Baby-friendly Hospital Initiative: descriptive analysis of regional implementation, maternity units and women characteristics. The 2021 French National Perinatal Survey

Background: Initially created to promote breastfeeding, the Baby-Friendly Hospital Initiative (BFHI) has evolved into a broader quality-of-care approach, centered on the needs of newborns and their families. In France, BFHI adoption increased from 2 % to 17 % of maternity units between 2010 and 2024. However, it remains unclear whether structural or population characteristics influence implementation. Objective: To describe the characteristics of maternity units, women and newborns in units BFHI-accredited or in-process of accreditation, compared to non-accredited. Methods: Data were extracted from the 2021 French National Perinatal Survey, including 10,446 women who gave birth to live infants between 36 and 42 weeks of gestation in 453 maternity units. Bivariate analyses compared three groups: BFHI-accredited, in-process, and non-accredited units. Results: Among maternity units, 12 % were BFHI-accredited and 9 % were in-process. Regional implementation varied widely (0–44 % for accredited and from 0–29 % for in-process). There were no significant differences regarding maternity units’ characteristics (size, level of care, administrative status, use of temporary staff). Women's profiles were similar in terms of age, education, employment, and low-risk pregnancy. Women with high social deprivation index were less represented in accredited and in-process units compared to non-accredited (4 % and 3 % vs. 5%), as well as foreign-born women (14 % and 15 % vs. 22%). Conclusion: In France in 2021, implementation of the BFHI program in France does not appear to be associated with structural, demographic or health characteristics of units and women. Further research should explore the motivations for adopting BFHI and its effects on perinatal care practices.