Exploring Lactation and Pasteurized Donor Human Milk Use Experiences among Black Families in NICU Settings

Summary: 
The study aims were to: 1) identify factors that promote or hinder breastfeeding, milk expression, and use of donor milk in neonatal intensive care unit (NICU) settings; and 2) gain insight into the role of racism and discrimination experienced by Black families.

Name of Awardee: Ifeyinwa Asiodu, RN, PhD | Family Health Care Nursing | UCSF School of Nursing.

Background

Black communities are disproportionately affected by poor maternal and infant health outcomes, including preterm birth and lower breastfeeding rates. For premature infants, human milk is a life-saving therapy.

Objective

The purpose of this study is to understand Black families’ experiences with lactation and infant feeding support in Bay Area NICU settings. The specific aims of this study are to: 1) identify factors that promote or hinder breastfeeding, milk expression, and use of donor milk in neonatal intensive care unit (NICU) settings; and 2) gain insight into the role of racism and discrimination experienced by Black families.

Method

A mixed-methods design was used, incorporating a one-time survey and ethnographic interviews, informed by the Life Course Perspective. A sample of Black women and family members with recent NICU experiences was recruited. The survey data (N=85) and ethnographic interviews (N=30) were analyzed using descriptive statistics and thematic analysis.

Results

Of the 85 survey participants, 93% identified as Black/African American and 6% as Multiracial. Most participants (75%) pumped or expressed breast milk for their NICU infant(s). Additionally, 71% received their pump from either the hospital (45%) or Women, Infants, and Children (WIC) program (26%). Only 39% had discussions about donor human milk. Most (67%) felt their family was treated differently than others in the NICU. Approximately 35% reported experiencing racism or discrimination during their NICU stay, mostly involving nurses (81%) and/or physicians (42%). Participants also reported feeling judged, being questioned frequently by hospital staff, and being provided with insufficient lactation support.

Conclusion

Our findings suggest the NICU environment may be an additional source of harm for Black families. Institution-level interventions, informed by community members, are needed to mitigate experiences of racism and discrimination and improve lactation resources.