Making the “Birthing-Friendly” hospital designation better

Abstract The “Birthing-Friendly” designation, intended to guide birthing individuals toward quality hospitals, has become widespread. However, our analysis of hospital data finds that the Birthing-Friendly designation does not differentiate hospitals based on meaningful quality measures. Our analysis shows that while Birthing-Friendly hospitals are larger and engage in quality improvement efforts, they do not consistently outperform non-designated hospitals on core maternal health metrics such as early elective delivery rates or births-to-staff ratios. The designation likely reflects a hospital's capacity to adopt basic quality improvement programming structures more than its ability to provide consistent, high-quality maternal care. To address this, we propose a more robust measure that includes clinical outcomes, patient experiences, and equity metrics, particularly for marginalized groups like Black and Indigenous birthing people.