Baby-Friendly Hospital Initiative(BFHI) designation is associated with improved breastfeeding rates in the United States(US). However little is known about the cost of pursuing designation. This study used structured interviews and existing hospital data to measure the institutional cost of pursuing BFHI designation at four large, urban academic medical centers representing the four census regions in the US. Key informants at each institution provided detailed responses to a written survey and participated in a follow-up interview for additional context on the time, money, and resources expended to support BFHI designation. Economic evaluation techniques were used to determine the staff time per birth and cost per birth. All cost data were measured in US$2017 and all staff costs were standardized to national median earnings for each job class used using the Department of Labor National Wage Data Index. Institutional births ranged from approximately 2,000–6,000 per year. The median time to achieve designation was 3.5 years (range:3-5). Median total annual staff time dedicated to pursuing BFHI designation was 2,486 hours (range:1,539-3499). Median staff time per birth was 0.533 hours (range:0.362-2.333). Median cost paid per birth including staff time was $26.44 (range:$19.17-$65.34) and excluding staff time was $4.94 (range:$3.65-$7.23). Institutions that used higher cost staff to facilitate the designation process (e.g., executives and physicians) had higher total cost per birth. Institutional cost to pursue BFHI designation for four urban academic hospitals was modest and was primarily driven by staff cost. Median total cost per birth was $26.44 which is 0.67% of the average total cost of an uncomplicated vaginal delivery in the US.¹ Institutions can use this information to support decisions about and budget planning for pursuing BFHI designation.

1. MS-DRG 775 Uncomplicated Vaginal Delivery. HCUP National Inpatient Sample(NIS). Healthcare Cost and Utilization Project(HCUP). 2014. Agency for Healthcare Research and Quality, Rockville, MD. hcup-us.ahrq.gov/nisoverview.jsp.