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Baby-Friendly Hospital Initiative (BFHI)

Resources Required

Staffing: 

  • Stakeholders from all departments (Pediatrics, Obstetrics and Gynecology, Midwifery, Family Medicine, Nursing, and others) were invited to participate in the Breastfeeding Task Force.  Task Force members were responsible for developing hospital breastfeeding policies and procedures, planning employee training, and coordinating education and publicity.  These duties were undertaken as part of extant job descriptions and were not separately compensated.  There was no dedicated administrative support for the Task Force.
  • Lactation consultants were hired.  At BMC, lactation consultants cover inpatients in the newborn nursery and NICU seven days a week and the pediatric outpatient clinic three days a week.  Additionally, lactation consultants see patients on the pediatric inpatient service and in other parts of the hospital as needed (for example, a breastfeeding mother is admitted to the surgical service and desires to pump while separated from her infant.)  Lactation consultant salaries were initially paid with grant funding; currently salaries are split between the hospital and grant funding. 
  • Peer counseling may be more cost-effective than using trained nursing professionals to counsel breastfeeding women in uncomplicated issues, though is not a requirement for Baby-Friendly status.  BMC peer counselors are paid through grant funding and cover the newborn nursery seven days per week.  

Training:  Staff training costs differ based on whether training is provided externally or conducted in-house.

Fees1:   Maternity facilities intending to become Baby-Friendly must pay a fee to Baby-Friendly USA at several points during the application process (details in “Implementation” section below.)  There is no fee to enter the Discovery phase; however, for hospitals and birth centers with 500 or more births annually, cost of entrance into the Development phase is $2,000; cost of entrance into the Dissemination phase is $2,000; and cost of entrance into the Designation phase is $2,000.  The cost of Development, Dissemination, and Designation phases is $1,200 each for birth centers and hospitals with fewer than 500 births annually.  This fee includes technical support, review of materials, and access to a discussion list.  Once a hospital receives Baby-Friendly designation, an annual fee ranging from $550 to $900, depending on number of births per year, is assessed.

Optional Services:  Support materials and videos are available from Baby-Friendly USA for a charge. 

Breastfeeding Rooms:  BMC created four breastfeeding/expressing rooms at a cost of $1000-$2,000 each.  Costs were covered by The Kids Fund, a children’s charity associated with Boston Medical Center.

Cost of formula and related supplies: The potential costs of purchasing formula at fair market rates (rather than receiving it free from formula manufacturers as most hospitals do) can present a daunting obstacle.  Surprisingly, formula companies usually do not want to receive payment for formula and can resist this step as hospitals enter the Baby-Friendly process.  This is a testament to the efficacy of the BFHI, which increases breastfeeding rates and decreases the use of formula.  Formula companies often quote a price for formula that inflates the actual cost of purchasing formula.  Alternatively, formula companies may offer to continue to supply formula for a nominal fee (or example, one dollar per year) as an attempt to satisfy the Baby-Friendly requirement for purchasing formula.  In addition, hospitals that receive free formula also typically receive free bottles and nipples; under Baby-Friendly guidelines, these also need to be purchased.  The cost of formula, bottles, and nipples need not be prohibitive.  At BMC, with an average of fewer than 2500 births per year, formula costs after becoming Baby-Friendly totaled approximately $1400 per month, or $16,800 per year. For a detailed discussion of this issue, please refer to Merewood and Philipp article, “Becoming Baby-Friendly: Overcoming the Issue of Accepting Free Formula.”2



1 In 2010, Baby-Friendly USA implemented the 4-D Pathway for becoming Baby-Friendly.  When BMC became Baby-Friendly in 1999, the 4-D Pathway did not yet exist, and the process was slightly different in structure and cost though not in overall content or goals. Institutions initiating the process of becoming Baby-Friendly now would follow the 4-D Pathway as explained in detail in the following section.

2 Merewood A, Philipp BL. Becoming Baby-Friendly: overcoming the issue of accepting free formula. J Hum Lact. 2000 Nov;16(4):279-82.