The Baby-Friendly Hospital Initiative (BFHI) is a global effort designed to protect and promote breastfeeding. The BFHI designation in hospitals and birthing facilities may help reduce disparities in breastfeeding in low-resource, vulnerable communities in the US. As such, we evaluated associations between county-level health and demographic factors and birth rates in both established and emerging BFHI facilities. We hypothesized that birth rates among counties with a higher-income, largely White population would be associated with more established BFHI facility births but that rural counties with larger communities of color would be associated with more emerging BFHI facility births.
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