Reducing Disparity in Receipt of Mother's Own Milk in Very Low Birth Weight Infants: An Economic Intervention to Improve Adherence to Sustained Maternal Breast Pump Use

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Project Summary The burden of very preterm (VPT, less than 32 weeks gestation, inclusive of extremely preterm or <28 weeks) birth in the United States is borne disproportionately by Black (non-Hispanic Black) mothers, who are 2.2-2.6 times more likely than non-Black mothers to deliver VPT infants, with 31% of all VPT infants born to black mothers. This disparity is amplified because black VPT infants are significantly less likely to receive mother’s own milk (MOM) feedings from birth until neonatal intensive care unit (NICU) discharge than nonblack infants, which precludes exclusive MOM feedings for the first 6 months of life as recommended by authorities and adds to the lifelong burden of VPT birth. Even though black mothers of VPT infants initiate MOM provision at rates similar to nonblack mothers and have similar goals to sustain MOM provision through to NICU discharge, there is a significant disparity in MOM feedings at NICU discharge. Only the mother can mitigate the disparity in MOM feedings at NICU discharge for the VPT infant, and this maternal behavior involves adhering to a two- part regimen that includes sustaining breast pump use (6-8 times/day) for the entire NICU hospitalization (average = 73 days) and transporting the MOM that is pumped in the home to the NICU for infant feedings. “Reducing Disparity in Receipt of Mother’s Own Milk in Very Low Birth Weight Infants” (ReDiMOM) is a randomized controlled trial that tests an economic intervention bundle designed to offset the out-of-pocket and opportunity costs borne by mothers of VPT infants and paid for by NICUs. The intervention bundle includes three components: free hospital-grade electric breast pump, pickup of MOM, and payment for opportunity costs compared to current standard of care. This Diversity Supplement will provide career development, mentorship and training to Dr. Stephanie Devane-Johnson that will accelerate her career trajectory to become an independent researcher. Dr. Devane-Johnson’s training goals are to (1) acquire knowledge about MOM provision in the NICU population; (2) acquire expertise in embedding qualitative research methods focused on Black NICU mothers and their matriarchs within a randomized controlled trial; (3) gain knowledge in the design, implementation, evaluation and ethics of behavior change techniques, with a focus on conditional cash transfer methodologies in vulnerable populations; and (4) acquire leadership skills necessary for the conduct of multidisciplinary research in the capacity of a principal investigator. The research aims are to (1) determine specific components of the economic intervention bundle that are barriers or facilitators to MOM provision through to NICU discharge for Black mothers of VPT infants and their matriarchs and (2) identify perceptions of Black mothers and their matriarchs about MOM provision for VPT infants in the NICU. The knowledge gained in this Diversity Supplement will provide information about how the intervention components work, identify the most essential components, and guide refinements to the intervention for scale up and broader dissemination.