Why you should care
A Georgia law regulating lactation consultants aimed to lower infant mortality. Instead, it decimated an important health care field.
More than a quarter of American professions require a license, compared to just one-twentieth in the ’50s. For fiscal conservatives, it’s a sign of the growing crawl of government into the pocketbooks of citizens trying to make a living, leading to such bizarre outcomes as hair braiders requiring more training hours than EMTs.
The next policy battleground? Breastfeeding. Starting last month, the Peach State found itself with a shortage of lactation consultants. That’s because two years ago, the Republican-controlled state legislature passed a law requiring all experts to complete 14 college courses in health science, 90 hours of breastfeeding education and 1,000 clinical hours, as well as pass a written exam. On this health care issue, Georgia finds itself nearly alone. In fact:
Georgia and Rhode Island are the only states that regulate lactation experts.
States are often called the laboratories of democracy for good reason, but few see them as testing grounds for nursing a newborn. Yet that’s what states like Georgia are becoming with the decision to police a profession that operated “just fine” untouched, says Buzz Brockway, a state legislator who voted against the law during the 2015–16 session.
In this case, Brockway didn’t see evidence of bad breastfeeding tips leading to illness or death. In fact, the legislation was not driven by cases of dire outcomes from sketchy breastfeeding advice. Instead, lawmakers said they acted when health experts came to them claiming the state’s high infant mortality rate demanded stricter health standards.
This [law] severely decreases access to care.
Shoshana Weissmann, R Street Institute
“It’s easy to fall into the trap, to misplace compassion” when dealing with a serious problem, Brockway says, but “the purpose of a professional license is to protect the public from harm or fraud.”
The problem with the new law is twofold: First, other states may follow suit; second, the current law has already created a massive shortage of lactation consultants. Of the 800 consultants in Georgia, fewer than 100 went through the costly and time-consuming licensing process. So when the law came into effect in July, it left Georgians with fewer than one licensed lactation consultant for every 1,300 babies born in the state. That’s the assessment by the Institute for Justice, a libertarian law firm started in part by Charles Koch. The institute is representing the consultants in a lawsuit against Georgia that says the legislation is unconstitutional (interestingly, the suit was levied against the state’s licensing arm, run by Secretary of State Brian Kemp, who is currently in a heated race for governor).
The main beneficiaries of the legislation are universities that provide general health courses and now get a new customer base, as well as the International Board of Lactation Consultant Examiners (IBLCE), which became the only certification group legally allowed to issue licenses in Georgia. The board generates hundreds of dollars per applicant in examination fees. Shoshana Weissmann, who works on licensing reform issues for the “free market” Washington think tank R Street Institute, notes the monopolistic arrangement with IBLCE “gives this one away” as not truly being about health or safety. The licensing group did not respond to requests for comment.
As is the case with many state licensing schemes, low-income and minority businesses are disproportionately affected. It hurts longtime consultants who “all of a sudden can’t do their jobs,” says Weissmann. New mothers also are impacted because “this severely decreases access to care,” Weissmann says. ”These [consultants] are not people who are going to go back to get a license. They’re going to retire.”