Maternal, Perinatal and Pediatric Nutrition
Objectives : The Baby-Friendly Hospital Initiative (BFHI) is a global effort designed to enhance the health of mothers and their newborn infants by protecting, promoting, and supporting breastfeeding. Evidence has shown that BFHI hospitals can help reduce disparities in breastfeeding rates—especially in low-income communities. We aimed to evaluate the geographic distribution of BFHI hospitals, considering the socioeconomic factors of income and unemployment in the US.
We considered all hospitals within each state. We categorized hospitals as having the BFHI designation (“established”), being on the formal path to obtaining this designation (“emerging”), and not having the designation. We obtained a list of hospitals from the American Hospital Association’s annual survey and information on BFHI designation from Baby-Friendly USA. We further obtained state-level employment and income information from census data and ranked states into quintiles for each variable. We then conducted separate one-way analysis of variance tests to compare the mean percent of BFHI hospitals and mean state-level 1) per capita income, and 2) unemployment rates separated into quintiles. We examined all BFHI hospitals that were established and emerging separately. Finally, we created maps using ArcGIS, overlaying the location of all hospitals on the socioeconomic data.
Our sample included 2,589 hospitals from all US states and the District of Columbia. Of those, 519 were established BFHI hospitals (Figure 1) and 298 were emerging (Figure 2). We found that higher unemployment was associated with a greater percentage of emerging but not established BFHI hospitals were present in states in the highest quintile for unemployment (p=0.01). Similarly for income, we observed a greater percentage of emerging BFHI hospitals in states with both the lowest and highest quintiles of per-capita income (p=0.003).
Emerging BFHI hospitals were present at a higher percentage in states in the highest quintile for unemployment and the lowest quintile for income. These emerging hospitals are on the pathway to achieving the BFHI designation, which may ultimately help reduce socioeconomic disparities in breastfeeding. Interestingly, states in the highest quintile for income also had a high percentage of emerging BFHI hospitals.
Funding Sources : W.K. Kellogg Foundation