biostudies-literatureUnknown3(9)Bonheur AThe "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 cHealth affairs scholarqxaf170https://www.ebi.ac.uk/biostudies/studies/S-EPMC12449076biostudies-literatureMaking the "Birthing-Friendly" hospital designation better.PMC12449076James KFBonheur AAndrew MfalseMaking the "Birthing-Friendly" hospital designation better.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 c2025-01-01T00:00:00Z2025 Sep2026-06-03T15:39:47.188Z2026-04-29T03:12:36.712ZS-EPMC124490764097923110.1093/haschl/qxaf170