by Anne Eglash MD, IBCLC, FABM
What are the barriers to breastfeeding among women who are incarcerated during pregnancy and childbirth?
According to a recent article on breastfeeding during incarceration, approximately 3-4% of women who enter the prison system in the USA are pregnant. Since prison sentences are often a year or longer, most pregnant women entering the prison system will give birth while incarcerated. Since only 9 states in the USA have prison nursery programs, most mothers who give birth in prison are separated from their newborns. The nine states include New York, Nebraska, Washington, Ohio, Indiana, South Dakota, Illinois, West Virginia, and Wyoming (What’s up CA?!)
The authors of today’s Clinical Question evaluated the rate of breastfeeding initiation among 39 incarcerated pregnant women who participated in a prison-based pregnancy and parenting support program provided by doulas. The women received doula support during the prenatal, intrapartum and postpartum periods. The authors found that the likelihood of initiating breastfeeding in the hospital correlated with the number of times the doula discussed breastfeeding with the mother. Some of the women did not initiate breastfeeding because they knew that the prison would not support pumping and milk storage, and for others, the hospital nurses did not enable breastfeeding because they didn’t know whether the mothers were allowed to breastfeed.
But aside from their findings, the discussion in this article raised interesting facts about correctional policies and norms in regard to breastfeeding.
What do you think are accurate statements regarding correctional policies that effect breastfeeding in prison?
- States that have prison nursery programs generally allow the infants to remain with their mothers for no longer than 6 months of age.
- States that do not have prison nursery programs send the infant to an elected caregiver within 48-72 hours after birth.
- In states without prison nursery programs, infants are typically not allowed to be breastfed during visitation due to rules preventing physical contact.
- It is a federal law that lactating mothers in prison are allowed lactation breaks three times a day.
See the Answer
The answers are B and C (not A and D)
Intention and Initiation of Breastfeeding Among Women Who Are Incarcerated
Shlafer RJ, Davis L, Hindt LA, Goshin LS, Gerrity E.
The Baby-Friendly Hospital Initiative recommends that all mothers be shown how to breastfeed, even when mothers and newborns are separated. Most incarcerated women are separated from their infants after the postpartum hospital stay, creating barriers to breastfeeding. We examined breastfeeding among a sample of women participating in a prison-based pregnancy program. Quantitative data indicated that women who discussed breastfeeding with their doulas were more likely to initiate breastfeeding. Three qualitative themes were identified: Benefits of Breastfeeding, Barriers to Breastfeeding, and Role of the Doula. We identified incongruence between the expected standard of breastfeeding support and the care incarcerated women received. Findings suggest that prison-based doula care might be an effective intervention for supporting breastfeeding among incarcerated women and highlight the importance of education for perinatal nurses about breastfeeding support of incarcerated women.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
It is amazing how few studies have been done on breastfeeding during incarceration. It is very sad that prison nurseries are legal in only 9 states. Prison nurseries typically allow children to remain in contact with their parents for 12-36 months. There is no federal law that allows incarcerated mothers to take pumping breaks, and there are no laws that mandate the provision of facilities to pump and store breastmilk.
This is an area of public health that would greatly benefit from action by local and state breastfeeding coalitions. According to a ruling in New Mexico in July 2017, it is unconstitutional to disallow incarcerated women from breastfeeding their infants. Community breastfeeding support groups could offer to educate prison administration and staff on the illegality of disallowing breastfeeding, what would be involved in breastfeeding during visitation, and how to establish a breast pump program to maintain lactation. Mothers in prison are a marginalized group who are faced with poorer health outcomes due to disallowing breastfeeding. In addition, their infants ought to have the right to be breastfed, to improve their chances for optimal growth and development in a stressful and possibly chaotic infancy.
monica waisman
In Argentina, incarcerated mothers and their children are allowed to stay together up to four years.
Of course they can brestfeed.
Vanessa Shanks
The prison system in our community used to allow inmates to pump and provide breast milk but the warden recently disallowed it after too many inmates were brutally attacked by other inmates for receiving “special treatment” to go pump. The warden said they wanted to support breastfeeding but also had to ensure the inmates were safe, so pumping is no longer allowed. Very sad.
Glenda Parks RN MSN IBCLC
B. Some mothers will try to do some breastfeeding while in the hospital but in our area baby leaves with care giver, about the same time as mother returns to her facility.
Melinda Lipe
I totally agree. How can we in the community promote the legalizing of prison based nurseries to promote maternal infant bonding and breastfeeding as a public health initiative?
Julie Ferrario
I love this I second that how do we get it on the ballot
juana rodriguez
The is a problem with an easy fix for society as a whole. Male inmates have conjugal visits, why wouldn’t a woman be able to nurse her infant?
Julie Ferrario
Exactly !
Sharon
Wow this is an area I did not even think of ! How would someone get started in helping to change this
Tina Lavy
Sharon, connect with me at [email protected] to get started in helping to change this.
Arletta Duprey
Interesting topic! We had a situation were a mom was arrested and her breastfeeding infant placed in other parent household. While she was incarcerated at the “city” police jail before being moved to the “county” jail, Mom was in need of a pump. The Officers did locate hers but realized a different type of need at the city jail location. More and more of this type of situation will occur! Interesting! So, what happens to the breastfeeding dyad before mom’s to to prison.
Lisa Diamond
Thank you for this discussion. I am a Lactation Support Specialist with Indiana/Marion County WIC and I, (along with another Breastfeeding Peer Counselor and Dietitian), provide breastfeeding education and support for women at the Indiana Women’s Prison. The Wee Ones Nursery is housed on the prison grounds. What we have found over the past 3 years is that many of the women are open to the support, and often have had breastfeeding /pumping experience with previous children prior to incarceration. We have had success with several mothers and babies breastfeeding. We educate nannies and administrative staff about pump set up, use and milk storage.
The difficulty has been finding a niche between what the prison/law/ rules are for punishment versus preferential treatment of offenders and what are basic human rights/necessities for female inmates.
There is so much to consider in terms of policy change. Would it be for all inmates no matter the length of sentence? If the offender is allowed to express milk for the baby, who would be responsible for transporting it? How well would latching work after separation from mom even if allowed to breastfeed during visitation? How long would she be allowed to maintain her supply if possible under the environmental stress of incarceration?
This is new territory and definitely warrants a deeper look.
Judith Blatchford
Do you know if Indiana has a breastfeeding policy for incarcerated mothers? I know that New Mexico does.
Tina Lavy
California has facilities which allow mothers and infants/children to remain together after birth. However, certain criteria must be met. Those facilities are: Community Prisoner Mother Program (CPMP) which currently consists of three facilities located in Oakland, Pomona and Bakersfield. Family Foundations facilities are located in Fresno, Santa Fe Springs and San Diego.
https://www.cdcr.ca.gov/Adult_Operations/FOPS/Community_Prisoner_Mother_Program.html. New Mexico breastfeeding advocates should be applauded for their work on lactation support and incarceration, the ruling in NM is a positive step. However, in 2017, a bill was introduced to NM state legislators requiring lactation policies for incarcerated females. The bill passed several committees with wide support (https://nmlegis.gov/Legislation/Legislation?Chamber=S&LegType=B&LegNo=293&year=17&AspxAutoDetectCookieSupport=1). When it reached the governor’s desk, the bill was pocket vetoed! In California, a bill was recently submitted (AB 2507) which addresses the issue: “County jails: infant and toddler breast milk feeding policy”. It is currently in committee. In our county jail (Sutter), we have had a lactation policy in place since 2012. Why? A situation arose in which a pregnant inmate wanted to breastfeed and the Health Officer worked with the jail staff to allow it to happen. Protocols did not exist then – they do now. See http://californiabreastfeeding.org/wp-content/uploads/2015/02/CBC-Breastfeeding-in-the-Incarcerated-Mother.pdf
Erin O'Reilly
Yes, this is an important issue if we want to help break the cycle of high incarceration rates in USA! If breastfeeding were comprehensively assessed (it is not in USA), then we would probably see that many people who land in prison also suffered from the many barriers to breastfeeding and low breastfeeding rates. We also know that many people in prison have mental illness that causes them to be more likely to end up in prison, and successful breastfeeding helps to decrease mental illness (or at least it is a first-line treatment for mental/behavioral problems even before they are diagnosed due to the interactive/therapeutic aspect of breastfeeding as well as the best nutrition and immunity)! So, by supporting incarcerated breastfeeding mothers and helping them to successfully breastfeeding, we could be effectively reducing the risk of their children following them into prison while simultaneously empowering their mothers on their journeys to healthier lifestyles!