Abstract

This article aims to identify and map the actions to promote, protect and support breastfeeding that are carried out within the prison system. Scope review, whose searches were performed in the Latin American and Caribbean Health Sciences Literature and Nursing databases, Virtual Health Library, Medical Literature, Analysis, and Retrieval System Online, via PubMed, Scientific Electronic Library Online and the Capes Periodicals Portal. A total of 465 studies were obtained, 177 duplicates and 175 by title exclusion were removed, 56 articles were eliminated by abstract, and eight articles were not found. After selection and reading by the review team, 16 articles were removed, thus constituting ten articles with relevant results for breastfeeding promotion in prison, 13 articles with important results for breastfeeding protection in prison, and ten articles with potential findings for breastfeeding support in prison. It is necessary to promote breastfeeding in prison with promotion, protection and support actions, because many children are still prevented from being breastfed soon after birth, which characterizes inequality in relation to the population in freedom.

Key words:
Prisons; Breastfeeding; Health promotion; Right to health; Comprehensive health care

Introduction

In Brazil, the female population deprived of liberty increased 525% from 2000 to 2016, reaching an imprisonment rate of 55.4 for every group of 100,000 women over the age of 18¹1 Brasil. Ministério da Justiça e da Segurança Pública. Departamento Penitenciário Nacional (DEPEN). Levantamento Nacional de Informações Penitenciárias [Internet]. 2ª ed. Brasília: DEPEN; 2018. [acessado 2020 Nov 10]. Disponível em: http://antigo.depen.gov.br/DEPEN/depen/sisdepen/infopen mulheres/infopenmulheres_arte_07-03-18.pdf. According to the study by Leal et al, 90% of pregnant women deprived of their liberty in Brazil are already pregnant²2 Leal MC, Ayres BVS, Esteves-Pereira AP, Sánchez AR, Larouzé B. Birth in prison: pregnancy and birth behind bars in Brazil. Cien Saude Colet 2016; 21(7):2061-2070..

As a result of the relevance of the subject, in 2010 the United Nations Assembly approved the Bangkok Rule for the treatment of women prisoners and non-custodial measures for women offenders recommending maternity care within prisons, affirming that these women have specific needs and that human rights must be guaranteed for them and their children³3 Organização das Nações Unidas (ONU). Regras de Bangkok - regra das Nações Unidas para o tratamento de mulheres presas e medidas não privativas de liberdade para mulheres infratoras. Bangkok: 65ª Assembleia [Internet]. 2016. [acessado 2022 Fev 05]. Disponível em: https://www.cnj.jus.br/wp-content/uploads/2019/09/cd8bc11ffdcbc397c32eecdc40afbb74.pdf
https://www.cnj.jus.br/wp-content/upload... .

In Brazil, the National Policy for the Promotion, Protection, and Support of Breastfeeding is based on the principles of the Unified Health System (UHS), which comprises equity, integrality, and universality. Thus, the people who benefit from this policy cannot suffer discrimination for social, economic, geographical, religious option, or sexual orientation reasons⁴4 Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Bases para a discussão da Política Nacional de Promoção, Proteção e Apoio ao Aleitamento Materno [Internet]. Brasília: MS; 2017. [acessado 2021 Jan 10]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/bases_discussao_politica_aleitamento_materno.pdf.

Despite the encouragement, the rate of Breastfeeding (BF) has been decreasing worldwide, and for countries to raise the rate, joint actions will be necessary to encourage breastfeeding and discourage infant formulas⁵5 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 387(10017):491-504., especially strategies for vulnerable groups, such as women deprived of their liberty, who need greater support to ensure breastfeeding in prison.

Therefore, the National Breastfeeding Policy encourages actions for promotion (educational campaigns, health education, in-service training, with continuing education); protection (institutional resources and laws that protect BF, such as tax incentives for companies for BF rooms, maternity and paternity leave; Brazilian Marketing Standards for Foods for Infants and Young Children, Nipples, Pacifiers and Feeding Bottles) and support (direct assistance to women, with consultation and support groups⁴4 Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Bases para a discussão da Política Nacional de Promoção, Proteção e Apoio ao Aleitamento Materno [Internet]. Brasília: MS; 2017. [acessado 2021 Jan 10]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/bases_discussao_politica_aleitamento_materno.pdf.

Thus, to protect women, pregnant and lactating women in Brazilian prisons, the National Policy for the Care of Women in Prison and Ex-prisoners (NPCWPE)⁶6 Brasil. Ministério da Justiça. Portaria Interministerial nº 210, de 16 de janeiro de 2014. Institui a Política Nacional de Atenção às Mulheres em Situação de Privação de Liberdade e Egressas do Sistema Prisional, e dá outras providências. Brasília: Diário Oficial da União 2014; 17 jan.. However, women deprived of liberty, during pregnancy, childbirth, postpartum and puerperium; receive inferior and unequal care compared to women who are free⁷7 Simas L, Batista VM, Ventura M. Mulheres, maternidade e o sistema punitivo: limites e possibilidades das audiências de custódia no estado do Rio de Janeiro. Rev Bras Cienc Criminais 2018; 149:455-89., requiring respect for human rights, especially in the restriction of BF in the prison space, with no reception and specialized space in many Brazilian prisons. Furthermore, the separation between mother and child is cited as barriers to the encouragement and maintenance of breastfeeding, contributing to early weaning and the decrease in the breastfeeding rate.

From this perspective, in order to understand breastfeeding within the penal system, there is a need to, scientifically deepen how breastfeeding occurs within this environment. Therefore, this article presents a theme of relevance to the phenomenon of breastfeeding in prisons.

Objective

To identify and map the actions to promote, protect and support breastfeeding carried out in the prison environment.

Method

Type of study

The scoping review methodology was used, according to the JBI manual, which proposes to map concepts, clarify research areas, identify knowledge gaps and explore the breadth of the literature⁸8 Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Scoping Reviews (2020 version). In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. JBI; 2020. [cited 2021 Jan 15]. Available from: https://synthesismanual.jbi.global
https://synthesismanual.jbi.global... .

Formulation of the research question

The review question was based on the use of the mnemonic PCC, being P for participants: puerperae and pregnant women; C for concepts: actions to promote, protect, and support breastfeeding; and C for context: prison system. Thus, the question was: what actions to promote, protect, and support breastfeeding are carried out in prisons?

Data source

The searches were conducted in October 2020 in the Latin American and Caribbean Literature on Health Sciences, Nursing Database, São Paulo State Health Secretariat Database, among others of the Virtual Health Library Regional Portal, and the Virtual Health Library Breastfeeding. As well as in the Medical Literature, Analysis, and Retrieval System Online, via PubMed, in the Scientific Electronic Library Online, in the Cape Periodical Portal, SCOPUS, and WOS. There was no time limit to extend the results.

In the Capes Periodicals Portal, we used the following databases: Web of Science (Clarivate Analytics), Scopus, Embase and Cumulative Index to Nursing and Allied Health Literature - Cinahl, Academic Search Premier; SocINDEX with Full Text, Applied Social Sciences Index & Abstracts, Education Resources Information Center; National Criminal Justice Reference Service Abstracts Database; Sociological Abstracts and American Psychological Association. We added a search of the Brazilian Digital Library of Theses and Dissertations of the Brazilian Institute of Information in Science and Technology, in the Google and Google Academic search tools.

Data selection

The terms were organized for the search strategies with quotation marks to establish the exact expression of the compound term and word order. And the Boolean operators OR for grouping of synonyms and AND for intersection of terms. The terms identified in the controlled vocabularies were: “Breastfeeding” OR “Lactancia Materna” OR Breastfeeding OR “Breastfeeding” OR “Alimentación al Pecho” OR Amamantamiento, “Breast Feeding” OR “Feeding, Breast” OR Breastfeeding, Prisons OR Prison OR “Penal Centers” OR “Social Rehabilitation Centers” OR Carcere* OR “Penal Institution” OR “Penal Institutions” OR Penitentiary OR Prison* OR Prison OR Reformatory* OR Prison OR “resocialization center” OR “penal center” OR “recovery center” OR “re-education center” OR “social reintegration center” OR reformatory OR “penal establishment” OR “penal colony” OR “agricultural colony” OR “penal complex” OR “public jail” OR “penal institute” OR “detention center” OR Prisoners OR prisoners OR Detention* OR Incarcerated* OR “Person Deprived of Liberty” OR “Persons Deprived of Liberty” OR “People Deprived of Liberty” OR “Incarcerated* OR “Detained population” OR “Persona Privada de Libertad” OR “Personas Encarceladas OR “People Deprived of Liberty” OR “Population Deprived of Liberty” OR Prisoner* OR Cautivo* OR Detenido* OR Detenidos OR “Persona Privada de Libertad” OR “Personas Encarceladas” OR “Personas Privadas de Libertad” OR Prisoner* OR Rehenes OR Prisiones OR “Centros Penales” OR “Centros de Readaptación Social” OR Carcele* OR “Instituciones Penales”.

The selection was started by first reading the titles, followed by the abstracts, and, after the selection, the full text was read. Inclusion criteria were established: types of studies: review and original articles, letter to the editor, case study, and experience reports that contemplated the theme breastfeeding in the prison system, available in full text. Exclusion criteria: articles available only in abstract, as well as studies that did not contain legible information about the method, phenomenon of interest, context, sample size, and results that were not aligned with the objective of this review⁸8 Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Scoping Reviews (2020 version). In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. JBI; 2020. [cited 2021 Jan 15]. Available from: https://synthesismanual.jbi.global
https://synthesismanual.jbi.global... .

The studies that were not available were requested from the librarian in charge of the Clementine University Hospital of the Federal University of Rio de Janeiro (HUCFF/UFRJ).

Data analysis and organization

The selected studies were observed regarding identification, authorship, year of publication, country, method, and BF actions. The Rayyan QCRI 0.0.1 software was used to organize the articles.

Results

The results of the process of database searches, inclusions and exclusions can be seen in the PRISMA Flowchart (Figure 1).

The 33 selected articles were critically analyzed in relation to actions to promote, protect and support breastfeeding, resulting in the synthesis of findings, which were summarized and categorized according to identification, authorship, year of publication, country, method and breastfeeding actions, according to the results (charts 1, 2, 3, 4). The articles were identified (ID) as A1, A2, A3, ... A33, in increasing order, according to the year, and inserted into categories, according to the relevance of the theme of discussion of results.

Ten articles were identified, with relevant results for breastfeeding promotion in prison, 13 articles for breastfeeding protection in prison, and ten for breastfeeding support in prison, which supported the discussion based on the categories presented below.

Actions to promote breastfeeding at the national and international level, in the prison space

In order for breastfeeding to be successful, actions to promote breastfeeding are essential; not only for the benefit of the child, but also as a woman’s right (A19)²⁷27 Cavalcanti AL, Costa GMC, Celino SDM, Corrêa RR, Ramos RA, Cavalcanti AFC. Born in chains: perceptions of Brazilian mothers deprived of freedom about breastfeeding; Pesq Bras Odontoped Clin Integr 2018; 18(1):e4144.. However, the lack of actions to promote breastfeeding can lead to early weaning in the prison environment²⁶26 Silva DKLR, Ribeiro ACB, Souza ALTD, Pereira RMS, Gomes MP, Pereira NCS. Aleitamento materno em mulheres da população carcerária. Rev UNINGA 2018;55(3):72-82.. Therefore, it is important that health professionals develop activities that promote and support breastfeeding in prison (A4, A5, A6, A11, A12, A17, A18, A19, A20, A29)¹²12 Monteiro EMLM, Silva ARS, Nascimento CAD, Maia AFLD, Araujo PDA, Santos SM. Maternal breastfeeding in the penitentiary system. Rev Enferm UFPE 2011; 5(8):1970-1978.^,1414 Ribeiro SG, Lessa PRA, Martins MH, Nicolau AIO, Fernandes AFC, Pinheiro AKB. Experiência do amamentar por mães privadas de liberdade: estudo exploratório descritivo. Enferm Foco 2013; 4(2):84-87.^,1919 Dumont DM, Wildeman C, Lee H, Gjelsvik A, Valera PA, Clarke JG. Incarceration, maternal hardship, and perinatal health behaviors. Matern Child Health J 2014; 18(9):2179-2187.^,2020 Mariano GJS, Silva IA, Andrews T. Amamentação em ambiente prisional: perspectivas das enfermeiras de uma penitenciária feminina Irlandesa. Rev Iberoam Educ Invest Enferm 2015; 5(3):15-24.^,2626 Silva DKLR, Ribeiro ACB, Souza ALTD, Pereira RMS, Gomes MP, Pereira NCS. Aleitamento materno em mulheres da população carcerária. Rev UNINGA 2018;55(3):72-82.

27 Cavalcanti AL, Costa GMC, Celino SDM, Corrêa RR, Ramos RA, Cavalcanti AFC. Born in chains: perceptions of Brazilian mothers deprived of freedom about breastfeeding; Pesq Bras Odontoped Clin Integr 2018; 18(1):e4144.

28 Santos RMA, Linhares FMP, Morais SCRV, Guedes TG, Guimarães ML. Nursing diagnoses of incarcerated mothers. Rev Esc Enferm USP 2018; 52:e03338.^-2929 Mariano GJS, Silva IA. Significando o amamentar na prisão. Texto Contexto Enferm 2018; 27(4):e0590017.^,3737 Paynter MJ, Drake EK, Cassidy C, Snelgrove-Clarke E. Maternal health outcomes for incarcerated women: a scoping review. J Clin Nurs 2019; 28(11-12):2046-2060., in order to provide conditions for lactating women deprived of their freedom to feel more secure when breastfeeding their children (A17)²⁵25 Paynter MJ, Snelgrove-Clarke E. Breastfeeding support for criminalized women in Canada. J Hum Lact 2017; 33(4):672-676..

The lack of knowledge about breastfeeding is recurrent in the studies (A4, A19), and the promotion of health education is urgent. Therefore, a trained multidisciplinary team is essential for the development of activities to promote breastfeeding (A4, A5, A11, A19, A20)¹²12 Monteiro EMLM, Silva ARS, Nascimento CAD, Maia AFLD, Araujo PDA, Santos SM. Maternal breastfeeding in the penitentiary system. Rev Enferm UFPE 2011; 5(8):1970-1978.^,1313 Huang K, Atlas R, Parvez F. The significance of breastfeeding to incarcerated pregnant women: an exploratory study. Birth 2012; 39(2):145-155.^,1919 Dumont DM, Wildeman C, Lee H, Gjelsvik A, Valera PA, Clarke JG. Incarceration, maternal hardship, and perinatal health behaviors. Matern Child Health J 2014; 18(9):2179-2187.^,2727 Cavalcanti AL, Costa GMC, Celino SDM, Corrêa RR, Ramos RA, Cavalcanti AFC. Born in chains: perceptions of Brazilian mothers deprived of freedom about breastfeeding; Pesq Bras Odontoped Clin Integr 2018; 18(1):e4144.^,2828 Santos RMA, Linhares FMP, Morais SCRV, Guedes TG, Guimarães ML. Nursing diagnoses of incarcerated mothers. Rev Esc Enferm USP 2018; 52:e03338., for the valorization of citizenship and respect for integrality¹²12 Monteiro EMLM, Silva ARS, Nascimento CAD, Maia AFLD, Araujo PDA, Santos SM. Maternal breastfeeding in the penitentiary system. Rev Enferm UFPE 2011; 5(8):1970-1978., because the practice of breastfeeding, still, is not in fact perpetuated in the prison space, due to insufficient information and encouragement for the practice (A18), increasing the vulnerability of women and children²⁶26 Silva DKLR, Ribeiro ACB, Souza ALTD, Pereira RMS, Gomes MP, Pereira NCS. Aleitamento materno em mulheres da população carcerária. Rev UNINGA 2018;55(3):72-82.. Thus, a professional as a health educator in the prison environment contributes with information that will motivate changes in habits about breastfeeding, influencing decisions that will impact the health of the woman and child²⁸28 Santos RMA, Linhares FMP, Morais SCRV, Guedes TG, Guimarães ML. Nursing diagnoses of incarcerated mothers. Rev Esc Enferm USP 2018; 52:e03338..

However, a study conducted in Ireland in 2016 corroborates authors¹²12 Monteiro EMLM, Silva ARS, Nascimento CAD, Maia AFLD, Araujo PDA, Santos SM. Maternal breastfeeding in the penitentiary system. Rev Enferm UFPE 2011; 5(8):1970-1978.^,2727 Cavalcanti AL, Costa GMC, Celino SDM, Corrêa RR, Ramos RA, Cavalcanti AFC. Born in chains: perceptions of Brazilian mothers deprived of freedom about breastfeeding; Pesq Bras Odontoped Clin Integr 2018; 18(1):e4144.^,2828 Santos RMA, Linhares FMP, Morais SCRV, Guedes TG, Guimarães ML. Nursing diagnoses of incarcerated mothers. Rev Esc Enferm USP 2018; 52:e03338., which describes that, although there is a policy for the female prison population, the actions to promote breastfeeding do not exist and women deprived of freedom do not breastfeed in prison, because the health professionals’ practices are focused on treatment and not on promotion. Thus, the activities to encourage breastfeeding and the benefits for the health of women and children do not occur²⁰20 Mariano GJS, Silva IA, Andrews T. Amamentação em ambiente prisional: perspectivas das enfermeiras de uma penitenciária feminina Irlandesa. Rev Iberoam Educ Invest Enferm 2015; 5(3):15-24.. There is a need for breastfeeding in the prison space, described in study A17, developed in 2018 in Canada, in which with the increase in the female prison population, the promotion of breastfeeding in prison becomes a positive activity and ensures benefits within the prison space²⁵25 Paynter MJ, Snelgrove-Clarke E. Breastfeeding support for criminalized women in Canada. J Hum Lact 2017; 33(4):672-676..

Another study conducted in the US (A29) in 2018 noted a large increase in people incarcerated in that country³⁷37 Paynter MJ, Drake EK, Cassidy C, Snelgrove-Clarke E. Maternal health outcomes for incarcerated women: a scoping review. J Clin Nurs 2019; 28(11-12):2046-2060., agreeing with the results of another survey (A17)²⁵25 Paynter MJ, Snelgrove-Clarke E. Breastfeeding support for criminalized women in Canada. J Hum Lact 2017; 33(4):672-676.. With this, there is an increase in the population of pregnant and lactating women. However, the study points out that there is little research on breastfeeding in prison that reports the importance of promoting breastfeeding in the prison setting³⁷37 Paynter MJ, Drake EK, Cassidy C, Snelgrove-Clarke E. Maternal health outcomes for incarcerated women: a scoping review. J Clin Nurs 2019; 28(11-12):2046-2060., and the few studies found only reported on the benefits of breastfeeding for the child within the prison system¹²12 Monteiro EMLM, Silva ARS, Nascimento CAD, Maia AFLD, Araujo PDA, Santos SM. Maternal breastfeeding in the penitentiary system. Rev Enferm UFPE 2011; 5(8):1970-1978.^,1414 Ribeiro SG, Lessa PRA, Martins MH, Nicolau AIO, Fernandes AFC, Pinheiro AKB. Experiência do amamentar por mães privadas de liberdade: estudo exploratório descritivo. Enferm Foco 2013; 4(2):84-87.^,1919 Dumont DM, Wildeman C, Lee H, Gjelsvik A, Valera PA, Clarke JG. Incarceration, maternal hardship, and perinatal health behaviors. Matern Child Health J 2014; 18(9):2179-2187.^,2020 Mariano GJS, Silva IA, Andrews T. Amamentação em ambiente prisional: perspectivas das enfermeiras de uma penitenciária feminina Irlandesa. Rev Iberoam Educ Invest Enferm 2015; 5(3):15-24.^,3737 Paynter MJ, Drake EK, Cassidy C, Snelgrove-Clarke E. Maternal health outcomes for incarcerated women: a scoping review. J Clin Nurs 2019; 28(11-12):2046-2060..

In another article (A6), developed in 2013, in a penitentiary in Ceará/BR, it was observed that most women deprived of liberty had previously breastfed, a positive factor for women, for having already experienced the practice of breastfeeding, however, inside the prison, these women were weakened, requiring health actions on breastfeeding developed by health professionals¹⁴14 Ribeiro SG, Lessa PRA, Martins MH, Nicolau AIO, Fernandes AFC, Pinheiro AKB. Experiência do amamentar por mães privadas de liberdade: estudo exploratório descritivo. Enferm Foco 2013; 4(2):84-87.. However, experience developed in the USA in 2011 (A11) shows that imprisonment is an important factor for public health, as it is a social determinant that interferes with the health of children under one year of age. Participants demonstrated very low rates at any time during breastfeeding. Therefore, the study suggested that health care providers need to support them to improve breastfeeding practice¹⁹19 Dumont DM, Wildeman C, Lee H, Gjelsvik A, Valera PA, Clarke JG. Incarceration, maternal hardship, and perinatal health behaviors. Matern Child Health J 2014; 18(9):2179-2187..

In another study developed in a penal institution in New York/USA (A5) in 2013, it was observed that there are no educational works on breastfeeding or specific policies for this population, and that, during the prison period, the mother-baby bond is affected, as well as mental health and breastfeeding, which directly interferes with the health of the woman and the child. The authors pointed out that only nine prisons in the US allow mothers to breastfeed their babies. Therefore, most babies are separated from their mothers at birth, not being an option for the woman, with an absence of policies to support and encourage breastfeeding in the prison environment¹³13 Huang K, Atlas R, Parvez F. The significance of breastfeeding to incarcerated pregnant women: an exploratory study. Birth 2012; 39(2):145-155..

National and international breastfeeding protection actions in the prison space

There are numerous obstacles for the protection of breastfeeding within the Brazilian prison space (A8, A9, A10, A13, A16, A21, A22, A23, A30). However, Brazil sets an example for protection, through legislations that protect breastfeeding in prison. Since 1984, with the Penal Execution Law; 1988, with the Brazilian Constitution; in 1990, with the Child and Adolescent Statute, means to guarantee breastfeeding are sought (A8)¹⁶16 Dalmácio LM, Cruz EJS, Cavalcante LIC. Percepções de mães encarceradas sobre o direito à amamentação no sistema prisional. Rev Bras Hist Cienc Soc 2014;;6(11):54-72..

Considerable progress occurred in 2011, when the right to house arrest for women who are pregnant, have disabled children and/or minors began¹⁶16 Dalmácio LM, Cruz EJS, Cavalcante LIC. Percepções de mães encarceradas sobre o direito à amamentação no sistema prisional. Rev Bras Hist Cienc Soc 2014;;6(11):54-72.. And, with the creation in 2014 of the National Policy for the Care of Women in Detention and Prison Egresses, the expansion of the protection of women in breastfeeding in prison was promoted (A9)¹⁷17 Ventura M, Simas L, Lauróze B. Maternidade atrás das grades: em busca da cidadania e da saúde. Um estudo sobre a legislação brasileira. Cad Saude Publica 2015; 31(3):607-619.. But, despite the various Brazilian norms, there are still fragilities in relation to guaranteeing the rights of these women and their children¹⁷17 Ventura M, Simas L, Lauróze B. Maternidade atrás das grades: em busca da cidadania e da saúde. Um estudo sobre a legislação brasileira. Cad Saude Publica 2015; 31(3):607-619..

As the violation of women’s rights, in which there is ignorance on their part, even with the legal protection, as described in the study developed in a Mother and Child Unit of a penal institution in Pará/BR (A23)³¹31 Leal GAS. Responsividade materna durante o banho e amamentação: análise da interação mãe-bebê no cárcere [dissertação]. Belém: Universidade Federal do Pará; 2018.. The relevance of the rules of the penal system is to protect breastfeeding in prison, however, these rules generate several stresses for women, because they are imposed and are considered barriers to successful breastfeeding (A22)³⁰30 Guimarães MLG, Guedes TG, Lima LS, Morais VSCR, Javorski M, Linhares FMP. Promoção do aleitamento materno no sistema prisional a partir da percepção de nutrizes encarceradas. Texto Contexto Enferm 2018; 27(4):e3030017..

In order to protect breastfeeding in prison, an integrative literature review (A30) mentions that the Brazilian criminal justice system has well-defined laws and public policies, but they need to be responsive to the real needs of women and their children³⁸38 Santos MV, Alves VH, Pereira AV, Vieira BDG, Rodrigues DP, Marchiori GRS, Rangel GCR, Cunha RC, Guerra JVV, Branco MBLR. Proteção à amamentação no espaço prisional: revisão integrativa. REDIB 2020; 9(9):e555997692.. As observed in the study conducted in the databases of the STF, STJ and the Courts of Justice of Rio Grande do Sul, Paraná, São Paulo and Mato Grosso (A10), in 2015, referring to the databases of the Brazilian higher courts, the right to maternity was an invisible theme, forgetting that women deprived of liberty have rights as citizens¹⁸18 Simas L, Ventura M, Baptista MR, Laurozé B. The Brazilian jurisprudence about motherhood in prison. Rev Direito GV 2015; 11(2):547-572.. These difficulties can be observed in the study conducted in Pará-Brazil (A23), in 2018, which describes impeditive situations for the practice of BF, with the absence of protection for women³¹31 Leal GAS. Responsividade materna durante o banho e amamentação: análise da interação mãe-bebê no cárcere [dissertação]. Belém: Universidade Federal do Pará; 2018..

This situation of obstacles could not happen, since the State has the duty to ensure respect for breastfeeding and protection in the prison system. A study conducted in the state of São Paulo (A21), in 2018, observed that women, when breastfeeding, had a feeling of protection towards their children, and breastfeeding was an act that aroused good emotions, consequently, women felt more valued when they were respected³¹31 Leal GAS. Responsividade materna durante o banho e amamentação: análise da interação mãe-bebê no cárcere [dissertação]. Belém: Universidade Federal do Pará; 2018..

Therefore, the Brazilian penal system, according to a study carried out in prison institutions in São Paulo/BR (A13), must protect and provide subsidies for the bond to remain not only with the mother and child, but also to be extended to family members and the community, understanding that breastfeeding can be a new perspective of change²¹21 Mariano GJS. Amamentação no ambiente prisional: detentas em penitenciárias do Estado de São Paulo [tese]. São Paulo: Universidade de São Paulo; 2016. It should be added that protection should be provided by the prison system, not only with laws, but with a differentiated prison environment, since the study (A16) highlights that prison is a stressful and often unhealthy environment, in which many women need to adapt to the rules of the penal institution in order to be able to stay with their children²⁴24 Fochi MCS, Higa R, Camisão AR, Turato ER, Lopes MHBM. Experiences of pregnant women in prison situation. Rev Eletr Enf 2017; 19:a57..

In other legislation, such as in Canada, the study conducted in federal prisons (A24) in 2018 reported that while there are laws that guarantee some rights to prisoners, there is no legislation that addresses breastfeeding³²32 Paynter MJ. Policy and legal protection for breastfeeding and incarcerated women in Canada. J Clin Nurs 2018; 34(2):276-281.. The authors confirm this information, in that in the Province of Manitoba, since 1998, there is a guarantee of the child living with the person deprived of liberty, but there is no evidence of a child in prison in the province of Manitoba³²32 Paynter MJ. Policy and legal protection for breastfeeding and incarcerated women in Canada. J Clin Nurs 2018; 34(2):276-281..

In Canada, there were nearly 5,000 incarcerated women and 5% of women in prison were pregnant. This population increased 66% from 2005 to 2014, even with this increase, few studies have been conducted to examine the impact of breastfeeding within the prison and penal institution. Punitive power supersedes health needs, as described by the authors of A28³⁶36 Paynter MJ, Snelgrove-Clarke E. "Breastfeeding in public" for incarcerated women: the baby-friendly step. Int Breastfeed J 2019; 14:16.. Thus, it is emphasized that Canadian prisons need to effectively implement policies that guarantee the effectiveness of women’s and children’s rights and the protection of AM, according to A24 and A28³²32 Paynter MJ. Policy and legal protection for breastfeeding and incarcerated women in Canada. J Clin Nurs 2018; 34(2):276-281.^,3636 Paynter MJ, Snelgrove-Clarke E. "Breastfeeding in public" for incarcerated women: the baby-friendly step. Int Breastfeed J 2019; 14:16..

Provincial prisons do not allow women to be with their children, but federal penal institutions have policies to assist women and children in prison. Thus, there is an urgent need for a unified implementation in Canadian prisons and a reference on the rights to breastfeed³⁶36 Paynter MJ, Snelgrove-Clarke E. "Breastfeeding in public" for incarcerated women: the baby-friendly step. Int Breastfeed J 2019; 14:16..

On the African continent, the authors of article A31, 2020, report that Malawi’s policies need to adapt to the needs of pregnant and breastfeeding women, as there are legislations for the treatment of women deprived of liberty in accordance with international rules, but there is no legislation to protect breastfeeding³⁹39 Gadama L, Thakwalakwa C, Mula C, Mhango V, Banda C, Kewley S, Hillis A, Van Hout MC. 'Prison facilities were not built with a woman in mind': an exploratory multi-stakeholder study on women's situation in Malawi prisons. Int J Prison Health 2020;16(3):303-318..

In Mozambique, another African country, the right to breastfeed in prison is guaranteed, according to A25 in 2018³³33 Arinde EL, Mendonça MH. Política prisional e garantia de atenção integral à saúde da criança que coabita com mãe privada de liberdade, Moçambique. Saúde Debate 2019; 43(120):43-53.. The study carried out in the penitentiary in Ndlavela reports the existence of the penitentiary health care service, in addition to having the special penitentiary establishment for women deprived of freedom, which has the assistance in the puerperal pregnancy period and attends to children from zero to five years old. However, the authors³³33 Arinde EL, Mendonça MH. Política prisional e garantia de atenção integral à saúde da criança que coabita com mãe privada de liberdade, Moçambique. Saúde Debate 2019; 43(120):43-53. report that women and their children live in conditions of vulnerability.

National and international breastfeeding support actions in the prison space

In 2010, a Brazilian article (A2) reported that the penal system did not have adequate conditions for breastfeeding to occur in this environment. The lactating women showed some knowledge about the health benefits for the woman and child, but these same women felt insecure about breastfeeding, especially after the separation of the child from the mother¹⁰10 Rios SR, Silva AL. Amamentação em presídio: estudo das condições e práticas no Estado de São Paulo, Brasil. BIS, Bol Inst Saude 2010; 12(3):293-299.. The need for support has been demonstrated in several studies (A1, A2, A3, A7, A15, A26, A27, A32, A33)⁹9 Beech BAL. How could I breast feed with a man in the room? BMJ 1996; 312(7025):256

10 Rios SR, Silva AL. Amamentação em presídio: estudo das condições e práticas no Estado de São Paulo, Brasil. BIS, Bol Inst Saude 2010; 12(3):293-299.^-1111 Marshall D. Birth Companions: working with women in prison giving birth. Br J Midwifery 2013; 18(4).^,1515 Allen D, Baker B. Supporting mothering through breastfeeding for incarcerated women. J Obstet Gynecol Neonatal Nurs 2013; 42(Supl. 1):S103.^,2323 Abbott L, Scott T. Women's experiences of breastfeeding in prison. MIDIRS Midwifery Digest 2017; 27:217-23.^,3434 Andrade ABCA, Gonçalves MJF. Motherhood in prison regime: maternal and neonatal outcomes. Rev Enferm UFPE 2018; 12(6):1763-1771.^,4040 Nogueira A, Ferreira BMV, Costa LVFA, Silva JCB, Guerra MCGC, Albuquerque NLA. Aleitamento materno no sistema penitenciário: sentimentos da lactante. Rev Ciênc Plural 2020; 6(1):18-31.^,4141 Friedman SH, Kaempf A, Kauffman S. The realities of pregnancy and mothering while incarcerated. J Am Acad Psychiatry Law 2020; 48(3):365-375., for example, the study in a Women’s Penal Colony in Recife/BR (A32), conducted in 2020, showed this obstacle regarding the support for breastfeeding in the prison system, by both professionals and family members⁴⁰40 Nogueira A, Ferreira BMV, Costa LVFA, Silva JCB, Guerra MCGC, Albuquerque NLA. Aleitamento materno no sistema penitenciário: sentimentos da lactante. Rev Ciênc Plural 2020; 6(1):18-31..

The lack of support is characteristic of vulnerable women, such as black women and those with unfavorable socioeconomic conditions, corroborating the statement of the need for family support for breastfeeding. Thus, women deprived of liberty are more exposed in the pregnant-puerperal period, since there is a potential shortage of health professionals and, when they have professionals, there is no activity to support breastfeeding (A26)³⁴34 Andrade ABCA, Gonçalves MJF. Motherhood in prison regime: maternal and neonatal outcomes. Rev Enferm UFPE 2018; 12(6):1763-1771..

In England, in a penitentiary (A1), in 1996, women were imprisoned during childbirth and breastfeeding was not effective, inhibiting the human right and health of the child and the woman, as a respect for citizenship⁹9 Beech BAL. How could I breast feed with a man in the room? BMJ 1996; 312(7025):256. In the study (A3), the need for change in England was argued¹¹11 Marshall D. Birth Companions: working with women in prison giving birth. Br J Midwifery 2013; 18(4)., with the creation of a group of women doulas, which aimed to carry out a birth plan and birth monitoring, in addition to supporting and encouraging the practice of BF in prison. The doulas are strategies to support BF, as described by A3 and A27¹¹11 Marshall D. Birth Companions: working with women in prison giving birth. Br J Midwifery 2013; 18(4).^,3535 Shlafer RJ, Davis L, Hindt LA. Goshin LS, Gerrity E. Intention and initiation of breastfeeding among women who are incarcerated. Nurs Womens Health 2018; 22(1):64-78..

Only six prisons in the UK have joint accommodation, which encourages separation of mother and child, as women’s prisons are not equipped to support and encourage breastfeeding, according to the study in prisons in Wales (A14)²²22 Abbott L. Becoming a mother in the prison. Pract Midwife 2016;19(9):8-12.. Agreeing with this statement, A7, A15, A27, A32¹⁵15 Allen D, Baker B. Supporting mothering through breastfeeding for incarcerated women. J Obstet Gynecol Neonatal Nurs 2013; 42(Supl. 1):S103.^,2323 Abbott L, Scott T. Women's experiences of breastfeeding in prison. MIDIRS Midwifery Digest 2017; 27:217-23.^,3434 Andrade ABCA, Gonçalves MJF. Motherhood in prison regime: maternal and neonatal outcomes. Rev Enferm UFPE 2018; 12(6):1763-1771.^,4040 Nogueira A, Ferreira BMV, Costa LVFA, Silva JCB, Guerra MCGC, Albuquerque NLA. Aleitamento materno no sistema penitenciário: sentimentos da lactante. Rev Ciênc Plural 2020; 6(1):18-31. say that support is paramount for successful breastfeeding.

In the United States, if a woman is in prison without day care, she is automatically separated from her child upon discharge from the hospital and unable to provide child care upon return to prison (A35), perpetuating important obstacles to breastfeeding. However, in a positive experience in a prison unit in the USA (A7), to support a woman in breastfeeding, a breastfeeding plan was developed, with the creation of a partnership with the health team, the lactating woman, the family members, and the unit, showing the possibility of promoting breastfeeding in a safe and effective way¹⁵15 Allen D, Baker B. Supporting mothering through breastfeeding for incarcerated women. J Obstet Gynecol Neonatal Nurs 2013; 42(Supl. 1):S103..

Thus, it is necessary to support women in prison for the success of breastfeeding, in order to break through the system’s obstacles and overcome the shortage of professionals, as well as the lack of a safe environment (A33)⁴¹41 Friedman SH, Kaempf A, Kauffman S. The realities of pregnancy and mothering while incarcerated. J Am Acad Psychiatry Law 2020; 48(3):365-375..

Discussion

The increase in the female prison population has been occurring in several countries around the world, such as the USA, China, Russia, Brazil, Thailand, India, the Philippines, Vietnam, Indonesia, Mexico, Myanmar and Turkey, and others⁵5 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 387(10017):491-504.. The Bangkok rules ensure respect for women deprived of their liberty, especially since many have vulnerabilities, most notably pregnant and lactating women, with access to health care¹⁶16 Dalmácio LM, Cruz EJS, Cavalcante LIC. Percepções de mães encarceradas sobre o direito à amamentação no sistema prisional. Rev Bras Hist Cienc Soc 2014;;6(11):54-72.^,2222 Abbott L. Becoming a mother in the prison. Pract Midwife 2016;19(9):8-12.^,2323 Abbott L, Scott T. Women's experiences of breastfeeding in prison. MIDIRS Midwifery Digest 2017; 27:217-23.^,3232 Paynter MJ. Policy and legal protection for breastfeeding and incarcerated women in Canada. J Clin Nurs 2018; 34(2):276-281., since most of them have their pregnancy discovered inside the prison system, having an important portion without access to care during the pregnancy-puerperal cycle, with the lack of incentive and support for breastfeeding and the separation of the children after birth, which are part of the reality of many prisons around the world²²22 Abbott L. Becoming a mother in the prison. Pract Midwife 2016;19(9):8-12.^,2424 Fochi MCS, Higa R, Camisão AR, Turato ER, Lopes MHBM. Experiences of pregnant women in prison situation. Rev Eletr Enf 2017; 19:a57.^,2727 Cavalcanti AL, Costa GMC, Celino SDM, Corrêa RR, Ramos RA, Cavalcanti AFC. Born in chains: perceptions of Brazilian mothers deprived of freedom about breastfeeding; Pesq Bras Odontoped Clin Integr 2018; 18(1):e4144.^,3434 Andrade ABCA, Gonçalves MJF. Motherhood in prison regime: maternal and neonatal outcomes. Rev Enferm UFPE 2018; 12(6):1763-1771.^,3535 Shlafer RJ, Davis L, Hindt LA. Goshin LS, Gerrity E. Intention and initiation of breastfeeding among women who are incarcerated. Nurs Womens Health 2018; 22(1):64-78..

The promotion of breastfeeding is an important strategy to ensure health and maintenance for children’s growth and development, but, despite the numerous benefits for women and children, it is not yet a reality for women in the prison system, with the nurse as the professional who most assumes the responsibility and commitment for the promotion and support of breastfeeding in this environment¹⁴14 Ribeiro SG, Lessa PRA, Martins MH, Nicolau AIO, Fernandes AFC, Pinheiro AKB. Experiência do amamentar por mães privadas de liberdade: estudo exploratório descritivo. Enferm Foco 2013; 4(2):84-87.^,2727 Cavalcanti AL, Costa GMC, Celino SDM, Corrêa RR, Ramos RA, Cavalcanti AFC. Born in chains: perceptions of Brazilian mothers deprived of freedom about breastfeeding; Pesq Bras Odontoped Clin Integr 2018; 18(1):e4144..

Among some of the barriers are the environment, the damaged bond, the absence of a multidisciplinary professional team, the guaranteed time for breastfeeding¹⁰10 Rios SR, Silva AL. Amamentação em presídio: estudo das condições e práticas no Estado de São Paulo, Brasil. BIS, Bol Inst Saude 2010; 12(3):293-299.^,1212 Monteiro EMLM, Silva ARS, Nascimento CAD, Maia AFLD, Araujo PDA, Santos SM. Maternal breastfeeding in the penitentiary system. Rev Enferm UFPE 2011; 5(8):1970-1978.^,1414 Ribeiro SG, Lessa PRA, Martins MH, Nicolau AIO, Fernandes AFC, Pinheiro AKB. Experiência do amamentar por mães privadas de liberdade: estudo exploratório descritivo. Enferm Foco 2013; 4(2):84-87.^,2424 Fochi MCS, Higa R, Camisão AR, Turato ER, Lopes MHBM. Experiences of pregnant women in prison situation. Rev Eletr Enf 2017; 19:a57.^,2727 Cavalcanti AL, Costa GMC, Celino SDM, Corrêa RR, Ramos RA, Cavalcanti AFC. Born in chains: perceptions of Brazilian mothers deprived of freedom about breastfeeding; Pesq Bras Odontoped Clin Integr 2018; 18(1):e4144.^,2828 Santos RMA, Linhares FMP, Morais SCRV, Guedes TG, Guimarães ML. Nursing diagnoses of incarcerated mothers. Rev Esc Enferm USP 2018; 52:e03338.^,3030 Guimarães MLG, Guedes TG, Lima LS, Morais VSCR, Javorski M, Linhares FMP. Promoção do aleitamento materno no sistema prisional a partir da percepção de nutrizes encarceradas. Texto Contexto Enferm 2018; 27(4):e3030017.^,3535 Shlafer RJ, Davis L, Hindt LA. Goshin LS, Gerrity E. Intention and initiation of breastfeeding among women who are incarcerated. Nurs Womens Health 2018; 22(1):64-78., the disregard for the recommendations, on free demand mentioned by the WHO and the MH, enabling a greater chance of early weaning and effective factors for not breastfeeding in prison⁴²42 Romão P, Durão F, Valente S, Saldanha J. Aleitamento materno: o que mudou em 12 anos. Nascer e Crescer - Birth and Growth Medical Journal. 2017; 26(3):171-177.. Thus, there is a need for the State to invest in the creation of specific spaces, such as breastfeeding rooms, with the participation of trained staff, in order to favor the promotion, protection and support of breastfeeding in prison¹²12 Monteiro EMLM, Silva ARS, Nascimento CAD, Maia AFLD, Araujo PDA, Santos SM. Maternal breastfeeding in the penitentiary system. Rev Enferm UFPE 2011; 5(8):1970-1978.^,1414 Ribeiro SG, Lessa PRA, Martins MH, Nicolau AIO, Fernandes AFC, Pinheiro AKB. Experiência do amamentar por mães privadas de liberdade: estudo exploratório descritivo. Enferm Foco 2013; 4(2):84-87.^,2626 Silva DKLR, Ribeiro ACB, Souza ALTD, Pereira RMS, Gomes MP, Pereira NCS. Aleitamento materno em mulheres da população carcerária. Rev UNINGA 2018;55(3):72-82.^,2727 Cavalcanti AL, Costa GMC, Celino SDM, Corrêa RR, Ramos RA, Cavalcanti AFC. Born in chains: perceptions of Brazilian mothers deprived of freedom about breastfeeding; Pesq Bras Odontoped Clin Integr 2018; 18(1):e4144..

It is noteworthy that some countries, such as Ireland, Canada, USA, Mozambique, Malawi, and Brazil have laws and policies for breastfeeding in the prison system, but there is a lack of more effective actions to guarantee the rights of women and children. At this juncture, Brazil stands out for its various laws and policies to protect breastfeeding, including the right to breastfeed in house arrest¹⁷17 Ventura M, Simas L, Lauróze B. Maternidade atrás das grades: em busca da cidadania e da saúde. Um estudo sobre a legislação brasileira. Cad Saude Publica 2015; 31(3):607-619.. However, an inequality is observed between what is determined in the Brazilian legislations and what is executed in the prison units, requiring the use of the legislative determinations for this effectiveness¹⁴14 Ribeiro SG, Lessa PRA, Martins MH, Nicolau AIO, Fernandes AFC, Pinheiro AKB. Experiência do amamentar por mães privadas de liberdade: estudo exploratório descritivo. Enferm Foco 2013; 4(2):84-87.^,2525 Paynter MJ, Snelgrove-Clarke E. Breastfeeding support for criminalized women in Canada. J Hum Lact 2017; 33(4):672-676..

In other countries such as Canada, Mozambique and Malawi, despite the existence of legislation for the population deprived of freedom, there is no legislation that guarantees breastfeeding within the penal institution, showing the need for the advancement of human rights within prisons, on the issue of women and children’s rights to breastfeeding. However, in these same countries, when some women are allowed to stay with their babies, they receive the support of doulas, midwives, and some have the support of society, as is the model in England¹¹11 Marshall D. Birth Companions: working with women in prison giving birth. Br J Midwifery 2013; 18(4).^,2222 Abbott L. Becoming a mother in the prison. Pract Midwife 2016;19(9):8-12.^,2525 Paynter MJ, Snelgrove-Clarke E. Breastfeeding support for criminalized women in Canada. J Hum Lact 2017; 33(4):672-676.. This was only possible with the sensibility of society and the State, because many women had this difficulty in England, and, with this support, a significant contribution was made to change this reality¹¹11 Marshall D. Birth Companions: working with women in prison giving birth. Br J Midwifery 2013; 18(4).^,1212 Monteiro EMLM, Silva ARS, Nascimento CAD, Maia AFLD, Araujo PDA, Santos SM. Maternal breastfeeding in the penitentiary system. Rev Enferm UFPE 2011; 5(8):1970-1978.. However, despite all efforts, there are still women being separated from their children, making it impossible for them to breastfeed²³23 Abbott L, Scott T. Women's experiences of breastfeeding in prison. MIDIRS Midwifery Digest 2017; 27:217-23..

It is emphasized that breastfeeding is not only the woman’s responsibility, but everyone’s, managers, health professionals, safety, state and society⁴³43 Prates LA, Schmalfuss JM, Lipinski JM. Rede de apoio social de puérperas na prática da amamentação. Esc Anna Nery 2015; 19(2):310-315.^,4444 Melo DS, Oliveira MH, Pereira DS. Brazil's progress in protecting, promoting and supporting breastfeeding from the perspective of the global breastfeeding collective. Rev Paul Pediatr 2021; 39:e2019296., in addition to the primordial support of the family, which guarantees more effective BF and a healthier population⁴⁵45 Victora CG, Barros AJD, França GVA, Bahl R, Rollins NC, Horton S, Kasevec J, Murch S, Sankar MJ, Walker N. Amamentação no século 21: epidemiologia, mecanismos e efeitos ao longo da vida. Epidemiol Serv Saude 2016; 16:1-24.. This reality must change in Brazil, especially due to the deficiencies of penal institutions, health and security professionals in guaranteeing the promotion, protection and support of BF⁹9 Beech BAL. How could I breast feed with a man in the room? BMJ 1996; 312(7025):256^,1010 Rios SR, Silva AL. Amamentação em presídio: estudo das condições e práticas no Estado de São Paulo, Brasil. BIS, Bol Inst Saude 2010; 12(3):293-299.^,3333 Arinde EL, Mendonça MH. Política prisional e garantia de atenção integral à saúde da criança que coabita com mãe privada de liberdade, Moçambique. Saúde Debate 2019; 43(120):43-53.

34 Andrade ABCA, Gonçalves MJF. Motherhood in prison regime: maternal and neonatal outcomes. Rev Enferm UFPE 2018; 12(6):1763-1771.^-3535 Shlafer RJ, Davis L, Hindt LA. Goshin LS, Gerrity E. Intention and initiation of breastfeeding among women who are incarcerated. Nurs Womens Health 2018; 22(1):64-78.^,3939 Gadama L, Thakwalakwa C, Mula C, Mhango V, Banda C, Kewley S, Hillis A, Van Hout MC. 'Prison facilities were not built with a woman in mind': an exploratory multi-stakeholder study on women's situation in Malawi prisons. Int J Prison Health 2020;16(3):303-318.^,4040 Nogueira A, Ferreira BMV, Costa LVFA, Silva JCB, Guerra MCGC, Albuquerque NLA. Aleitamento materno no sistema penitenciário: sentimentos da lactante. Rev Ciênc Plural 2020; 6(1):18-31..

Thus, the prison system needs to emphasize the WHO recommendations regarding breastfeeding and understand how a practice benefits the health of women, children, and society as a whole. Women’s prisons around the world should ensure actions to promote, protect, and support breastfeeding. Breastfeeding in prisons is a right guaranteed internationally by the Bangkok Rules³3 Organização das Nações Unidas (ONU). Regras de Bangkok - regra das Nações Unidas para o tratamento de mulheres presas e medidas não privativas de liberdade para mulheres infratoras. Bangkok: 65ª Assembleia [Internet]. 2016. [acessado 2022 Fev 05]. Disponível em: https://www.cnj.jus.br/wp-content/uploads/2019/09/cd8bc11ffdcbc397c32eecdc40afbb74.pdf
https://www.cnj.jus.br/wp-content/upload... , as a human right. However, penal institutions still lack the structural conditions to meet the needs of women and children for BF, thus, alternative measures must be created to reduce inequalities and the violation of rights.

Concluding remarks

The study identified and mapped the actions of promotion, protection, and support in the field of breastfeeding within the prison system, many of them nullifying the guarantee of the right of women and children who live in this environment.

Therefore, the actions need to be intensified, with support from the WHO and UNICEF, in addition to the efforts of health and safety professionals, managers, academia and society as a whole, since this is a relevant issue for women’s and children’s health.

Thus, breastfeeding in prison should favor actions of promotion, protection and support, since many children with mothers deprived of their liberty are still prevented from being breastfed soon after birth, which characterizes inequality in relation to the population in freedom.

References

Supplementary material

This study is the result of the products of the Thesis entitled: Lactating women and the axiological understanding of breastfeeding in the prison space, Universidade Federal Fluminense. The data from the research carried out and defended is available in its entirety at the link: https://app.uff.br/riuff/handle/1/23807.

Publication Dates

History