What Do Republicans and Democrats say about Breastfeeding?
A bill to license lactation consultants highlights a failure of imagination across the political spectrum.
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A bill that requires licensure for lactation consultants passed recently in Connecticut, sparking debate about the need to professionalize lactation help versus the belief that breastfeeding is something natural that doesn’t need bureaucratic oversight.
This raises the question we love to yammer about: do women actually benefit from bureaucratic ‘help’ in the birth/boob space?
For context, here are some other professions that require a license: cosmetologist, sonographer, medical assistant, funeral director.
The idea behind licensure is that your license is regulated through your state’s department of public health, that means there’s standardized criteria for what you need to do to earn and upkeep that license. Which means there’s also fees and renewals that come with licensure but also a greater likelihood of receiving Medicaid and insurance reimbursements if you work in healthcare. This is the biggest argument behind getting lactation consultants licensed.
You might have seen the clip Republican House representative Gale Mastrofrancesco saying that, “bills like this absolutely drive me crazy” because, “nobody needs to be taught how to breast feed. It infuriates me that we have to put bills like this together. It's madness. Do we need a license to teach our children to go to the bathroom?"
This was delivered in the way your divorced aunt might rant at a Superbowl party about the way young men wear their pants now-a-days. She’s a little cranky and tone deaf but not… entirely wrong?
As a retort, a Democratic representative stood up and (softly) tried to defend the need for a lactation consultant while going through great pains to never utter the words “women” or “mothers.”
Not exactly the full throated support breastfeeding moms deserve.
The clip went viral and the online discourse brought up all the familiar grievances: no paid leave, no village, the inherent difficulties of breastfeeding, and how the country seems to care little about mothers and babies.
ALL TRUE! BUT…no one is really getting the point and asking the question, will a licensing help more women breastfeed?
Well, as Rad Mom nemesis, Emily Oster would say, let’s look at the data!
As of 2024, the United States has 19,904 registered licensed lactation consultants (IBCLCs).
What do our breastfeeding rates look like? Most mothers, roughly 85% initiate breastfeeding, but that number has a sheer drop off at 6 months where it plummets to 25% of mothers exclusively nursing their infants.
Now compare that to a country like Sweden, at six months, they have almost TRIPLE the exclusive breastfeeding rate at 73% and how many IBCLCs do they have?
THIRTY EIGHT! That’s less people than it takes to write a Drake song! (Rad moms have officially entered the beef).
Western countries with the highest breastfeeding numbers actually have lowest number of consultants. Norway, which has 78% percent breastfeeding rate six months has ... ELEVEN LACTATION CONSULTANTS! ELEVEN!
Indeed, the mere existence of lactation consultants indicates how far away we are from the natural order of things.
The answer isn’t gross GDP, education, or even paid leave, it’s culture. Culture beats policy every time.
The cranky Republican is right: women SHOULDN’T NEED to be taught how to breastfeed (and young men SHOULD pull up their pants!). We should be growing up watching our aunts and grandmas and cousins breastfeed. We should be so used to seeing a boob out that we don't have to wear ridiculous cover ups while nursing at a the family BBQ. We should lay in bed for WEEKS postpartum while family and friends hand feeding us chunks of bread dipped in stewed meat.
We SHOULDN’T have to be taught how to breastfeed, but unfortunately we do.
So, how will this bill help more women breastfeed?
The bill prohibits unlicensed people from using the term “lactation consultant” and requires IBCLCs to also be certified by the Department of Public Health (for a fee and renewal every two years, of course!). The bill reiterates that people can keep practicing under another title (i.e. lactation counselor) as long as they stay in their scope of practice.
I know lots of people with the “inferior” lactation counselor title (like me!) who don’t claim to be lactation consultants, but I suppose it’s possible. Many lactation consultants argue that if they were licensed then they could be reliably covered by insurance, particularly state-subsidized insurance for low income women—women, in other words, who could benefit the most from the breastfeeding support. So in theory, this sort of legislation could make lactation support more accessible.
But all of this can happen without a bill that specifically LIMITS who can help women breastfeed (and get paid for it) and also makes women pay for a title when they’re already required to re-certify every 5 years for a hefty $600 through their own governing body. So CT legislature may be effectively DECREASING the amount of lactation consultants by passing this bill.
When I became passionate about lactation, I wanted to pursue an IBCLC. But my bachelor’s degree in the humanities meant I would have to go back to college to take several science classes that did not have much to do with lactation, plus $700 to just sit for the exam. I decided to stick with being just a lactation counselor.
Which raises the question how do all those Norwegian women support breastfeeding without knowing all latin names for all the bones in your feet?
The bill, as with any licensure, subjects the person with the title to work within the constraints of the certification and face disciplinary action if they don’t comply with the norms. Is this the best we can do?
I agree with you broadly! I also think that a big portion of the professionalization of lactation support is on IBCLE or ILCA or whatever it is that made the prereqs for IBCLC more difficult and thus more medicalized. I remember around the time when I became a doula was when they changed the pathways to make it suuuuper easy for any nurse etc to become an IBCLC but much harder for anyone with “just a community lactation support background, eg an LLL leader. That ultimately is contributing to these licensing bills (although I am in favor of IBCLCs being able to get reimbursed by insurance and thus serve more families). I’m in the same boat as you—I have a humanities degree and it would be a huge barrier for me to go back and take all of the science classes needed to become an IBCLC. It’s bullshit. The culture doesn’t change without people pushing it at all levels—in the community, in hospitals, in schools, in insurance companies, in public health, in mom groups, on social media, in the government (it’s true!) etc, so I see *some* value in conversations like the one that happened around this CT bill.
There is without a doubt an impulse within American culture that tells mothers and parents that any sort of "good" thing for your kids must be paid for, learned, and dolled out by an expert. IE, we must have a trained, certified consultant teaching you the proper way to do things. There is some maybe consumerist tendency here, that if I have the money, I should be able to buy the thing/life/result I want. I really couldn't agree with the republican legislator more, and what I appreciate from all the RMU articles (while I may not agree with absolutely everything of course) is that you are coming at motherhood from an actually nonpartisan lens, non ideological, not left or right or dem or republican. Everything we talk about in the country has to be seen in some tribalistic, political lens and its dumbs down the argument and means we don't critically think about things (its just, how do I prove my side is the best). I used to think that women posting pictures breastfeeding was silly, like before having kids, but I have soooo come around to the idea that we have to change culture on this for any real change to happen. It just has to be something we see if families, we hear is talked about, we see in art and pictures. Anyway, great, throughful article.