Racial and socioeconomic disparities in breast milk feedings in US neonatal intensive care units

Pediatr Res. 2021 Jan;89(2):344-352. doi: 10.1038/s41390-020-01263-y. Epub 2020 Nov 13.


Very low birth weight (VLBW; <1500 g birth weight) infants are substantially more likely to be born to black than to non-black mothers, predisposing them to potentially preventable morbidities that increase the risk for costly lifelong health problems. Mothers' own milk (MOM) may be considered the ultimate "personalized medicine" since milk composition and bioactive components vary among mothers and multiple milk constituents provide specific protection based on shared exposures between mother and infant. MOM feedings reduce the risks and associated costs of prematurity-associated morbidities, with the greatest reduction afforded by MOM through to NICU discharge. Although black and non-black mothers have similar lactation goals and initiation rates, black VLBW infants are half as likely to receive MOM at NICU discharge in the United States. Black mothers are significantly more likely to be low-income, single heads of household and have more children in the home, increasing the burden of MOM provision. Although rarely considered, the out-of-pocket and opportunity costs associated with providing MOM for VLBW infants are especially onerous for black mothers. When MOM is not available, the NICU assumes the costs of inferior substitutes for MOM, contributing further to disparate outcomes. Novel strategies to mitigate these disparities are urgently needed. IMPACT: Mother's own milk exemplifies personalized medicine through its unique biologic activity. Hospital factors and social determinants of health are associated with mother's own milk feedings for very low-birth-weight infants in the neonatal intensive care unit. Notably, out-of-pocket and opportunity costs associated with providing mother's own milk are borne by mothers. Conceptualizing mother's own milk feedings as an integral part of NICU care requires consideration of who bears the costs of MOM provision-the mother or the NICU?

Publication types

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

MeSH terms

  • Age Factors
  • Birth Weight
  • Black or African American*
  • Breast Feeding* / economics
  • Breast Feeding* / ethnology
  • Child Development
  • Female
  • Gestational Age
  • Health Care Costs
  • Health Expenditures
  • Healthcare Disparities* / economics
  • Healthcare Disparities* / ethnology
  • Humans
  • Infant Nutritional Physiological Phenomena
  • Infant, Newborn
  • Infant, Premature / growth & development*
  • Infant, Very Low Birth Weight / growth & development*
  • Intensive Care Units, Neonatal*
  • Milk, Human*
  • Nutritional Status
  • Nutritive Value
  • Premature Birth
  • Race Factors
  • Social Determinants of Health* / economics
  • Social Determinants of Health* / ethnology
  • Socioeconomic Factors*
  • United States