CLCs included in 2014 Breastfeeding Report Card

Each year, during World Breastfeeding Week, the Centers for Disease Control and Prevention (CDC)  releases its annual Breastfeeding Report Card providing state-by-state data to help health care workers, community members and families protect, promote and support breastfeeding.

This year’s Report Card indicators measure types of support in key community settings–birth facility support, mother-to-mother support, professional support from breastfeeding experts, and support in child care settings– as well as the most current data on the breastfeeding goals outlined in Healthy People 2020. [Retrieved from:]

The Report Card shows that breastfeeding rates continue to rise in the United States, yet exclusivity and duration recommendations are not being met.unnamed

In the past, the Report Card has been used to track the number of one professional breastfeeding credential, International Board Certified Lactation Consultants (IBCLCs) per 1,000 live births. This year’s Report Card also includes the number of Certified Lactation Counselors (CLCs) per 1,000 live births.

Healthy Children Project’s Executive Director and Lead Faculty Karin Cadwell, PhD, FAAN, RN, IBCLC says that the inclusion of CLCs on the Report Card represents an enormous amount of work over the past 20 years.

According to the report, the number of IBCLCs increased from 2.1 to 3.5 per 1,000 live births over seven years. It also shows that the number of CLCs has increased. In 2013, there were 3.8 CLCs per 1,000 live births, compared to 2.5 in 2011.

American National Standards Institute (ANSI) accredits the CLC Certification. It certifies that The Academy of Lactation Policy and Practice (TALPP) meets the ANSI accreditation program requirements under the International Standard ANSI/ISOIEC 17024:2003.

The National Commission on Certifying Agencies (NCCA) accredits the IBCLC credential.

“ANSI [provides] the highest level of personnel certification in the world,” Cadwell says.

While not required as part of the ANSI accreditation process, Cadwell and colleagues generated a survey to better understand the demographics of CLCs. There are roughly 15,000 CLCs in the U.S. The following charts display the findings from the survey and compares them to the latest U.S. population demographics.


Race/Ethnicity % of CLCs % of US Population
White 69.65 72.4
Black 11.73 12.61
Asian/ Hawaiian/ Pacific Islanders 5.03 4.92
American Indian/ Alaskan 0.93 .95
Hispanic 8.57 17.1
Other 1.3 N/A
No response 2.61 —-



Age Group in Years % of CLCs
18-24 5.33
25-34 35.49
35-44 25.60
45-54 17.70
55-64 11.86
65 and over .34
No response .69

“It’s really clear that CLCs reflect the population of childbearing women, but also our different ethnic groups,” Cadwell comments.

Nearly 70 percent of CLCs are under the age of 44.

Cadwell acknowledges that there is work to be done in order to better represent Hispanic women.

“We are developing an action plan,” she says.

There is an obvious need for more representation by certified lactation professionals in the southern part of the country, Cadwell continues. The report confirms that states like Louisiana, Mississippi and Alabama have First Food Deserts with some of the lowest breastfeeding rates in the U.S.unnamed-2

Further, the Report Card shows that less than eight percent of U.S. births occur at a Baby-Friendly designated facility. (Baby-Friendly USA reports that 8.4 percent of births occur in Baby-Friendly designated facilities.) Six states, mostly in the south, do not have any births occurring at a Baby-Friendly facility. In a handful of states, over 20 percent of their births happen in a Baby-Friendly facility.

In some states like Alaska where the percent of Baby-Friendly births is just over 20 percent, there may only be one large hospital, or a few hospitals, where the majority of births occur, Cadwell explains this phenomenon.

Whereas in Rhode Island, for instance, six out of seven of their hospitals are Baby-Friendly. However, the hospital without the Baby-Friendly designation accommodates the highest number of births per year.

U.S. breastfeeding rates in all categories included on the report fall short of Healthy People’s 2020 Targets.unnamed-1

Currently, 18.8 percent of infants exclusively breastfeed at six months, falling short of a 25.5 percent target. The 2020 target for infants breastfeeding at 12 months is 34.1 percent, whereas the U.S. national average is just under 27 percent.

“The numbers are hopeful but fragile,” Cadwell says.

She says she’s thankful for the Healthy People goals that increase our breastfeeding exclusivity expectations and our expectations for better maternity care and workplace support.

Cadwell also praises the work of the late Chris Mulford esteemed stalwart breastfeeding advocate.

According to Cadwell, Mulford’s dedication to maternal child health and hard work is the reason why breastfeeding continued to be represented in the Healthy People goals.

The 2014 Report Card includes Stories From the Field, shedding light on the positive impact the featured support indicators have on families and communities.

The African American Breastfeeding Network  (AABN) in Milwaukee, Wis. holds monthly Community Breastfeeding Gatherings (CBGs) where lactation professionals and families meet for a family style meal and engage in an “informal and educational community dialogue” about breastfeeding. []

In other parts of the country, City Health Departments like the New York City Department of Health and Mental Hygiene host The Lactation Counselor Training Course to ensure health care providers are best equipped to serve mothers and their babies.

Schools like Tempe Christian Preschool in Tempe, Ariz. participate in the CDC’s Early Care and Education Learning Collaborative (ECELC) to provide breastfeeding support for mothers and employees in early education settings.

More and more birthing facilities are adopting evidence-based policies to help moms and babies get off to the best start. Health care providers at Terrebonne General Medical Center in Louisiana now place all babies skin to skin after vaginal and cesarean births. According to the CDC report, Terrebonne’s breastfeeding initiation has increased 25 percent in just two and half years with the adoption of evidence-based practice.

The release of each year’s Breastfeeding Report Card provides insight on the state of infant feeding in our country and offers a renewed opportunity to take action to improve maternal child health. Lactation professionals, health care providers, community members, policy makers and families may all find the information useful to continue to work toward and eventually achieve the infant feeding and maternal child health goals set by Healthy People.

Leave a Reply