Barriers to Human Milk Feeding at Discharge of Very-Low-Birth-Weight Infants: Maternal Goal Setting as a Key Social Factor

Breastfeed Med. Jan/Feb 2017;12(1):20-27. doi: 10.1089/bfm.2016.0105. Epub 2016 Dec 1.


Background: While black mothers initiate human milk (HM) provision at lower rates than non-black mothers in the United States, some neonatal intensive care units (NICUs) report similar initiation rates regardless of race/ethnicity for mothers of very-low-birth-weight (VLBW) infants. However, racial disparity frequently becomes evident in the proportion of black infants who continue to receive HM feedings at NICU discharge. Since social factors have been associated with differences in HM provision for term infants, we sought to identify differences in social factors associated with HM feeding at discharge based on race/ethnicity.

Materials and methods: A prospective cohort study of racially diverse mothers of VLBW infants measured social factors including maternal education, breastfeeding support, return to work/school, HM feeding goal, previous breastfeeding, or formula experience. Multivariate logistic regression modeling was applied to social factors to predict HM feeding at discharge. Additional regression models were created for racial/ethnic subgroups to identify differences.

Results: For all 362 mothers, WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) eligibility and maternal goal near time of discharge of providing any HM negatively and positively predicted HM feeding at discharge, respectively. Perceived breastfeeding support from the infant's maternal grandmother negatively predicted HM feeding at discharge for black mothers.

Conclusions: Future interventions to increase duration of HM provision in VLBW infants should focus on the establishment and maintenance of maternal HM feeding goals. Further studies of the familial support system of black mothers are warranted to determine multigenerational impact and potential interventions.

Keywords: NICU; barriers; human milk; premature infant; social factors.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • African Americans / psychology
  • African Americans / statistics & numerical data
  • Breast Feeding* / psychology
  • Breast Feeding* / statistics & numerical data
  • Continental Population Groups / psychology
  • Continental Population Groups / statistics & numerical data*
  • Educational Status
  • European Continental Ancestry Group / psychology
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Goals*
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Infant
  • Infant Nutritional Physiological Phenomena
  • Infant, Newborn
  • Infant, Premature
  • Infant, Very Low Birth Weight*
  • Intensive Care Units, Neonatal
  • Logistic Models
  • Male
  • Milk, Human*
  • Mothers* / psychology
  • Mothers* / statistics & numerical data
  • Patient Discharge*
  • Pregnancy
  • Prospective Studies
  • Return to Work
  • Social Support*
  • United States / epidemiology