46 - Donor Human Milk Access following Legislative Action in Washington State

Publication Number: 4045.46

Rachel N. LaFontaine, University of Washington School of Medicine, Seattle, WA, United States; Daniel Enquobahrie, University of Washington, Seattle, WA, United States; Bat-Sheva Stein, University of Washington School of Medicine, TUMWATER, WA, United States; Rebecca A.. Penders, DOH/Providence, Spokane, WA, United States; Amy B. Hair, Baylor College of Medicine, Houston, TX, United States; Ivana Brajkovic, Seattle Children's, Seattle, WA, United States; Katie M.. Strobel, University of Washington School of Medicine, Seattle, WA, United States; Rebecca Hoban, Seattle Children's, Seattle, WA, United States; Gregory C. Valentine, University of Washington School of Medicine, Tacoma, WA, United States; Krystle Perez, University of Washington School of Medicine, Snohomish, WA, United States

Background: An exclusive human milk diet in early life improves newborn-child outcomes and decreases disease risk in lactating mothers. When a mother's own milk is unavailable or insufficient in volume, pasteurized donor human milk (DHM) is the preferred substitute. Despite this, significant inequities in DHM access exist. In line with many US states passing legislation to optimize access, Senate Bill (SB) 5702 was passed, effective June 2022, in Washington State (WA), and now requires select insurers, including Medicaid, to cover DHM when medically indicated.

Objective: We examined changes in DHM availability across WA birthing hospitals subsequent to passage of SB 5702 and hospital characteristics associated with DHM access.

Design/Methods: Data were collected from all birthing hospitals in WA (55 in 2023 and 53 in 2025) During this time period, 2 birthing units closed and one hospital's nursery designation shifted from level III to II. One military hospital was excluded due to a lack of publicly available data. Surveys were distributed to each birthing unit and managed using REDCap. Data were supplemented with public hospital and county data. Descriptive statistics were used to characterize DHM access among hospital categories defined by nursery level, Medicaid-funded deliveries, county population, and annual deliveries.

Results: In 2023, 31/55 (56%) of birthing hospitals had access to DHM, while in 2025, 35/53 (66%) of birthing hospitals had DHM access. No hospital lost DHM access during the study period. DHM availability increased in birthing hospitals in the urban Puget Sound region and less dense East and South Central regions (Figure 1). DHM access increased in all categories of hospitals except in level IV NICUs and hospitals in counties with populations < 200,000, where the level remained the same. The increase in DHM access was statistically significant in hospitals serving counties with population size ≥200,000 (p < 0.05) or had annual births ≥ 1,000 (p < 0.05) (Table 1).

Conclusion(s): DHM access in WA increased by 17.5% between 2023 and 2025. This may reflect the impact of SB 5702, although we did not control for other factors that may have contributed to the increase. Variation in improved DHM access occurred across geographic regions, nursery level, and percentage of Medicaid funded deliveries. Future work should compare DHM access across states with and without legislation; study the duration and exclusivity of human milk feeding and the associated infant and maternal outcomes. Studies should also evaluate hospital and geographic factors.

Table 1
The proportion and percentage of hospitals with donor milk by category with the percent difference between 2023 and 2025. (*p-value <0.05)

Figure 1
Donor human milk access among Washington state birthing hospitals by region. A reflects access in 2023. B reflects access in 2025. Regions were determined by the Washington state department of health based on health systems and resources in the area as part of the Healthy Washington plan.