O2038: Ethnic Disparities Among California Hospital Donor Human Milk Access

Background: The benefits of human milk for the neonate are substantial, but mother’s own milk is not always available or adequate for nutritional needs. In these circumstances, the AAP recommends using donor human milk (DHM) for very low birth weight (VLBW) infants. While there are well-documented racial and ethnic disparities in DHM use, there is very little evidence on equitable access to DHM which is determined by hospital policy. It is important to determine whether disparities in access to DHM exist since we know there are significant racial and ethnic disparities among any human milk use in the NICU.

Methods: 124 California (CA) NICUs were surveyed through the California Perinatal Quality Care Collaborative (CPQCC) and the Mothers' Milk Bank of San José on whether their NICU had access to DHM. Using a 5-year average (2016-2020), access to DHM data was then stratified by maternal race/ethnicity using CPQCC data. Additionally, a 5-year average (2014-2018) of delivery insurance among CA births according to CA Department of Health Care Access and Information (HCAI) data was also stratified by DHM access. There were 8 hospitals with missing insurance data, leaving 116 hospitals in the final analytic cohort. Both the median 2-sample test and ANOVA test were used to compare the distribution of sociodemographic variables with DHM accessibility.

Results: NICUs with a higher percentage of white maternal race were more likely to have access to DHM (p=0.040, ANOVA). NICUs with a higher percentage of Hispanic maternal ethnicity were less likely to have access to DHM (p=0.030, ANOVA). There was no statistical significance for other races or ethnicities [Figure 1]. The median 2-sample test did find that uninsured patients were also less likely to have access to DHM (p=0.015) [Figure 2]. However, these numbers represent only 4% of the population for the years examined.

Conclusion: We found that CA hospitals that serve a higher population of Hispanic or uninsured families are less likely to have access to DHM for infants in the NICU. Inequitable access to DHM among hospitals may contribute to other disparities in infant care and health outcomes.