Lactation Consultant Access and Breastfeeding Outcomes in the United States: Cross-Sectional Analysis.

Abstract

Background: Breastfeeding provides unmatched health, developmental, and economic benefits to both infants and mothers, yet breastfeeding continuation rates remain suboptimal in the United States, especially beyond the early postpartum period. Despite well-documented advantages, many mothers face challenges that lead to early cessation, including lack of access to skilled lactation support. International Board Certified Lactation Consultants (IBCLCs) are considered the clinical gold standard in lactation care, but their availability varies widely across states. Understanding how IBCLC access relates to breastfeeding outcomes at the population level is critical to informing equitable public health interventions.

Objective: The aim of this study is to determine whether state-level IBCLC density is associated with breastfeeding initiation and exclusive breastfeeding at 3 and 6 months.

Methods: This cross-sectional analysis used publicly available 2022 data from the Centers for Disease Control and Prevention, US Census Bureau, and the International Board of Lactation Consultant Examiners. IBCLC density per 100,000 women of childbearing age (15-49 years) was calculated for each of the 50 US states. Breastfeeding outcome data included initiation, exclusive breastfeeding at 3 months, and exclusive breastfeeding at 6 months. Simple and multiple linear regressions were conducted to evaluate the association between IBCLC density and breastfeeding outcomes, adjusting for income, education, and insurance coverage.

Results: IBCLC density ranged from 14.4 to 60.7 per 100,000 women of childbearing age across US states, with a national average of 25.5. Pearson correlation analysis indicated significant positive associations between IBCLC density and breastfeeding outcomes, including initiation (r=0.38; P<.001), exclusive breastfeeding at 3 months (r=0.52; P<.001), and exclusive breastfeeding at 6 months (r=0.32; P<.001). In multiple linear regression models adjusting for income, education, and insurance status, IBCLC density remained significantly associated with all 3 outcomes. For breastfeeding initiation, the adjusted β was 0.26 (95% CI 0.08-0.44; P=.005); for exclusive breastfeeding at 3 months, β was 0.43 (95% CI 0.23-0.63; P<.001); and for exclusive breastfeeding at 6 months, β was 0.25 (95% CI 0.12-0.39; P<.001). Adjusted R² values for the models ranged from 0.42 to 0.44, indicating moderate explanatory power.

Conclusions: Higher IBCLC density is significantly associated with improved breastfeeding outcomes at the state level, particularly exclusive breastfeeding at 3 months. These findings support initiatives to expand access to professional lactation support as part of public health strategies to improve breastfeeding rates.