Social drivers in lactation for mothers of very premature infants.

Provision of mother's milk for very premature infants (≤32 weeks' gestation) is a critical, modifiable factor that improves outcomes in this highly vulnerable population. Despite this, however, longstanding lactation disparities persist. Mothers who are non-Hispanic Black, non-English speaking, have lower income, lower educational attainment, or public insurance are less likely to provide mother's milk, and these inequities have remained largely unchanged over decades. For mothers of very preterm infants, sustaining lactation presents unique challenges. Mothers are typically dependent on breast pumps to express milk every 3-4 h due to infant physiologic immaturity and prolonged hospitalization. They must do so while navigating the physical separation from their infant, transportation barriers, and financial strain from a NICU admission. Although NICUs commonly provide hospital-grade pumps and specialized lactation support in the hospital, mothers may face multi-level barriers to lactation, including limited access to equipment at home, difficulty visiting the NICU, and inadequate social or resource support. These barriers often intersect to contribute to disparate lactation outcomes, as racially and ethnically minoritized mothers are disproportionately affected by adverse social drivers of health. Addressing inequities in lactation requires multilevel, evidence-based interventions. In this report, we structure barriers and proposed interventions within a socio-ecological framework.