The evidence
Every number we use, and where it came from.
One page, so that checking a figure takes a minute rather than an afternoon. Grouped by what each source supports, with a line on why it is here. Most are open access.
Does this care work
What lactation support changes.
- D’Hollander CJ and colleagues. Breastfeeding Support Provided by Lactation Consultants: A Systematic Review and Meta-Analysis. JAMA Pediatrics, 2025;179(5):508–520. doi.org/10.1001/jamapediatrics.2024.6810
Forty randomised trials in high-income countries. Lactation consultant support reduced the risk of stopping exclusive breastfeeding and any breastfeeding, and added 3.63 weeks of any breastfeeding (95% CI 0.13 to 7.12). Led from the University of Toronto, St Michael’s and SickKids. This is the strongest single source on the site, and the one that says the care works. - Chetwynd EM, Wasser HM, Poole C. Breastfeeding Support Interventions by International Board Certified Lactation Consultants: A Systematic Review and Meta-Analysis. Journal of Human Lactation, 2019;35(3):424–440. doi.org/10.1177/0890334419851482
Seventeen interventions, eight of them reporting breastfeeding at three or six months. For any breastfeeding at six months the pooled difference was 8 percentage points: one more mother still breastfeeding for every 12 who saw an IBCLC. The authors are careful that the answer depends on which outcome is measured and when, and we quote the six-month figure they state. - Lugo A, Moriarty H, Trout KK, Spatz DL. An integrative review of the impact of International Board Certified Lactation Consultants in outpatient postnatal settings in the United States. Journal of Perinatology, 2026;46:526–535. doi.org/10.1038/s41372-025-02425-8
Six studies of IBCLC care given after discharge rather than on the ward, in a practice or by telehealth, and both were associated with longer and more intensive breastfeeding. It is the closest published thing to what this register is for, and its own conclusion is that policy and access are what is missing. American, so it is evidence about the model rather than about Ontario. - Chiurco A, Montico M, Brovedani P, Monasta L, Davanzo R. An IBCLC in the Maternity Ward of a Mother and Child Hospital: A Pre- and Post-Intervention Study. International Journal of Environmental Research and Public Health, 2015;12(8):9938–9951. doi.org/10.3390/ijerph120809938
With an IBCLC on the ward, mothers reporting real help with breastfeeding rose from 60% to 93%, those saying staff understood their needs rose from 78.5% to 95.8%, and sore or cracked nipples fell from 41.5% to 24.6%. The same study found no difference in exclusive breastfeeding at discharge or at two weeks, which is why we claim experience and comfort here and nothing more. - Lugo A, Dean Durning J, Trout KK, Spatz DL. Mothers’ Satisfaction with Breastfeeding Assistance from International Board Certified Lactation Consultants: An Integrative Review. Breastfeeding Medicine, 2026;21(4):243–249. doi.org/10.1177/15568253251412394
Six qualitative studies, mothers interviewed between four weeks and eight months after birth. What they said made a consultation good: enough time, encouragement, knowing her subject, answering the thing actually worrying them. These are mothers’ own words rather than a rate, which is why it sits beside Chiurco rather than replacing it. - Esselmont E, Moreau K, Aglipay M, Pound CM. Residents’ breastfeeding knowledge, comfort, practices and perceptions: results of the Breastfeeding Resident Education Study (BRESt). BMC Pediatrics, 2018;18(1):170. doi.org/10.1186/s12887-018-1150-7
201 residents across Canada’s general paediatrics programmes. Only 4% were very comfortable evaluating a latch, teaching positioning and answering a parent’s questions about a feeding difficulty, and more than a quarter had never watched a patient breastfeed. The gap this describes is Canadian and current, which is why it sits beside the two teaching studies rather than under them. - Tender JA, Cuzzi S, Kind T, Simmens SJ, Blatt B, Greenberg L. Educating Pediatric Residents about Breastfeeding: Evaluation of 3 Time-Efficient Teaching Strategies. Journal of Human Lactation, 2014;30(4):458–465. doi.org/10.1177/0890334414548459
First-year paediatric residents on a newborn nursery rotation, each given one of three things: an hour shadowing an IBCLC, a 25-minute DVD, or a three-hour prenatal class. The hour with the IBCLC gained them the most knowledge and they rated it highest. - Feldman-Winter L, Barone L, Milcarek B, Hunter K, Meek J, Morton J, Williams T, Naylor A, Lawrence RA. Residency Curriculum Improves Breastfeeding Care. Pediatrics, 2010;126(2):289–297. doi.org/10.1542/peds.2009-3250
417 residents in paediatrics, family medicine and obstetrics across thirteen programmes, six teaching the curriculum and seven not. The residents who were taught came out ahead on knowledge, on what they then did in practice, and on confidence — and exclusive breastfeeding rose among their own patients. Teaching the doctor reaches the family. - Pascual M, Migliorelli F, Goberna J, Arranz Á, Archs J, Martí H, Marcè N, Manresa M. Impact of Lactation Consultants on Breastfeeding Prevalence at 6 Months. Breastfeeding Medicine, 2025;20(12):871–887. doi.org/10.1177/15568253251386459
Nineteen studies, 1,475 women. Support given around the birth and continued afterwards doubled the chance of exclusive breastfeeding at six months, risk ratio 2.04 (95% CI 1.27 to 3.27); care at the birth alone was 1.42 (1.19 to 1.70). The two numbers are the continuity argument, and the whole shape of a community safety net: the larger one is not true of a single hospital visit and must never be quoted as though it were. - Hamid MA, Kumar A and colleagues. Innovative online care: A cross-sectional survey study of potential benefits and challenges of online lactation consultation service with paediatrician consultation. Paediatrics & Child Health, 2022;27(7):414–20. pmc.ncbi.nlm.nih.gov/articles/PMC9732844
177 mothers surveyed. The second author is Dr Anubha Kumar, IBCLC. The study was carried out at a previous clinic rather than at the Ontario Breastfeeding Clinic, and we cite it as evidence that virtual lactation care works, never as our own research.
What it costs not to
The bill the province already pays.
- Onah MN, Hoy S, Slofstra K. The costs of suboptimal breastfeeding in Ontario, Canada, and potential healthcare resource impacts from improving rates: a pediatric health system costing analysis. International Breastfeeding Journal, 2025. doi.org/10.1186/s13006-025-00702-y. Open access.
US$72.2 million a year in treatment for four childhood illnesses and US$61.0 million in long-term conditions, for one Ontario birth cohort; US$32 to 63 million and US$23.6 to 51.6 million of it avoidable. The only Ontario figure there is. Its authors call it a conservative estimate and say what it leaves out. - Bartick MC, Stuebe AM, Schwarz EB, Luongo C, Reinhold AG, Foster EM. Cost analysis of maternal disease associated with suboptimal breastfeeding. Obstetrics & Gynecology, 2013;122(1):111–19. pubmed.ncbi.nlm.nih.gov/23743465
A United States cohort of 1.88 million women. Five maternal conditions modelled: breast cancer, premenopausal ovarian cancer, high blood pressure, type 2 diabetes and heart attack. This is where the figure comes from that 79% of the medical cost of suboptimal breastfeeding is maternal, which the Ontario paper cites. American, and said to be American wherever we use it. - Health Canada. Canada’s breastfeeding dashboard, 2024 edition, using 2022 survey data. health-infobase.canada.ca/breastfeeding
91% of parents start breastfeeding and 38% breastfeed exclusively for six months, against global targets of 50% by 2025 and 70% by 2030. The steepest fall is in the first month, which is the month a family is home and on its own. - BORN Ontario. Birth volumes, live and stillbirths in Ontario by fiscal year, 2023/24 annual report. bornontario.ca
144,063 births, which is where “more than 140,000 babies a year” comes from. Said as babies born rather than mothers giving birth, because twins make those two numbers differ.
The mother’s own health
What lactation does for her.
- Tschiderer L, Seekircher L, Kunutsor SK, Peters SAE, O’Keeffe LM, Willeit P. Breastfeeding Is Associated With a Reduced Maternal Cardiovascular Risk: Systematic Review and Meta-Analysis Involving Data From 8 Studies and 1 192 700 Parous Women. Journal of the American Heart Association, 2022;11(2):e022746. pmc.ncbi.nlm.nih.gov/articles/PMC9238515. Open access.
Compared with women who never breastfed: hazard ratio 0.89 for cardiovascular disease, 0.86 for coronary heart disease, 0.88 for stroke and 0.83 for fatal cardiovascular disease. The 0.83 is the 17% we use. Risk fell further with lifetime breastfeeding up to twelve months. - Academy of Breastfeeding Medicine. Clinical Protocol #4: Mastitis, revised 2014. abm.memberclicks.net
Rapid weaning is among the predisposing factors it names for mastitis. This is the clinical half of what we say about weaning.
Who can afford to
Feeding a baby is a household cost.
- Frank L. Out of Milk: Infant Food Insecurity in a Rich Nation. UBC Press, 2020. ubcpress.ca/out-of-milk
Dr Lesley Frank is Canada Research Chair at Acadia University. Her argument is that promotion without material support moves the work and the blame onto the mothers least able to carry either. The figure that only 44% of families outside Quebec with incomes under $30,000 receive employment insurance maternity or parental benefits is from her notes, citing McKay L, Mathieu S, Doucet A, Parental-Leave Rich and Parental-Leave Poor, Journal of Industrial Relations 58(4), 2016. - Frank L. The Cost and Affordability of Growing and Feeding a Baby in Nova Scotia. Canadian Journal of Public Health, 2020;111(4):531–42. doi.org/10.17269/s41997-020-00306-5
The costing work the book is built on. - Frank L. Breastfeeding Paradox: A Critique of Policy Related to Infant Food Insecurity in Canada. Food, Culture & Society, 2015;8(1):107–29. doi.org/10.2752/175174415X14101814953927
- Orr SK and colleagues. Relation between household food insecurity and breastfeeding in Canada. CMAJ, 2018;190(11):E312–19. doi.org/10.1503/cmaj.170880
National Canadian data on what happens to breastfeeding in households that cannot reliably afford food. - PROOF, University of Toronto, from Statistics Canada data. proof.utoronto.ca
30.8% of children under 18 in Canada lived in a food-insecure household in 2025. - United Nations Special Rapporteur on the right to food. Report of the Special Rapporteur on the right to food, Mission to Canada, 2012. documents.un.org · reported by Laura Payton, CBC News, 2012. cbc.ca
One in ten Canadian families with a child under six could not meet their daily food needs. Olivier De Schutter: the right to food is “a matter of principle and it’s a matter of political will”. The report is the primary source and the reporting is what brought it to Canadians; we cite both. The visit was politically contested at the time and our pages leave that out, because the finding stands on its own.
Who gets paid, and who decides
The list, the precedent and the principle.
- Government of Ontario. What OHIP covers. ontario.ca/page/what-ohip-covers
Only physicians and other practitioners prescribed by regulation under the Health Insurance Act may be paid by OHIP, and that list names midwives for services in birth centres. We link this for who may be paid. We link nothing for the missing fee code, because no page states an absence. - College of Midwives of Ontario. 30 Year Timeline. cmo.on.ca
The province agreed in 1985 that midwifery should be legalized, the Midwifery Act passed in 1991, and it took effect in 1994. This is the precedent: the list of who may be paid has been added to before. - House of Commons of Canada. Vote 12, 42nd Parliament, 1st session, 3 February 2016. openparliament.ca/votes/42-1/12
A pay equity motion carried 224 to 91. The Bloc Québécois, the New Democrats, the Liberals and the Green Party voted for it; the Conservatives voted against. We say “across parties” and not “every party”, because that is what the division shows. - Government of Canada. Pay equity. canada.ca
The federal Pay Equity Act came into force on 31 August 2021. Equal pay for work of equal value is law rather than a position. - IBLCE. Public registry of International Board Certified Lactation Consultants. ibclc-commission.org/public-registry
Where a certification is checked. It is the registry our own register checks against.
Said without a citation
What we say that nobody has published.
Four things on this site are the clinic’s own observation rather than published research. They are marked as such wherever they appear, and they are listed here so that a reader checking our sources finds them rather than discovering them.
- More than 17,000 consults, and about three to resolve a feeding difficulty. From the Ontario Breastfeeding Clinic’s own appointment records. The total is rounded down and carries a plus sign. The average is from the period when care was fully funded, and the exact figure is still being confirmed.
- Mentoring takes time and is rarely paid. What community IBCLCs report to each other. No survey has measured it in Ontario.
- A weaning that hurt is something we meet again when she is pregnant with her next baby. Clinical experience, and the reason the clinics offer a prenatal visit: a plan made before the baby arrives covers the ending as well as the beginning. The mastitis risk of rapid weaning is published; this is not.
- No certification on the register has been checked against IBLCE’s registry yet. The worklist exists and the checking has not started. Until it has, nothing on this site calls a listing verified, and no listing goes public unchecked.
Spotted a figure that’s off?
Every figure here links to its source. If one doesn’t match, or a newer study has replaced it, email info@clcontario.ca and we’ll update it and note what changed.