The Growth of Licensure in Health Adjacent Fields Reduces Access to Care

by Jaimie Cavanaugh

In 2011, the Surgeon General released the Call to Action to Support Breastfeeding. The report highlights the health benefits associated with breastfeeding and recognizes that community support is necessary to increase breastfeeding rates. In response, Kimarie Bugg and Mary Nicholson Jackson founded Reaching Our Sisters Everywhere (“ROSE”) with the goal of offering community-based breastfeeding support to communities of color.

Kimarie and Mary have both worked as breastfeeding counselors for three decades and are pioneers in their field. In fact, they helped develop the curriculum that is taught to Women, Infant and Children (“WIC”) Peer Counselors. Peer Counselors are women who have breastfed who are then trained to provide education and emotional support to their peers.

The Peer Counselor program has positively impacted breastfeeding outcomes around the country. Receiving support from empathetic peers makes breastfeeding less daunting. New moms are more receptive to support from a community member—someone who talks like them and shares common cultural beliefs—than from a stranger at a hospital.

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Based on the success of the WIC Peer Counselor program, ROSE established a similar program. Women who have successfully breasted for at least six months can complete a training to become Community Transformers. Peer Counselors and Community Transformers are often so inspired by their initial training that they go on to become Certified Lactation Counselors (“CLCs”) or complete other advanced breastfeeding trainings. Thus, not only are breastfeeding rates increasing, but these programs are providing a new path to employment for many women.

But all of these benefits may be thwarted by efforts to license lactation consultants. For example, Georgia enacted a lactation consultant license so strict that only International Board Certified Lactation Consultants (“IBCLCs”) are eligible to apply for a license. In 2013, there were over 800 active CLCs in Georgia as opposed to around 335 active IBCLCs. If Georgia’s licensing law takes effect hundreds of CLCs will lose their jobs. And as you might imagine, IBCLCs are concentrated in urban and affluent areas, leaving many rural and minority communities without breastfeeding support.

The lactation consultant license includes an exception for volunteers and government employees. Those individuals can continue providing breastfeeding support without a license. So a Community Transformer can work for free, but if she receives payment for her work, she faces fines of up to $500 per incident. Likewise, a WIC Peer Counselor can work in the WIC office, but she can no longer offer in-home support for payment.

Photo by Institute for Justice

As a result, I have personally heard from several CLCs who are apologetic that they charge modest rates for in-home visits. They truly care about helping their community members, but they have their own families to provide for, too. I tell each of these women not to apologize or make excuses for why they should be paid. They deserve to be compensated for the services they offer! In fact, it appears that the only people who stand to benefit from Georgia’s lactation consultant license are IBCLCs who will have a monopoly on the lactation care industry.

Because Georgia’s law would force hundreds of women out of work, Mary and ROSE have partnered with the Institute for Justice to sue Georgia to stop the lactation consultant license from taking effect. But a victory in one case will not solve the greater problem.

Thanks to the mania for credentials, new occupational licenses keep popping up—especially in health-care adjacent fields. For example, at least 12 states have created licenses for art therapists. Proponents of licensure argue that licensure will increase access to care. But as is the case with lactation consultants in Georgia, licensure generally creates barriers to entry and decreases the availability of services. Maybe the answer to increasing access to health care is less government intervention, not more.

Jaimie Cavanaugh is an attorney in the Minnesota office for the Institute for Justice, a national public interest law firm. The Institute for Justice seeks to preserve the right of all Americans to work in the profession of their choosing, free from irrational government interference. To find out more, visit

Photo by Institute for Justice