A Transition Strategy for Becoming a Baby-Friendly Hospital: Exploring the Costs, Benefits, and Challenges

Abstract

The objectives of this study were to provide an economic assessment as well as a calculated projection of the costs that typical U.S. tertiary-care hospitals would incur through policy reconfiguration and implementation to achieve the UNICEF/World Health Organization Baby-Friendly® Hospital designation and to examine the associated challenges and benefits of becoming a Baby-Friendly Hospital. We analyzed hospital resource utilization, focusing on formula use and staffing profiles at one U.S. urban tertiary-care teaching hospital, as well as conducted an online survey and telephone interviews with a selection of Baby-Friendly Hospitals to obtain their perspective on costs, challenges, and benefits. Findings indicate that added costs for a new Baby-Friendly Hospital will approximate $148 per birth, but these costs sharply decrease over time as breastfeeding rates increase in a Baby-Friendly environment.

The Baby-Friendly Hospital Initiative in US Hospitals

“…28 DelliFraine and colleagues found that following Baby-Friendly guidelines initially added about $148 per infant to hospital costs, an amount that decreased sharply over time as the breastfeeding rates increased. 29 Implementing skin-to-skin care (Step 4) as one of the first strategies often does not meet with much resistance and can yield impressive results in initiation of breastfeeding and patient satisfaction scores. McKeever and St Fleur found that infants in skin-to-skin care did not become hypothermic, most breastfed within an hour, and they continued to successfully breastfeed the second day.…”

“…28 DelliFraine and colleagues found that following Baby-Friendly guidelines initially added about $148 per infant to hospital costs, an amount that decreased sharply over time as the breastfeeding rates increased. 29…”

How much does it cost to implement the Baby-Friendly Hospital Initiative training step in the United States and Mexico?

“…Dellifraine et al [ 22 ] estimated first-year training costs as USD 15,493 (adjusted for inflation from 2013 to 2020 using the Consumer Price Index [ 49 ]) in a Southwestern hospital in the US with 2800 annual deliveries, equaling USD 5.5 per birth. Our method, which calculated the average training cost per birth in the US rather than for one hospital, estimated a slightly higher but comparable cost of USD 7.3 per birth (for hospitals with ≥1300 annual births, obstetric level 2 care and minimal training) ( Table 8 ).…”

“…Fifth, we assumed all training was performed in the hospital facility. Training outside of the facility can incur travel and per diem costs [ 32 ]—these, however, were very small (0.4% of the total BFHI training cost) in one US study [ 22 ], yet could vary depending on the location. Sixth, staff turnover can affect implementation costs [ 15 ] since newly hired staff require more costly training, which we did not take into consideration.…”

Examining the Evidence, Seeking Solutions

“…One ''Baby-Friendly'' initiative was examined by DelliFraine et al, 8 concerning the costs, benefits, and challenges of implementation, Macaluso et al 9 reviewed data from BabyFriendly communities in Italy, and Tsai et al 10 measured the effect of a Baby-Friendly workplace on mother's intent to continue breastfeeding after returning to work. Lee et al 11 considered perspectives on promoting breastmilk feedings for premature infants during a quality improvement project.…”