Gender pay gap
Fair pay for the women who give the care.
Lactation care in Ontario is given almost entirely by women, and almost entirely unfunded. This page is the money half of the argument: who the province already pays, who carries the cost when it does not, and what it would take to change.
Who the province pays
Midwives show the list can grow.
OHIP pays physicians and the other practitioners named under the Health Insurance Act, including midwives for services in birth centres. An IBCLC is not on that list, so no fee code pays for her work, and a service used almost entirely by women sits outside the insured system.
Midwives were once outside it too. In the mid-1980s, midwives, nurses, physicians and families came together, the province agreed in 1985 that midwifery should be legalized, the Midwifery Act passed in 1991, and it took effect in 1994. A profession of women caring for women was welcomed into the system because people across health care decided it should be.
Today, the road to that list means building a regulatory college, hiring lawyers and seeking provincial recognition, years of work that costs a great deal of money. IBCLCs are a profession of mostly women doing that work for women, with no funding to do it.
What OHIP covers, Government of Ontario · College of Midwives of Ontario, 30 year timeline
Who carries the cost
Telling a mother to breastfeed is not the same as making it possible.
Dr Lesley Frank, Canada Research Chair at Acadia University, has spent twenty years studying infant feeding in households that cannot reliably afford food. Her work shows that promotion without material support moves the work and the blame onto the mothers least able to carry either.
Outside Quebec, only 44% of families with annual incomes under $30,000 receive employment insurance maternity or parental benefits at all. The leave that makes breastfeeding possible is most reliably available to the mothers who already have the most.
Out of Milk, UBC Press, 2020 · Food insecurity and breastfeeding in Canada, CMAJ, 2018
Equal pay for work of equal value
Parliament has already agreed the principle.
Canada accepts that work of equal value deserves equal pay. A pay equity motion passed the House of Commons in February 2016 by 224 votes to 91, carried by the Bloc Québécois, the New Democrats, the Liberals and the Green Party, and the federal Pay Equity Act came into force on 31 August 2021. It is no longer a position. It is law, and it binds whoever is in government.
Lactation care is a clear place to apply it. IBCLCs complete health science education, lactation-specific education, supervised clinical practice and an international exam, and recertify every five years. Yet with no fee code and few budget lines, much of their work is paid far below comparable health professions, or not paid at all. A profession of mostly women, caring for mothers and babies, deserves the principle Parliament has already endorsed.
The link to mothers is clear. A mother whose feeding plan is not working cannot return to work with confidence. IBCLCs help mothers plan feeding around going back to work, including pumping and protecting milk supply, so that care for her baby does not cost her her career.
The 2016 vote, House of Commons · Pay equity, Government of Canada
The solution is ready
The wheel is built, and it works.
Community IBCLCs did not wait for funding to build the system Ontario needs. It already exists.
Checkable. Every IBCLC on the register holds the international credential, and anybody can confirm it on IBLCE’s public registry. Each one tells us she carries professional liability insurance and is current in CPR and basic life support, and each gives us the certification number that makes a check exact.
Educated. IBCLCs train their own: the Breastfeeding Medicine Program, Clinical Rounds, and mentorship for the next generation.
Collaborative. IBCLCs and physicians already work side by side. Peer-reviewed research on virtual lactation care, co-authored by an Ontario IBCLC, found that families valued it.
Proven. More than 17,000 consults, some fully funded, many with an OHIP copay and some at full private rates. Most feeding difficulties resolve in about three consults.
What it needs now is fuel.
Breastfeeding Medicine Program · Clinical Rounds · The published study
What would change it
Fund it now, with what already exists.
Start a funded pilot. Fully funded community IBCLC care for families in a few regions, contracted through public health units, hospitals or Ontario Health Teams, and measured with data the register already collects. A pilot partner should be ready on day one, with:
- IBCLCs whose certification is checked and current
- physicians working alongside IBCLCs for medically complex cases
- a record of outcomes and consult data to measure against
- home, office and virtual care, so families anywhere in the region are reached
- its own education program for students and referring providers
Fund mentorship. It is how the number of IBCLCs grows to match the number required to support any family in need of clinical lactation and infant feeding care.
Count the maternal cost in Ontario. The paediatric costing exists and calls itself conservative. Measuring the mothers’ side would show the full return.
A ready partner. The Ontario Breastfeeding Clinic, whose founders started this register, meets every one of these criteria today and is ready to host the first pilot. We say so openly. Its IBCLCs appear on the register on the same terms as everyone else.
Recognition in the insured system is the long road, as it was for midwives. A pilot lets families benefit while that road is travelled.
A question for every candidate
Will you fund community IBCLC care for Ontario mothers and babies, and pay the women who give it fairly?
Ask every party. The safety of mothers and babies is common ground.
Every figure on this page, and where it came from.
- Government of Ontario. What OHIP covers. ontario.ca/page/what-ohip-covers.
- College of Midwives of Ontario. 30 Year Timeline. cmo.on.ca/wp-content/uploads/2024/03/30-Year-Timeline.pdf.
- Frank L. Out of Milk: Infant Food Insecurity in a Rich Nation. UBC Press, 2020. The employment insurance figure 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.
- 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.
- House of Commons of Canada. Vote 12, 42nd Parliament, 1st session, 3 February 2016: a pay equity motion carried 224 to 91. openparliament.ca/votes/42-1/12. Government of Canada, Pay equity. canada.ca.