Donor Human Milk: The Disparities Continue

Disparity:/dəsperədē/noun: a great difference. ¹

Disparities in maternal and child health begin even before the baby is born. I see this every day as a pediatrician. During pregnancy, black women are three to four times more likely to die as a result of their pregnancy as compared with white women. The infant mortality rate for black babies (14%) is almost double than that of white babies (9%). This is often due to low birthweight, increased rates of prematurity, or complications that arise during pregnancy and/or delivery. Black women are less likely to access prenatal care; they also experience higher rates of preventable diseases and chronic health conditions, such as diabetes, hypertension, and cardiovascular disease, all that can influence both maternal and infant health outcomes. ² And these statistics are true regardless of income, education level, or zip code. We have seen this time and time again. From Serena Williams to Beyonce and more recently, a physician.^3,4

As a pediatrician, I, along with my obstetric and neonatology (NICU) colleagues, see the direct benefits of donor human milk (DHM) for our premature infants. DHM is essential for these infants, especially since many times, the mother may be unable to provide her own breast milk immediately, and DHM helps bridge that gap. The literature has consistently shown that DHM can decrease rates of necrotizing enterocolitis, late-onset sepsis, and retinopathy of prematurity. Provision of DHM can also help lower rates of hospitalizations within that first year of life as well as improve neurodevelopmental outcomes within this high-risk group of infants. ⁵

In addition to the racial disparities described earlier, is it any surprise that the disparities continue to persist for premature black infants? Kair et al. showed that Hispanic and black infants were less likely to receive DHM. This was especially true for those families where English was not their primary language or if they had public insurance. ⁶

Another study examined the rates at which extremely premature infants received DHM, a group that undoubtedly benefit greatly from it. The authors showed that only 67% of black and 61% of Native American/Alaskan extremely premature infants received life-saving DHM as compared with 75% for other racial groups, thereby highlighting persistent disparities based on race and ethnicity. ⁷

In this month's Breastfeeding Medicine, authors McCune and Perrine performed a meta-analysis highlighting the use of DHM for all infants, not just premature infants. Their study highlights the use of DHM expanding to not just preterm infants. ⁸

In another article, Esquerra-Zwiers et al. conducted a retrospective study looking at the role of DHM as a bridge to the provision of mother's own milk in the NICU setting. In the cohort that had access to DHM, they had favorable outcomes such as reduced use of preterm formula and higher rates of exclusive human milk given to these premature babies. However, this benefit was solely seen with non-Hispanic white and Hispanic infants, but not with non-Hispanic black infants in the same cohort. ⁹

As more studies are conducted on this emerging topic, the impetus is on us as physicians to recognize and address the continued health inequities newborns face at the moment of birth. Since the benefits of DHM are clear, why are not all premature infants, regardless of race, receiving it? As physicians, we need to continue to study the reasons for these disparities, on macro- and microlevels, looking at economic and access issues, cultural and personal beliefs, and especially the mistrust that many of our mothers and families may have with our health care system.

We must do better.

Our mamas and babies are counting on us.