Disparities in Exclusive Human Milk Feeding and Unintended Formula Supplementation Among Infants Discharged Following Birth at an Academic Medical Center

Background: The mitigation of existing disparities in human milk intake is a shared responsibility. Health systems have emphasized antenatal decision making to increase the proportion of infants that receive Exclusive Human Milk (EHM). However, our recent focus group reported that inadequate communication and other systemic barriers were contributing to unintended formula supplementation. Methods: To explore the influence of sociodemographic factors on EHM intake, we analyzed records for 10,214 newborns discharged from our medical center. Results: While race or ethnicity and prenatal EHM intent were the best predictors of EHM, the lowest rates were seen among infants born to Muslim women or women with non-English language preference (NELP). Even when analysis was restricted to those with a prenatal plan for EHM, unintended formula use exceeded 50% among those that identified as Black, Muslim, or having a NELP. In exploratory analysis, the same predictors were associated with the lowest rates of pasteurized donor human milk (PDHM) utilization. Conclusions: Looking deeper than race and ethnicity, Muslim women and women with NELP have the lowest rates of PDHM utilization and the highest rates of unintended formula use at our institution. These findings can inform culturally responsive interventions focused on education and effective communication.