D4 Designation

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When your birthing facility is confident, based on data from its quality improvement audits, that you are meeting the standards outlined in BFHI Guildelines and Evaluation Criteria, your hospital or birthing center may request approval to move to the final phase of the 4-D pathway, D4: Designation Phase. BFUSA will move your facility to the Designation Phase upon receipt of a letter of request and payment of the Designation Phase FeeOnce received, BFUSA will mail a Dissemination Phase Certificate of Completion and provide access to the online Designation Phase tool kit.

Implementation of the International Code of Marketing of Breast Milk Substitutes

One of the final steps facilities must address is determining, paying and documenting fair market value for all infant nutrition supplements, bottles, nipples, pacifiers, and associated feeding equipment.  Success in this area requires that you establish a fair market value for these products, document your process for determining fair market value, notify vendors of your intent to pay fair market value for all infant nutritionals, and maintain current invoices on file as proof that your birthing facility is paying fair market value for these products. The online Designation Phase tool kit has resources to assist your facility in accomplishing this Baby-Friendly standard.

Telephone Readiness Assessment Interview

Birthing facilities are required to complete the Telephone Readiness Assessment Interview. This 90-minute phone interview conducting by BFUSA staff will ask you a series of questions intended to assess your facility's readiness for the on-site review.  BFUSA will provide verbal and written feedback on areas in need of improvement.  Facilities find that the readiness interview helps them identify areas that require additional attention prior to the on-site assessment being scheduled.


Preparing for the On-site Assessment


Once the areas identified in the interview are corrected, the facility sends a letter to BFUSA requesting that their on-site assessment to be scheduled. In addition, BFUSA requires that you complete a pre-assessment narrative and submit it to BFUSA, along with the most recent infant feeding policy.  

The on-site assessment is a two-staged process. The first is the on-site evaluation conducted by a Baby-Friendly USA assessment team. Upon completion of their visit, the findings are compiled into a report, blinded and sent to the Baby-Friendly USA External Review Board (ERB). The ERB determines whether or not the facility has fully implemented the Ten Steps. Upon successful completion of this process, the facility will be granted a license to use the Baby-Friendly certification mark. If the facility does not pass their on-site assessment, the hospital or birthing center may apply for re-assessment when identified problems have been corrected.

Link to: Maintaining Your Designation

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