1
1Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Insights
Mothers from racial and ethnic minority groups had lower rates of receiving pasteurized donor human milk (PDHM) during postpartum hospitalization. This study highlights inequities in PDHM access and calls for antiracist interventions to ensure equitable support.
Area of Science:
- Neonatal care
- Public health
- Health equity
Background:
- Maternal race-ethnicity can influence infant feeding practices.
- Pasteurized donor human milk (PDHM) is an alternative for infants unable to receive mother's own milk (MOM).
- Understanding disparities in PDHM use is crucial for equitable infant nutrition.
Purpose of the Study:
- To evaluate differences in pasteurized donor human milk (PDHM) utilization among mothers of different racial and ethnic backgrounds during postpartum hospitalization.
- To identify potential inequities in access to PDHM based on maternal demographics.
Main Methods:
- Retrospective cohort study of 7097 live-born infants from July 2014 to June 2016.
- Electronic medical records (EMRs) were used to track infant feeding (MOM, PDHM, formula).
- Generalized estimating equation models adjusted for covariates to assess odds of PDHM use by maternal race-ethnicity.
Main Results:
- Infants of non-Hispanic Black and Hispanic mothers showed significantly lower rates of PDHM use compared to non-Hispanic White mothers, both in neonatal critical care and among well infants.
- Adjusted models revealed lower odds of PDHM for non-Hispanic Black (OR 0.47) and Hispanic (OR 0.65) mothers in neonatal critical care.
- Among well infants, non-Hispanic Black (OR 0.25) and Hispanic (OR 0.38) mothers had substantially lower PDHM use compared to non-Hispanic White mothers.
Conclusions:
- Significant inequities exist in the utilization of pasteurized donor human milk (PDHM) based on maternal race-ethnicity.
- Antiracist interventions are necessary to address disparities and promote equitable access to PDHM.
- Enhanced lactation support and counseling are recommended to improve PDHM use among underrepresented minority groups.
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.
