Fostering Breastfeeding Equity in the Neonatal Intensive Care Unit

The benefits of mother's milk are abundant and well known for both term and preterm infants (Note: Not everyone who provides human milk identifies as a woman or relates to the term "breastfeeding," but because this accompanies the majority of infant feeding experiences, we have made the decision to phrase it this way while also acknowledging that this language can be exclusionary). The American Academy of Pediatrics now supports longer breastfeeding duration through the first 2 years of age.1 United States legislation in the last 2 decades has made progress in supporting breastfeeding, with policies such as improved access to antenatal and postpartum lactation support, some improvements in double electric breast pump access, and protected time and private spaces to pump at work for many employees.2,3 Despite this progress, sustained breastfeeding beyond the early postpartum period remains challenging. Among all infants born in 2021, 84.1% received breast milk for some time after birth, but this rate fell to 59.8% by 6 months and 39.5% at 1 year.4 There are also striking disparities in which infants receive mother's milk, with fewer non-Hispanic Black infants (75.4%) ever breastfeeding compared with Asian infants (92.7%), non-Hispanic white infants (86.2%) and Hispanic infants (83.4%).4 Young mothers aged 20 to 29 years were also less likely to ever breastfeed than mothers 30 years and older.4 Similar disparities have been shown among racial and ethnic groups who have been marginalized, with lower prevalences of any human milk at discharge for non-Hispanic Black and Native American very low birth weight (VLBW) infants compared with white VLBW infants.5,67Through the case reviews we present, we will discuss the underlying drivers of these breastfeeding inequities in neonatal intensive care units (NICUs) by understanding the inherent costs of breastfeeding as well as the individual and institutional level factors that impact mother's milk provision.