In May of this year, the governor of Georgia signed HB649 into law, providing for the licensure of International Board Certified Lactation Consultants (IBCLCs). Georgia is only the second state in the United States to pass this type of legislation. USLCA member Leah Aldridge, JD, IBCLC recently received the USLCA Award of Excellence for her pivotal role in the legislative process. Fellow member Mary Francell, MA, IBCLC, recently spoke to Leah about her involvement.
MF: Leah, to start, can you tell us a little about your background?
LA: Certainly! Before having children, I was an attorney specializing in healthcare mergers and acquisitions. For the last six years, I have been in what I like to call my “encore” career as an IBCLC. I have also been a La Leche League (LLL) Leader for thirteen years, following in the footsteps of my mother, who was founder of LLL Florida. I am a principal with Atlanta Breastfeeding Consultants, an active clinical practice here in Atlanta. I’m the mother of three children, one girl and two boys, ages 10-16 and am married. I have also been on the board of Healthy Mothers, Healthy Babies Coalition of Georgia (HMHB) for ten years and am currently the board president.
MF: How did you get involved in lobbying for this bill?
LA: For the past forty years, the mission of HMHB has been to advocate for improved access to care for Georgia’s mothers and babies. When the US Surgeon General’s Call to Action to Support Breastfeeding was published in 2011, it called on states to reimburse services for IBCLCs. It also said that if this reimbursement was not available without licensure, then states should seek licensure. The Centers for Disease Control was involved in drafting the surgeon general’s report, so this call came from public health. As a new IBCLC and also a lawyer, I was approached by the lactation community to take on this issue. When I presented it to HMHB and asked if lactation consultant licensure could be added to its legislative agenda for that year, I had no idea that this would be the start of a five-year journey!
MF: Tell us a little about the process.
LA: Well, we started by drafting a bill. The USLCA presented sample language for us to use, and two HMHB attorney board members began to work on a draft to be presented for consideration at the Capitol. While we used the USLCA sample language, we also based our Georgia law on existing statutes that license dietitians. We found a sponsor for the bill, Republican representative Sharon Cooper, who is also a nurse and chair of the House Heath and Human Services (HHS) committee. Rep. Cooper presented the bill as a starting point to the legislative council, who then drafted HB363. Once a bill is filed, the legislative process begins. We had to convince other representatives to co-sponsor before the first hearing in HHS committee. Our bill did not get out of committee the first three times it was presented, so there was a great deal of education and consensus building that had to be done behind the scenes before it was finally passed out of committee this year. After passing out of the House HHS committee, the bill went to the House rules committee and was voted on the House floor. We then found a different sponsor in the Senate HHS committee – this particular sponsor is an OB-Gyn physician. After passing that committee, the bill went on to the Senate rules committee, was voted on the Senate floor and was finally signed by the Governor.
Of course, the bill that passed this year (HB 649) was very different from the one we first drafted (HB363). During the drafting of the original bill, we went on a listening tour of the state, traveling to eight different communities to get input from health departments, WIC offices, OB-GYNs, hospitals, pediatricians, community groups, etc. Over the years, we amended the bill with input from Reaching Our Sisters Everywhere (ROSE), the Georgia Nurses Association, the Georgia Hospital Association, the Secretary of State’s office and other organizations. We also spent a great deal of time garnering support for the bill, getting endorsements from various medical and community organizations, gathering 800 signatures in an online petition and delivering over 2000 handwritten notes to the Capitol. This law grew and changed over five years to truly reflect the views of Georgia’s healthcare community and, most importantly, its breastfeeding mothers.
This new law goes into effect July 1, 2016. At this point, it is up to the Secretary of State’s office, in consultation with an advisory committee, to implement the law and set up a mechanism to issue licenses.
MF: What were some roadblocks and how did you overcome them?
LA: Some legislators did not understand the need for this bill, so we had to educate them on the importance of clinical care for breastfeeding mothers. In addition, some members of the lactation community were concerned about how this would impact their ability to support breastfeeding moms, so we listened to their concerns and amended the bill to reflect these concerns and to protect other members of the breastfeeding support team. There continues to be skepticism about how the law will impact various groups, but we are confident that this law allows the important work of our Georgia breastfeeding educators, from WIC peer counselors to La Leche League leaders to doulas and other breastfeeding perinatal educators, to continue. This law will only strengthen access to care for breastfeeding moms and babies in Georgia. We hope this legislation will lead to greater access to private insurance panels for IBCLCs to receive reimbursement of services and perhaps even allow for a conversation about Medicaid reimbursement to occur, in time.
MF: As you mentioned, the bill did not pass out of the House subcommittee the first three years it was proposed. What did you learn that helped move the bill along this time?
LA: The main thing we learned was how important it was to continue to educate those legislators on the committee. We also learned the importance of having people in the community, particularly in their districts, contact these legislators about the need for greater access to lactation care. Our listening tour early in the process allowed us to garner the support of many in diverse communities, as well as to employ our breastfeeding coalitions, La Leche League and our USLCA chapter to engage grassroots networks to support the bill.
MF: What do you think were the most important aspects of lobbying that helped the bill be successful this year?
LA: The single most important part of our success was partnering with an established mother/baby nonprofit that is regularly involved in advocacy at the state level. This nonprofit had the financial resources to be able to employ the services of a paid, part-time lobbyist who could guide the process and make sure Georgians had their voices heard. This bill would not have passed without the leadership and support of Healthy Mothers, Healthy Babies Coalition of Georgia, Inc. Gaining the support of the provider community was also tremendously important. Having organizations of medical professionals behind and aligned with us in a united front was key – some of these also sent their lobbyists to testify for the bill. A full list of our supporters can be found on the HMHB website at http://www.hmhbga.org/en/.
MF: What advice would you give lactation communities in other states working toward licensure?
LA: Step one is to form a committee and start an online petition to begin capturing the everyday voices of mothers and providers – let them share why greater access to lactation consultants is important to them. The lead of this committee should then talk to his or her public health agency/Medicaid/WIC to educate and advocate for licensure. While they may not take an active position on your bill, their understanding of the need for licensure of IBCLCs is important. I would then secure a champion – a mother/baby advocacy nonprofit that knows the process and can guide you through it. Early on in the process, work with your champion to solicit medical providers to support the bill through their professional organizations – the state medical association, the state chapters of the AAP, the OB-GYNs, the nurse midwives, the dietitians, the nurses, etc. It’s also critical to gather input from communities across your state – understand who is doing what in terms of breastfeeding support and craft a bill that focuses on licensure of the IBCLC but respects the work of other non-IBCLC breastfeeding educators. I was able to write a grant through HMHB to fund our listening tour throughout state – that kind of grassroots input allowed us to put forth a bill that meets the needs of mothers and babies in our state while also responding to hospital and community needs. This was a rewarding and exciting process and we are thrilled to have passed HB649 this session. Good luck in your state!