The Impacts of “Baby-Friendly” Hospital Designations

This study considers a voluntary hospital certification program and how it shapes patient health outcomes. The Baby-Friendly Hospital Initiative designates participating hospitals as “Baby-Friendly” if they adhere to various practices thought to promote breastfeeding. We estimate the effect of being born in a Baby-Friendly hospital on breastfeeding initiation and infant health. Identification relies on a within-mother analysis that compares siblings who were born in the same hospital: one when the hospital was not certified and another when the hospital was certified. Data come from South Carolina birth certificates from 2010 to 2019 linked to subsequent emergency department records, hospital records, and death certificates. The results indicate that Baby-Friendly accreditation has no widespread effects on breastfeeding initiation. It does, however, increase breastfeeding rates among a subset of Black mothers with a history of bottle-feeding. Infants exposed to the designation are more likely to leave the hospital in under two days, and there is also some evidence of subsequent reductions in healthcare utilization in the next year. We do not find precise changes in all-cause one-year mortality, although we do observe a marginally significant reduction in deaths caused by “extreme immaturity.” This paper was accepted by Anita Carson, healthcare management. Supplemental Material: The data files are available at https://doi.org/10.1287/mnsc.2024.06422 .