Baby-Friendly Hospital Initiative and Breastfeeding Across Social Determinants of Health

BACKGROUND: Breastfeeding provides significant short- and long-term health benefits for mothers and infants. Despite national efforts, breastfeeding rates in the United States remain below target levels, particularly among underserved populations. OBJECTIVE: We used a scoping review to examine the influence of the Baby-Friendly Hospital Initiative (BFHI) on breastfeeding rates (initiation, exclusivity, duration) across five Centers for Disease Control and Prevention categories: age, race and ethnicity, education, income, and geographic location, and interpreted findings using the Kaiser Family Foundation framework to provide social context. Due to the limited evidence available, the review encompassed all BFHI-related articles published from 1996 onward. RESULTS: Twenty articles were included in the review. BFHI practices improve breastfeeding rates overall. However, the impact is not consistent across all social determinants of health. Evidence suggests BFHI may positively influence rates for mothers of varying income levels and racial/ethnic backgrounds, though findings are mixed. The influence of BFHI on maternal education and age was less conclusive. CONCLUSIONS: Although BFHI is associated with improved breastfeeding rates, its ability to reduce disparities linked to social determinants of health remains unclear. Further research is needed to explore how BFHI interacts with intersecting social and structural factors to promote equitable breastfeeding rates.