RAFFENSPERGER v. JACKSON (And Vice Versa)

Mary Jackson, a certified lactation counselor at a hospital, and ROSE, a nonprofit that trains community members (mostly in African-American communities) to support breastfeeding mothers, sued the Georgia Secretary of State over a 2016 law. That law said only people with a privately issued IBCLC certification could get a state license to provide lactation care and services for pay, effectively barring Jackson, ROSE's trained workers, and other certified lactation counselors from continuing their paid work. A Fulton County trial court sided with the state on due process but with the plaintiffs on equal protection, and both sides appealed. The Supreme Court of Georgia held that the law violates the Georgia Constitution's Due Process Clause because it blocks people from a lawful occupation without any real evidence that non-IBCLC providers harm mothers or babies. The court reversed the trial court on due process and did not need to decide the equal protection question.

The court held that Georgia's Due Process Clause protects the right to pursue a lawful occupation free from unreasonable government interference, and that restricting paid lactation care work to IBCLC-certified providers is unconstitutional because the state offered no evidence that non-IBCLC providers harm the public, making the restriction not reasonably necessary to protect health or safety.

Hundreds of certified lactation counselors and community-trained breastfeeding educators in Georgia, including many serving underserved communities, can now continue working for pay without an IBCLC credential, and the decision sets a framework Georgia courts will use to judge future occupational licensing laws.

Judgment reversed in the cross-appeal; judgment vacated in the main appeal

1. The court traced a long line of Georgia cases interpreting the Due Process Clause (a constitutional guarantee against being deprived of liberty or property without fair legal process) as protecting the right to pursue a lawful occupation free from unreasonable government interference.
2. It set out a three-step framework: first, the challenger must show the occupation is otherwise lawful and that the regulation actually burdens their ability to practice it; second, the government must offer a legitimate health, safety, or public-morals interest; third, the challenger must prove the regulation is not reasonably necessary to serve that interest.
3. Applying step one, the court found that lactation care is a lawful profession and that the Act's requirement of an IBCLC certification actually stopped Jackson, ROSE-trained workers, and other certified lactation counselors from continuing the paid work they had been doing, based on the plain meaning of the law's definition of 'lactation care and services.'
4. Applying step two, the court accepted that the state's asserted interest, promoting access to quality lactation care, was at least facially a recognized type of interest, but noted that a generic desire for higher-quality services, without a specific tie to public health or safety, has never been enough under Georgia's due process cases, citing a 1930s case about photographer licensing.
5. Applying step three, the court found the state had no actual evidence that non-IBCLC providers ever harmed mothers or babies: the Secretary admitted knowing of no such harm, no complaints had been filed, and a legislative review council had found no substantive evidence of harm and warned that excluding these providers could actually reduce access to care.
6. Because the restriction rested on speculation rather than a demonstrated risk to health or safety, the court concluded the law imposed an unreasonable burden on a lawful occupation and therefore violated the Due Process Clause, making it unnecessary to reach the separate equal protection claim.

• lactation consultants
• occupational licensing
• due process rights
• breastfeeding support
• Georgia Constitution