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.