(P15-014-20) County-Level Health and Demographic Factors and Baby-Friendly Hospital Initiative Facility Birth Rates in the Contiguous US

Objectives: The Baby-Friendly Hospital Initiative (BFHI) is a global effort designed to protect and promote breastfeeding.  The BFHI designation in hospitals and birthing facilities may help reduce disparities in breastfeeding in low-resource, vulnerable communities in the US.  As such, we evaluated associations between county-level health and demographic factors and birth rates in both established and emerging BFHI facilities.  We hypothesized that birth rates among counties with a higher-income, largely White population would be associated with more established BFHI facility births but that rural counties with larger communities of color would be associated with more emerging BFHI facility births.

Methods: We obtained birth data from American Hospital Association’s 2019 survey and information on BFHI designation from Baby-Friendly USA.  Next, we geocoded facility locations and then assigned each facility county-level contextual descriptors using demographic information from Robert Wood Johnson’s 2019 County Health Rankings data.  We employed linear mixed effect modeling to estimate associations between standardized county-level factors and the percentage of emerging and established BFHI facility births after controlling for female population (ages 15-44 years), state grouping structure, and an error structure assumed to be spatially dependent across counties within states.

Results: Our sample included births from 548 established and 192 emerging BFHI facilities from 1457 counties (about 47% of US counties).  We found that violent crime offenses (β 0.04, CI 0.02, 0.06; p=< 0.001) and infant mortality were positively associated with birth rates at established facilities. Conversely, higher percentage of teen births (β -0.07, CI -0.1, -0.05; p=< 0.001), higher percentage of high school graduates (β -0.02, CI -0.04, -0.001; p=0.04), and greater rurality (β -0.02, CI -0.04, -0.001; p=0.04) were negatively associated with established facility birth rates.  We did not observe any significant associations for emerging facilities.

Conclusions: County-level health and demographic factors were significantly associated with percentage of births at established but not BFHI facilities.  Targeted interventions to increase BFHI facilities in rural and more vulnerable communities may be warranted.

Funding Sources: W.K. Kellogg Foundation