Law jeopardizes access to lactation services

The first time Taneeka Davis attempted to breastfeed, it did not go well.

She was already sold on the benefits of breastfeeding, but after leaving the hospital, she couldn’t get her son to latch onto her breast. She began supplementing with formula almost immediately and ended up mostly bottle-feeding him until he was 7 months old.

At the time, Davis had no idea how much milk an infant needed. She didn’t understand that putting her son to her breast more often would help her produce more milk. Her husband worried she was starving their child.

The experience left Davis feeling defeated, unsupported and unsuccessful.

The American Academy of Pediatrics recommends that infants be exclusively breastfed for the first six months, with continued breastfeeding and appropriate foods for one year or more. Infants who are breastfed have a lower risk of conditions ranging from asthma to Type 1 diabetes. Mothers who breastfeed have a lower risk of breast and ovarian cancers and other diseases.

Despite such medical guidelines, rates for exclusive breastfeeding remain low. In 2011, 14.5% of mothers in Georgia exclusively breastfed their newborns for six months. By 2018, that had increased to 24.3%.

Two years later, when her daughter was born, Davis connected with the women at Reaching Our Sisters Everywhere (ROSE), a nonprofit dedicated to addressing breastfeeding disparities among people of color. The experience was markedly different compared to the limited lactation counseling she received with her son.

“Breastfeeding is a very personal journey. It was challenging to continue,” said Davis, 33, of Grayson. “The support from those ladies meant everything to me.” With the skills she learned at ROSE, Davis was able to breastfeed for the first eight months of her daughter’s life. Now, as the mom of a 5-monthold, Davis has been confidently breastfeeding exclusively.

But for the past four years, the kind of support Davis received at ROSE has been in jeopardy. Mary Jackson, co-founder of ROSE, and hundreds of lactation consultants like her across the state could lose the ability to continue helping new moms on their breastfeeding journeys if the Georgia Supreme Court upholds the constitutionality of a 2016 law.

The law requires lactation

consultants to be licensed by the secretary of state’s office. A consultant would have to earn a specific certification from the International Board of Lactation Consultant Examiners to be licensed and compensated. The process would require the equivalent of two years of college courses, 300 to 1,000 hours of experience and an exam that costs about $700, said Renee Flaherty, the attorney representing Jackson in a petition filed in 2018 to challenge the licensing law.

Flaherty said a decision is expected soon and if the law is upheld (it is not currently being enforced while the petition is active), it would reduce access to care by putting the majority of providers out of work.

Lactation providers in Georgia include Certified Lactation Counselors (CLC), International Board Certified Lactation Counselors (IBCLC), peer counselors who are trained by the national Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and community-based consultants.

Lawmakers said the licensing was birthed from a desire to protect the health, safety and welfare of the public by regulating workers engaged in lactation care and services. Lactation consultants do not diagnose or treat medical conditions and they work in a range of settings from hospitals to client homes. There have been no instances in the U.S. in which a person has been harmed from the services of a lactation consultant. Certain occupations, including licensed health care providers and volunteers, are exempt and can provide lactation consulting services to clients without the need for certification.

When the legislation was first introduced in 2013, the Georgia Occupational Regulation Review Council deemed licensing unnecessary to protect the public. There had been no harm done and no complaints.

CLC certification was the more prevalent one in Georgia with six or more CLCS per 1,000 live births compared to fewer than three IBCLCS per live birth, according to data from the Centers for Disease Control and Prevention. So why introduce legislation that would make the less prevalent certification the standard?

“They don’t really believe this is unsafe,” Flaherty said. “The IBCLCS see themselves as the best and so they want more of the work.” As of this week, 183 lactation consultants in the state are licensed. If the law stays, hundreds of CLCS would have to acquire a license or provide their services free of charge.

Jackson is a CLC with more than 30 years experience. When mothers leave the hospital with their newborns, she slips them her card and invites them to video chat with her any time before 10 p.m., she said.

Davis was so motivated by the care and education she received from the women at ROSE that she entered their community training program to support other breastfeeding mothers.

“Breastfeeding is not surgery,” Davis said. “It’s not something that takes a high level of educational skill. It takes a lot of experience, human contact and personalization. This law is trying to infringe on those things and the ability of people like Ms. Jackson to actually help moms outside of the 15-minute window that you can see a lactation consultant in an office.”

In a statement, the Southeastern Lactation Consultants Association (SELCA) argued that the law would improve access to clinical lactation care and create new jobs, a community college program, and in-network lactation consultants for mothers using Medicaid.

It’s unclear to me how a license would suddenly create job opportunities. It is very clear to me how forcing a licensing process would keep hundreds of people from continuing the work they are already doing.

For some lactation consultants, licensure would likely herald greater opportunity. For others, mainly those in rural communities or communities of color, it seems more like an unnecessary hurdle.

And it’s an example of government overreach that could benefit some but isn’t likely to benefit the masses.