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The Costs of BFHI

January 2021

2021!  It’s a new year with fresh beginnings and so much potential!  With this new year, Step 2 Education will be looking closely at the new Baby-friendly Hospital Initiative (BFHI) guidelines.  Working together and knowing where challenges lie in moving forward together with the BFHI designation for your facility, we can make this journey so much easier.  So let’s get started.

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One of the most frequent concerns I hear from facilities trying to implement the Baby-friendly Hospital Initiative in their birthing facility is that of finances. Who will pay for the work being completed in that 1-2 year process, out of who’s budget will those dollars/pounds/Euros etc. be taken? In this new year, we’ll spend January looking at some options for funding the BFHI at your facility and the costs of not breastfeeding.

Walters et al. (1) looked at the cost of not breastfeeding in seven Southeast Asian countries and found that “investing in a national breastfeeding promotion strategy in Viet Nam could result in preventing 200 child deaths per year and generate monetary benefits of 139% return on investment”. They also found that “the economic benefits associated with potential improvements in cognition alone, through higher IQ and earnings, total $1.6 billion annually”, and “potential saving in health care treatment costs from reducing the incidence of diarrhea and pneumonia could help offset the cost of breastfeeding promotion”.

Carroll et al. (2) discussed the current global costing methodologies, studying the World Breastfeeding Cost Initiative (WBCi), World Bank costing frameworks, the Global Strategy or Infant and Young Child Feeding (IYCF), and BFHI. “Our findings suggest that the World Bank costing methodology is more appropriate for estimating the financial needs for scaling-up breastfeeding programs at a country level”.

DelliFraine et al. (3) reported that “nursery plus labor-and-delivery costs for the baby-friendly sites were $2205 per delivery, compared with $2170 for the non-baby-friendly matched pair. Baby-friendly facilities have slightly higher costs than non-baby-friendly hospitals, the cost difference was not statistically significant”. In their discussion, one particular note stands out: “Another consideration for hospitals deciding to pursue baby-friendly status is the need to get support from upper management, key physicians, and nurses before attempting to implement baby friendliness… it is important to identify champions who will be able to push the program through and sell it to others”. I can personally attest to this, as one who led a facility to the BFHI designation. Without management and physicians to back the work of the IBCLC or leader of the BFHI team, you are working for naught. Find those champions!!

The three studies discussed here are all available for free download through Google Scholar, which is a terrific resource for studies you might need in your professional work. Although one of these studies is older (in the view of “current” research) they contain valuable insight into the rationale of instituting and maintaining the BFHI program.


Professional Development Educator

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1. Walters, D., Horton, S., Siregar, A.Y.M., Pitriyan, P., Hajeebhoy, N., Mathisen, R., Phan, L.T.H., and Rudert, C. (2016). The cost of not breastfeeding in Southeast Asia. Health Policy and Planning; 31: 1107-1116.
2. Carroll, G.J., Buccini, G.S., and Perez-Escamilla, R. (2018). Perspective: What will it cost to scale-up breastfeeding programs? A comparison of current global costing methodologies. Adv Nutr; 572-580.
3. DelliFraine, J., Langabeer II, J., Williams, J.F., Gong, A.K., Delgado, R.I., and Gill, S.L. (2011). Cost comparisons of baby-friendly and non-baby-friendly hospitals in the United States. Pediatrics; 127(4): e989-3994.

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