“You Know if You Quit, That’s Failure, Right?”: Barriers to Professional Lactation Certification

Background: Researchers have confirmed that breastfeeding disparities persist and that International Board Certified Lactation Consultants (IBCLCs) play a key role in reducing them. However, there continues to be a limited availability of IBCLCs throughout the United States, with racial minorities facing persistent barriers during the certification process. Research aim: Using a critical race theory framework, the aim was to describe the barriers and supports that IBCLCs experience during the course of their certification. Methods: This study used a prospective, cross-sectional, qualitative design with semistructured interviews with IBCLCs ( N = 36) from across the United States. Interviews were audio-recorded and professionally transcribed. Results were analyzed using an in-depth thematic analysis from the perspective of critical race theory. Results: Women made up the majority ( n = 35; 97.22%) of the sample. People of color made up slightly less than half of the sample ( n = 16; 44.44%). Barriers were initially coded by the stages of the certification process. Existing healthcare providers experienced advantages in the certification process because of their connection to social networks and resources in their hospital or place of employment. Cost and racial discrimination were identified, using a structural racism lens, as primary barriers for certification. Race-related barriers were particularly pervasive and were detailed by each stage of the certification process. Conclusion: Lactation organizations and care providers need to consider ways to mitigate these perceived differences in support and infrastructure. These changes could help to ensure equity in the profession and may reduce racial discrimination in lactation care.