Abstract

In Brazil, there has been an uncontrolled increase in incarceration of women, and this situation is not interrupted during periods of pregnancy or lactation. A scoping review was carried out to systematically map and synthesize evidence published since 2000 on the practice of exclusive breastfeeding (EBF) among imprisoned people in Brazil. Intersectionality and penal abolitionism were the theoretical-methodological approaches used to analyze the studies. A total of 25 studies were selected, 90% of which were published from 2010 to 2020. In the context of maternal and child health, they mainly exposed the difficulties of maintaining EBF in prison, including the lack of definition of a minimum period of stay for the baby, the lack of professional guidance for the practice of EBF, and the inadequate structure of prison units. In the area of law, the studies reported tensions between the disciplinary order and children’s irreducible human right to food. The studies focused the investigation on the mothers’ experiences, but did not question the practical and historical forms of imprisonment, especially regarding Black, female, and poor bodies. Critical and propositional approaches are necessary to produce evidence toward the guarantee of rights to health and food.

Keywords:
Breastfeeding; Prisons; Maternal and Child Health; Brazil

Introduction

Breastfeeding is a process that involves deep interaction between the breastfeeding person and the baby. The World Health Organization (WHO), endorsed by the Brazilian Ministry of Health, recommends breastfeeding for two years or more, being exclusive for the first six months and preferably started within the first hour after birth (Brasil, 2021BRASIL. Ministério da Saúde. Guia Alimentar para Crianças Brasileiras Menores de 2 Anos. Brasília, DF, 2021.). Despite the increases recorded in recent decades (Boccolini et al., 2017BOCCOLINI C. S. et al. Tendência de indicadores do aleitamento materno no Brasil em três décadas. Revista de Saúde Pública, São Paulo, v. 51, 2017. DOI: 10.11606/S1518-8787.2017051000029
https://doi.org/10.11606/S1518-8787.2017... ), the Brazilian National Survey of Child Nutrition (ENANI) estimated that the prevalence of exclusive breastfeeding (EBF) for up to six months was 45.8% in 2019, without significant differences across macro-regions (UFRJ, 2021UFRJ - UNIVERSIDADE FEDERAL DO RIO DE JANEIRO. Aleitamento materno: Prevalência e práticas de aleitamento materno em crianças brasileiras menores de 2 anos, ENANI 2019. Rio de Janeiro: UFRJ, 2021. Disponível em: <Disponível em: https://enani.nutricao.ufrj.br/wp-content/uploads/2021/11/Relatorio-4_ENANI-2019_Aleitamento-Materno.pdf/ >. Acesso em: 26 jan. 2024.
https://enani.nutricao.ufrj.br/wp-conten... ). Among the aspects that need to be addressed in the discussion about the practice of EBF in the country is attention to vulnerable and minority populations, including those in prison (Boccolini et al., 2017BOCCOLINI C. S. et al. Tendência de indicadores do aleitamento materno no Brasil em três décadas. Revista de Saúde Pública, São Paulo, v. 51, 2017. DOI: 10.11606/S1518-8787.2017051000029
https://doi.org/10.11606/S1518-8787.2017... ). As the first healthy eating practice, EBF is part of the understanding of food as a basic human right, guaranteed by article 6 of the 1988 Federal Constitution, as well as the protection of motherhood and childhood.

In Brazil, the incarceration of women when they are pregnant or lactating is not avoided. Thus, these experiences make up the experiences of incarcerated women, in the same way that incarceration must make up food scenarios in the country. However, it is noted that national surveys do not systematically document the prevalence of EBF under such conditions. The situation of breastfeeding women is protected by article 5, item L, of the Federal Constitution, which ensures that incarcerated women can stay with their children during the breastfeeding period (Brasil, 1988BRASIL. [Constituição (1988)]. Constituição da República Federativa do Brasil de 1988. Brasília, DF: Presidência da República, 1988.). Therefore, penal establishments intended for women must be equipped with a nursery where they can take care of their children, including breastfeeding them until at least six months of age (Law 7210/84, art.83, §2º, with changes to Law 11942/09) (Brazil, 2009BRASIL. Lei nº11.942, de 28 de maio de 2009. Dá nova redação aos arts. 14, 83 e 89 da lei n° 7.210, de 11 de julho de 1984 - Lei de Execução Penal, para assegurar às mães presas e aos recém-nascidos condições mínimas de assistência. Brasília, DF: Presidência da República, 2009.). It is necessary to highlight that female imprisonment in the country grew 664% from 2000 to 2019 (Brazil, 2019BRASIL. Ministério da Justiça e Segurança Pública. Levantamento Nacional de Informações Penitenciárias: Painel Interativo. Brasília, DF: Depen , 2019.), and of the women incarcerated, 56% are Black, more than half are under 30 years of age and 66% did not have access to high school (Brazil, 2018BRASIL. Ministério da Justiça e Segurança Pública. Levantamento Nacional de Informações Penitenciárias. 2. ed. Brasília, DF: Depen, 2018.), which reveals the intensification of gender, race, and class inequalities.

A recent scoping review published in Portuguese assessed 33 studies on breastfeeding in prison conducted in Brazil, USA, Canada, England, Mozambique and Malawi according to actions to promote, protect and support the practice (Santos et al., 2022aSANTOS, M. V. et al. Promoção, proteção e apoio ao aleitamento materno no espaço prisional: uma scoping review. Ciência & Saúde Coletiva , Rio de Janeiro, v. 27, n. 7, p. 2689-2702, 2022a. DOI: 10.1590/1413-81232022277.19432021
https://doi.org/10.1590/1413-81232022277... ). In different scenarios, the authors emphasized the health professionals as a solution to overcome the lack of knowledge and activities that encourage breastfeeding in the prison environment. Despite mentioning the occurrence of rights violations and affirming that the environment can “often be sickening” (Santos et al., 2022aSANTOS, M. V. et al. Promoção, proteção e apoio ao aleitamento materno no espaço prisional: uma scoping review. Ciência & Saúde Coletiva , Rio de Janeiro, v. 27, n. 7, p. 2689-2702, 2022a. DOI: 10.1590/1413-81232022277.19432021
https://doi.org/10.1590/1413-81232022277... . p. 2698), this review did not focus on the means of knowledge production or the agents involved in breastfeeding practices and their effects in prison. On the contrary, the evidence was synthesized to highlight the consummate fragility of women, the lack of support to meet WHO recommendations and the potential of breastfeeding as “a new perspective for change” (Santos et al., 2022aSANTOS, M. V. et al. Promoção, proteção e apoio ao aleitamento materno no espaço prisional: uma scoping review. Ciência & Saúde Coletiva , Rio de Janeiro, v. 27, n. 7, p. 2689-2702, 2022a. DOI: 10.1590/1413-81232022277.19432021
https://doi.org/10.1590/1413-81232022277... . p. 2698).

For a better understanding of health and food conditions and access to rights for incarcerated women and their children, we believe it is necessary to pay critical attention to the context and practices of the prison system in Brazil today. In this sense, we turn to a field of prison studies that has been fueled by what is known as penal abolitionism. This theoretical-political framework is based on a critique of punitive reason, which rejects punishment itself as a general model for resolving conflicts, rather than the historical forms that shape these dynamics (Batista, 2015BATISTA, V. M. A juventude e a questão criminal no Brasil. In: MAGALHAES, J. L. Q.; SALUM, M. J. G.; OLIVEIRA, R. T. (Org.). Mitos e verdades sobre a justiça infanto juvenil brasileira: por que somos contrários à redução da maioridade penal? Brasília, DF: Conselho Federal de Psicologia. P. 22-30, 2015.; Passetti, 2004PASSETTI, E. A atualidade do abolicionismo penal. In: PASSETTI, E. (coord.). Curso livre de abolicionismo penal. Rio de Janeiro: Revan. p. 13-34, 2004. v. 2.). Instead of re-socializing the person in prison, this framework considers that the penal system proliferates suffering, violence and stigmatization, does not restore the rights of the victim, and creates and reproduces delinquency, failing to satisfactorily resolve the issues (Pinto, 2008PINTO, C. A. F. O abolicionismo penal. Recanto das Letras, Rio de Janeiro, 2008. Seção Textos Jurídicos. Disponível em: <Disponível em: https://www.recantodasletras.com.br/textosjuridicos/922323 >. Acesso em: 26 jan. 2024.
https://www.recantodasletras.com.br/text... ). Much of this way of thinking discusses the extreme racism of the prison system in countries like Brazil and the USA, which takes on particular forms of suffering in women and young people (Davis, 2018DAVIS, A. Estarão as prisões obsoletas? 2. ed. Rio de Janeiro: DIFEL, 2018.; Batista, 2015BATISTA, V. M. A juventude e a questão criminal no Brasil. In: MAGALHAES, J. L. Q.; SALUM, M. J. G.; OLIVEIRA, R. T. (Org.). Mitos e verdades sobre a justiça infanto juvenil brasileira: por que somos contrários à redução da maioridade penal? Brasília, DF: Conselho Federal de Psicologia. P. 22-30, 2015.; Alves, 2017ALVES, D. Rés negras, juízes brancos: uma análise da interseccionalidade de gênero, raça e classe na produção da punição em uma prisão paulistana. Revista Cs, Cali, n. 21, p. 97-120, 2017. DOI: 10.18046/recs.i21.2218
https://doi.org/10.18046/recs.i21.2218... ).

It is therefore important to develop analytical paths that take into account an intersectional logic. Intersectionality as a form of critical investigation into differences, inequalities, and power relations demands an analytical and practical effort to complexify forms of oppression. This theory helps to understand axes of power and inequality, such as those marked by gender, race, class, sexuality, etc., in a situated, articulated, and codependent way (Collins; Bilge, 2021COLLINS, P. H.; BILGE, S. Interseccionalidade. São Paulo: Boitempo, 2021.). The understanding of inequalities related to racism, critical contexts, and violence has been increasingly used in Brazilian public health (Couto et al., 2019COUTO, M. T. et al. The feminist perspective of intersectionality in the field of public health: a narrative review of the theoretical-methodological literature. Salud Colectiva, La Plata, v. 15, e1994, 2019. DOI: 10.18294/sc.2019.1994
https://doi.org/10.18294/sc.2019.1994... ; Shannon et al., 2022SHANNON, G. et al. Intersectional insights into racism and health: not just a question of identity. Lancet, London, v. 400, n. 10368, p. 2125-2136, 2022. DOI: 10.1016/S0140-6736(22)02304-2
https://doi.org/10.1016/S0140-6736(22)02... ).

Therefore, this article seeks to advance the understanding of theoretical, political, and methodological frameworks through which EBF practices by people in prison in Brazil are investigated. To this end, empirical evidence published since 2000 on the topic is critically synthesized, focusing on literature produced in the areas of health and law. To deepen reflections, it is essential to identify the types of evidence available on this topic and which research lenses have been favored, through research questions and their methods, as well as the most important gaps regarding the breastfeeding experience for consideration of women and the punitive reasons of the prison system, a topic not yet reported in the studies found. It is of particular interest to dispute reflections on this topic in order to advance in the construction of knowledge that is useful to state actors in guaranteeing the rights of this population, as well as to the social movements of survivors of the prison system.

Methodology

We used the scoping review based on the following research question: what is the state of knowledge regarding exclusive breastfeeding practices among people in prison in Brazil since 2000?

The search strategy focused on EBF among imprisoned women in Brazil, from the year 2000 onwards. We highlighted the framing of the breastfeeding period under the current recommendation of exclusivity of this practice (Brazil, 2021BRASIL. Ministério da Saúde. Guia Alimentar para Crianças Brasileiras Menores de 2 Anos. Brasília, DF, 2021.). The search filter was applied to words or terms for each database, with the search strategy built on three topics: (1) Breastfeeding; (2) Prison; (3) Brazil. The variation of terms was defined with the OR operator, while the three topics were connected by the AND operator.

The following databases were searched to find manuscripts on the subject: PubMed; Scopus; Portal Regional da BVS; CINAHL; Lilacs; APA PsycInfo; and Scielo. Additional searches were carried out on Google Scholar, as well as the Theses and Dissertations Library of the University of São Paulo (USP) , the Brazilian Digital Library of Theses and Dissertations (BDTD), and the Theses and Dissertations Catalog of the Coordination for the Improvement of Personnel Foundation. Higher Education (CAPES). The search procedures took place between May and June 2022.

All the material was exported to the online version of the Endnote platform. Duplicate studies were excluded. For screening, two independent researchers read title and abstract of all manuscripts. Eligibility was confirmed by reading all the studies that were approved in the previous phase, following the criteria:

Manuscripts not derived from scientific research, single case studies and review studies were excluded. Studies carried out in other countries or prior to 2000 were disregarded, as well as those that did not cover, partially or completely, the period of the first six months postpartum.

After confirmation of eligibility, data from each study selected for this scoping review were extracted into standardized forms. As possible, the following information was considered: year of publication, authors, title of the work, place of study, characterization of the study population, methodological approach, research question, and main findings.

The extracted data were summarized into two main areas of research, namely maternal and child health and reproductive rights. A first layer of analysis sought to understand the selected material in its own logic and framework. Subsequently, in the light of penal abolitionism and intersectionality, a reading "against the grain" was performed (Stoller, 2002 apud Lowenkron; Ferreira, 2014LOWENKRON, L.; FERREIRA, L. Anthropological perspectives on documents: ethnographic dialogues on the trail of police papers. Vibrant, Brasília, DF , v. 11, n. 2, p. 76-112, 2014. DOI: 10.1590/S1809-43412014000200003
https://doi.org/10.1590/S1809-4341201400... ) to critically analyze the limits and possible effects of the knowledge produced.

Results and discussion

Study selection overview

Findings were organized in a flowchart, as shown Figure 1. During identification, 156 articles were found from the databases and 106 articles from complementary searches, from thesis and dissertation bases and Google Scholar, totaling 262 articles. Of these, 77 duplicate records were removed. In the screening phase, 99 articles from the databases and 86 articles from complementary sources were evaluated, of which 127 were excluded based on the title and abstract. After fully reading the papers to confirm eligibility, a total of 58 studies were analyzed, of which 33 were excluded according to the following criteria: concept/population (29); context (1); and study design (3). Overall, 25 studies were included in this scoping review.

General characteristics of the included studies

Among the 25 studies included, only two were published between 2000 and 2010, and the others published from 2011 to 2022. They were conducted with participants or referred to the population of the states of São Paulo, Mato Grosso do Sul, Rio de Janeiro, Rio Grande do Sul, Amapá, Pará, Pernambuco, Paraíba, Ceará, Bahia, Santa Catarina, Mato Grosso, Paraná, Sergipe, and Espírito Santo. The studies were divided into two tables, separated into those that sought to address aspects of maternal and child health (n=19) in the prison system and those that brought results within the field of reproductive rights (n=6).

The studies that sought to study EBF practices in prison in the context of maternal and child health directed their questions to: (1) analyze participants’ perceptions and experiences about breastfeeding in prison; (2) identify participants’ knowledge about breastfeeding; (3) understand maternal and child health conditions in the prison system. Details about the location, methodological approach and main findings of these studies are shown in Table 1. The main characteristics of the participants included: age ranging from 20 to 57 years, having low schooling, serving a sentence in a closed regime, sharing prison with a child, being single, and incarcerated for non-violent crimes, mostly theft and drug trafficking.

In turn, studies that examined breastfeeding in the light of issues related to reproductive rights in the country sought to: (1) analyze the guarantees and violations of mothers' right to breastfeed in prison, using national and international laws and conventions as parameters; (2) understand the knowledge of legal guarantees and daily practices for breastfeeding by mothers and health professionals in the prison system. Information about the questions and the context of these studies is available in Table 2.

Most studies used qualitative methods, from a descriptive and cross-sectional perspective. There were no reported cases of breastfeeding by incarcerated trans people.

Critical analysis of Brazilian production on the practice of EBF in prison settings

In this review, studies on EBF practices in prison in the area of maternal and child health showed that breastfeeding women reported ambivalent experiences. For some of these women, breastfeeding was portrayed as a special state, which could be worthwhile for both mother and baby. Care actions exclusively carried out by the mother were perceived as a means of strengthening the connection with her child, generating feelings of joy and satisfaction, in addition to benefiting maternal self-esteem (Rios; Silva, 2010RIOS, G. S.; SILVA, A. L. Amamentação em presídio: estudo das condições e práticas no Estado de São Paulo, Brasil. Boletim do Instituto de Saúde, São Paulo, v. 12, n. 3, p. 293-299, 2010.; Monteiro et al., 2011MONTEIRO, E. M. L. M. et al. Aleitamento materno no sistema penitenciário. Revista Enfermagem UFPE online, Recife, v. 5, n. 8, p. 1970-1978, 2011.; Araújo et al., 2014ARAÚJO, A. N. V. de et al. Percepção de mães presidiárias sobre os motivos que dificultam a vivência do binômio. Revista Enfermagem Contemporânea, Salvador, v. 3, n. 2, 2014. DOI: 10.17267/2317-3378rec.v3i2.411
https://doi.org/10.17267/2317-3378rec.v3... ; Oliveira; Miranda; Costa, 2015OLIVEIRA, L.V.; MIRANDA, F. A. N.; COSTA, G. M. C. Vivência da maternidade para presidiárias. Revista Eletrônica de Enfermagem , Goiânia, v. 17, n. 2, p. 360-369, 2015. Universidade Federal de Goiás. DOI: 10.5216/ree.v17i2.29784
https://doi.org/10.5216/ree.v17i2.29784... ). There was an understanding that breastfeeding is a means of protection for the baby (Silva et al., 2011SILVA, E. F.; LUZ, A. M. H.; CECCHETTO, F. H. Maternidade atrás das grades. Enfermagem em Foco, Brasília, DF , v. 2, n. 1, p. 33-37, 2011. DOI: 10.21675/2357-707x.2011.v2.n1.71
https://doi.org/10.21675/2357-707x.2011.... ; Mariano; Silva, 2018MARIANO, G. J. S.; SILVA, I. A. Significando o amamentar na prisão. Texto & Contexto - Enfermagem , Florianópolis, v. 27, n. 4, e0590017, 2018. DOI: 10.1590/0104-07072018000590017
https://doi.org/10.1590/0104-07072018000... ; Santos et al., 2022bSANTOS, M. V. et al. O valor vital do aleitamento materno para mulheres custodiadas. Texto & Contexto - Enfermagem , Florianópolis, v. 31, e20210455, 2022b.), as well a chance to fully exercise motherhood (Silva et al., 2011SILVA, E. F.; LUZ, A. M. H.; CECCHETTO, F. H. Maternidade atrás das grades. Enfermagem em Foco, Brasília, DF , v. 2, n. 1, p. 33-37, 2011. DOI: 10.21675/2357-707x.2011.v2.n1.71
https://doi.org/10.21675/2357-707x.2011.... ; Mariano; Silva, 2018MARIANO, G. J. S.; SILVA, I. A. Significando o amamentar na prisão. Texto & Contexto - Enfermagem , Florianópolis, v. 27, n. 4, e0590017, 2018. DOI: 10.1590/0104-07072018000590017
https://doi.org/10.1590/0104-07072018000... ; Medeiros et al., 2020MEDEIROS, A. N. et al. Aleitamento materno no sistema penitenciário: sentimentos da lactante. Revista Ciência Plural, Natal, v. 6, n. 1, p. 18-31, 2020. DOI: 10.21680/2446-7286.2020v6n1ID18255
https://doi.org/10.21680/2446-7286.2020v... ) and also building a new identity (Fochi et al., 2017FOCHI, M. C. S. et al. Vivências de gestantes em situação de prisão. Revista Eletrônica de Enfermagem, Goiânia, v. 19, a57, 2017. DOI: 10.5216/ree.v19.46647
https://doi.org/10.5216/ree.v19.46647... ).

However, most of the studies included highlighted the great suffering associated with these women’s experiences during pregnancy and EBF. Feelings of fear, anxiety, incapacity, and regret were mentioned when the practice was interrupted (Rios; Silva, 2010RIOS, G. S.; SILVA, A. L. Amamentação em presídio: estudo das condições e práticas no Estado de São Paulo, Brasil. Boletim do Instituto de Saúde, São Paulo, v. 12, n. 3, p. 293-299, 2010.; Oliveira; Miranda; Costa, 2015OLIVEIRA, L.V.; MIRANDA, F. A. N.; COSTA, G. M. C. Vivência da maternidade para presidiárias. Revista Eletrônica de Enfermagem , Goiânia, v. 17, n. 2, p. 360-369, 2015. Universidade Federal de Goiás. DOI: 10.5216/ree.v17i2.29784
https://doi.org/10.5216/ree.v17i2.29784... ; Fochi et al., 2017FOCHI, M. C. S. et al. Vivências de gestantes em situação de prisão. Revista Eletrônica de Enfermagem, Goiânia, v. 19, a57, 2017. DOI: 10.5216/ree.v19.46647
https://doi.org/10.5216/ree.v19.46647... ; Diuana; Corrêa; Ventura, 2017DIUANA, V.; CORRÊA, M. C. D. V.; VENTURA, M. Mulheres nas prisões brasileiras: tensões entre a ordem disciplinar punitiva e as prescrições da maternidade. Physis: Revista de Saúde Coletiva, Rio de Janeiro, v. 27, n. 3, p. 727-747, 2017. DOI: 10.1590/s0103-73312017000300018
https://doi.org/10.1590/s0103-7331201700... ; Medeiros et al., 2020MEDEIROS, A. N. et al. Aleitamento materno no sistema penitenciário: sentimentos da lactante. Revista Ciência Plural, Natal, v. 6, n. 1, p. 18-31, 2020. DOI: 10.21680/2446-7286.2020v6n1ID18255
https://doi.org/10.21680/2446-7286.2020v... ; Santos et al., 2022bSANTOS, M. V. et al. O valor vital do aleitamento materno para mulheres custodiadas. Texto & Contexto - Enfermagem , Florianópolis, v. 31, e20210455, 2022b.). The impossibility of breastfeeding in prison was commonly reported as mothers giving up in order to avoid suffering separation and weaning their babies, as well as the compulsory removal of the children after the maximum period provided by the prison administration (Rios; Silva, 2010RIOS, G. S.; SILVA, A. L. Amamentação em presídio: estudo das condições e práticas no Estado de São Paulo, Brasil. Boletim do Instituto de Saúde, São Paulo, v. 12, n. 3, p. 293-299, 2010.; Monteiro et al., 2011MONTEIRO, E. M. L. M. et al. Aleitamento materno no sistema penitenciário. Revista Enfermagem UFPE online, Recife, v. 5, n. 8, p. 1970-1978, 2011.; Oliveira; Miranda; Costa, 2015OLIVEIRA, L.V.; MIRANDA, F. A. N.; COSTA, G. M. C. Vivência da maternidade para presidiárias. Revista Eletrônica de Enfermagem , Goiânia, v. 17, n. 2, p. 360-369, 2015. Universidade Federal de Goiás. DOI: 10.5216/ree.v17i2.29784
https://doi.org/10.5216/ree.v17i2.29784... ; Diuana, Corrêa; Ventura, 2017DIUANA, V.; CORRÊA, M. C. D. V.; VENTURA, M. Mulheres nas prisões brasileiras: tensões entre a ordem disciplinar punitiva e as prescrições da maternidade. Physis: Revista de Saúde Coletiva, Rio de Janeiro, v. 27, n. 3, p. 727-747, 2017. DOI: 10.1590/s0103-73312017000300018
https://doi.org/10.1590/s0103-7331201700... ; Fochi et al., 2017FOCHI, M. C. S. et al. Vivências de gestantes em situação de prisão. Revista Eletrônica de Enfermagem, Goiânia, v. 19, a57, 2017. DOI: 10.5216/ree.v19.46647
https://doi.org/10.5216/ree.v19.46647... ; Mariano; Silva, 2018MARIANO, G. J. S.; SILVA, I. A. Significando o amamentar na prisão. Texto & Contexto - Enfermagem , Florianópolis, v. 27, n. 4, e0590017, 2018. DOI: 10.1590/0104-07072018000590017
https://doi.org/10.1590/0104-07072018000... ; Santos et al., 2022bSANTOS, M. V. et al. O valor vital do aleitamento materno para mulheres custodiadas. Texto & Contexto - Enfermagem , Florianópolis, v. 31, e20210455, 2022b.; Medeiros et al., 2020MEDEIROS, A. N. et al. Aleitamento materno no sistema penitenciário: sentimentos da lactante. Revista Ciência Plural, Natal, v. 6, n. 1, p. 18-31, 2020. DOI: 10.21680/2446-7286.2020v6n1ID18255
https://doi.org/10.21680/2446-7286.2020v... ). For these women, breastfeeding becomes an artifact of punishment and control. In situations where there was a choice to wean, there were reports of women being reprimanded for offering bottles due to exhaustion from breastfeeding (Nunes; Deslandes; Jannotti, 2020NUNES, L. R. C.; DESLANDES, S. F.; JANNOTTI, C. B. Narrativas sobre as práticas de maternagem na prisão: a encruzilhada da ordem discursiva prisional e da ordem discursiva do cuidado. Cadernos de Saúde Pública, Rio de Janeiro, v. 36, n. 12, e00215719, 2020. DOI: 10.1590/0102-311x00215719
https://doi.org/10.1590/0102-311x0021571... ).

Even with the preponderance of perceptions of distress, several studies identify participants’ understanding of the importance of breastfeeding during the period in which such practices are recommended exclusively. Knowledge about the benefits of EBF is influenced by the experiences of the interviewees’ mothers and grandmothers (Medeiros et al., 2020MEDEIROS, A. N. et al. Aleitamento materno no sistema penitenciário: sentimentos da lactante. Revista Ciência Plural, Natal, v. 6, n. 1, p. 18-31, 2020. DOI: 10.21680/2446-7286.2020v6n1ID18255
https://doi.org/10.21680/2446-7286.2020v... ) and covered biological aspects and nutritional characteristics of breast milk, in addition to contributions to safety, disease prevention and promotion of physical and mental health in children (Freire, 2017FREIRE, G. O. B. Cárcere e maternidade: o desafio de conciliar custódia e amamentação. 2017. 114 f. Dissertação (Mestrado em Segurança Pública) - Universidade Federal do Pará, Belém, 2017.; Ferreira et al., 2021FERREIRA, A. C. R. et al. Cuidados maternos em ambiente penal: representação por meio de desenho-estória. Revista Enfermagem UERJ, Rio de Janeiro, v. 29, n. 1, e51211, 2021. DOI: 10.12957/reuerj.2021.51211
https://doi.org/10.12957/reuerj.2021.512... ; Silva et al., 2011SILVA, E. F.; LUZ, A. M. H.; CECCHETTO, F. H. Maternidade atrás das grades. Enfermagem em Foco, Brasília, DF , v. 2, n. 1, p. 33-37, 2011. DOI: 10.21675/2357-707x.2011.v2.n1.71
https://doi.org/10.21675/2357-707x.2011.... ; Araújo et al., 2014ARAÚJO, A. N. V. de et al. Percepção de mães presidiárias sobre os motivos que dificultam a vivência do binômio. Revista Enfermagem Contemporânea, Salvador, v. 3, n. 2, 2014. DOI: 10.17267/2317-3378rec.v3i2.411
https://doi.org/10.17267/2317-3378rec.v3... ; Santos et al., 2022bSANTOS, M. V. et al. O valor vital do aleitamento materno para mulheres custodiadas. Texto & Contexto - Enfermagem , Florianópolis, v. 31, e20210455, 2022b.; Medeiros et al., 2020MEDEIROS, A. N. et al. Aleitamento materno no sistema penitenciário: sentimentos da lactante. Revista Ciência Plural, Natal, v. 6, n. 1, p. 18-31, 2020. DOI: 10.21680/2446-7286.2020v6n1ID18255
https://doi.org/10.21680/2446-7286.2020v... ).

These findings conflict with the emphasis on the lack of knowledge about breastfeeding by women in prison outlined in the scoping review by Santos et al. (2022aSANTOS, M. V. et al. Promoção, proteção e apoio ao aleitamento materno no espaço prisional: uma scoping review. Ciência & Saúde Coletiva , Rio de Janeiro, v. 27, n. 7, p. 2689-2702, 2022a. DOI: 10.1590/1413-81232022277.19432021
https://doi.org/10.1590/1413-81232022277... ). In the present review, the studies recorded participants’ questions regarding breastfeeding time (Diuana; Corrêa; Ventura, 2017DIUANA, V.; CORRÊA, M. C. D. V.; VENTURA, M. Mulheres nas prisões brasileiras: tensões entre a ordem disciplinar punitiva e as prescrições da maternidade. Physis: Revista de Saúde Coletiva, Rio de Janeiro, v. 27, n. 3, p. 727-747, 2017. DOI: 10.1590/s0103-73312017000300018
https://doi.org/10.1590/s0103-7331201700... ; Rios; Silva, 2010RIOS, G. S.; SILVA, A. L. Amamentação em presídio: estudo das condições e práticas no Estado de São Paulo, Brasil. Boletim do Instituto de Saúde, São Paulo, v. 12, n. 3, p. 293-299, 2010.; Cavalcanti et al., 2018CAVALCANTI, A. L. et al. Born in Chains: perceptions of Brazilian mothers deprived of freedom about breastfeeding. Pesquisa Brasileira em Odontopediatria e Clínica Integrada, João Pessoa, v. 18, n. 1, 2018. DOI: 10.4034/pboci.2018.181.69
https://doi.org/10.4034/pboci.2018.181.6... ; Mariano; Silva, 2018MARIANO, G. J. S.; SILVA, I. A. Significando o amamentar na prisão. Texto & Contexto - Enfermagem , Florianópolis, v. 27, n. 4, e0590017, 2018. DOI: 10.1590/0104-07072018000590017
https://doi.org/10.1590/0104-07072018000... ; Medeiros et al., 2020MEDEIROS, A. N. et al. Aleitamento materno no sistema penitenciário: sentimentos da lactante. Revista Ciência Plural, Natal, v. 6, n. 1, p. 18-31, 2020. DOI: 10.21680/2446-7286.2020v6n1ID18255
https://doi.org/10.21680/2446-7286.2020v... ) and repeatedly denounced the lack of adequate structural conditions for EBF in penitentiaries. The various obstacles identified included the lack of quality food for breastfeeding women (Fochi et al., 2017FOCHI, M. C. S. et al. Vivências de gestantes em situação de prisão. Revista Eletrônica de Enfermagem, Goiânia, v. 19, a57, 2017. DOI: 10.5216/ree.v19.46647
https://doi.org/10.5216/ree.v19.46647... ; Silva et al., 2011SILVA, E. F.; LUZ, A. M. H.; CECCHETTO, F. H. Maternidade atrás das grades. Enfermagem em Foco, Brasília, DF , v. 2, n. 1, p. 33-37, 2011. DOI: 10.21675/2357-707x.2011.v2.n1.71
https://doi.org/10.21675/2357-707x.2011.... ), insufficient health care (Rios; Silva, 2010RIOS, G. S.; SILVA, A. L. Amamentação em presídio: estudo das condições e práticas no Estado de São Paulo, Brasil. Boletim do Instituto de Saúde, São Paulo, v. 12, n. 3, p. 293-299, 2010.; Pícoli et al., 2014PÍCOLI, R. P. et al. Gestação e puerpério no cárcere: estudo descritivo da atenção à saúde. Revista Baiana Saúde Pública, Salvador, v. 38, n. 3, p. 67-82, 2014. DOI: 10.5327/z0100-0233-2014380100013
https://doi.org/10.5327/z0100-0233-20143... ; Oliveira, 2011OLIVEIRA, V. S. Presidiária do Amapá: percepção sobre a importância de amamentar. Estação Científica (Unifap), Macapá, v. 1, n. 2, p. 127-141, 2011.; Stella et al., 2016STELLA, C.; SEQUEIRA, V. C.; ROSA, T. L. Mothers and babies in a Brazilian prison: a study exploring the impact of prison conditions. Forensic Research & Criminology International Journal, Oklahoma, v. 2, n. 3, p. 104-110, 2016. DOI: 10.15406/frcij.2016.02.0005
https://doi.org/10.15406/frcij.2016.02.0... ; Medeiros et al., 2020MEDEIROS, A. N. et al. Aleitamento materno no sistema penitenciário: sentimentos da lactante. Revista Ciência Plural, Natal, v. 6, n. 1, p. 18-31, 2020. DOI: 10.21680/2446-7286.2020v6n1ID18255
https://doi.org/10.21680/2446-7286.2020v... ), very unfavorable environment for child development (Silva et al., 2011SILVA, E. F.; LUZ, A. M. H.; CECCHETTO, F. H. Maternidade atrás das grades. Enfermagem em Foco, Brasília, DF , v. 2, n. 1, p. 33-37, 2011. DOI: 10.21675/2357-707x.2011.v2.n1.71
https://doi.org/10.21675/2357-707x.2011.... ), described as cold, dark, cruel, and unhygienic (Monteiro et al., 2011MONTEIRO, E. M. L. M. et al. Aleitamento materno no sistema penitenciário. Revista Enfermagem UFPE online, Recife, v. 5, n. 8, p. 1970-1978, 2011.), and the lack of a family support network (Oliveira; Miranda; Costa, 2015OLIVEIRA, L.V.; MIRANDA, F. A. N.; COSTA, G. M. C. Vivência da maternidade para presidiárias. Revista Eletrônica de Enfermagem , Goiânia, v. 17, n. 2, p. 360-369, 2015. Universidade Federal de Goiás. DOI: 10.5216/ree.v17i2.29784
https://doi.org/10.5216/ree.v17i2.29784... ; Silva et al., 2011SILVA, E. F.; LUZ, A. M. H.; CECCHETTO, F. H. Maternidade atrás das grades. Enfermagem em Foco, Brasília, DF , v. 2, n. 1, p. 33-37, 2011. DOI: 10.21675/2357-707x.2011.v2.n1.71
https://doi.org/10.21675/2357-707x.2011.... ; Medeiros et al., 2020MEDEIROS, A. N. et al. Aleitamento materno no sistema penitenciário: sentimentos da lactante. Revista Ciência Plural, Natal, v. 6, n. 1, p. 18-31, 2020. DOI: 10.21680/2446-7286.2020v6n1ID18255
https://doi.org/10.21680/2446-7286.2020v... ).

The precarious conditions of the prison environment were compounded by the participants’ tensions with the professionals involved. In this sense, at least two layers of discussion are possible, namely: interaction with professionals working in the settings studied and the researchers’ role, particularly in the field of maternal and child health.

The first layer revealed professional approaches centered on the biomedical model of health care and focused on children (Stella et al., 2016STELLA, C.; SEQUEIRA, V. C.; ROSA, T. L. Mothers and babies in a Brazilian prison: a study exploring the impact of prison conditions. Forensic Research & Criminology International Journal, Oklahoma, v. 2, n. 3, p. 104-110, 2016. DOI: 10.15406/frcij.2016.02.0005
https://doi.org/10.15406/frcij.2016.02.0... ; Guimarães et al., 2018GUIMARÃES, M. L. et al. Promoção do aleitamento materno no sistema prisional a partir da percepção de nutrizes encarceradas. Texto & Contexto - Enfermagem, Florianópolis, v. 27, n. 4, e3030017, 2018. DOI: 10.1590/0104-07072018003030017
https://doi.org/10.1590/0104-07072018003... ), amid insufficient guidance on the promotion and management of EBF, breast care, and maternal health (Silva et al., 2011SILVA, E. F.; LUZ, A. M. H.; CECCHETTO, F. H. Maternidade atrás das grades. Enfermagem em Foco, Brasília, DF , v. 2, n. 1, p. 33-37, 2011. DOI: 10.21675/2357-707x.2011.v2.n1.71
https://doi.org/10.21675/2357-707x.2011.... ; Oliveira, 2011OLIVEIRA, V. S. Presidiária do Amapá: percepção sobre a importância de amamentar. Estação Científica (Unifap), Macapá, v. 1, n. 2, p. 127-141, 2011.; Pícoli et al., 2014PÍCOLI, R. P. et al. Gestação e puerpério no cárcere: estudo descritivo da atenção à saúde. Revista Baiana Saúde Pública, Salvador, v. 38, n. 3, p. 67-82, 2014. DOI: 10.5327/z0100-0233-2014380100013
https://doi.org/10.5327/z0100-0233-20143... ). In a supervisory tone, breastfeeding was portrayed as a conditional element for mothers and babies to continue together (Guimarães et al., 2018GUIMARÃES, M. L. et al. Promoção do aleitamento materno no sistema prisional a partir da percepção de nutrizes encarceradas. Texto & Contexto - Enfermagem, Florianópolis, v. 27, n. 4, e3030017, 2018. DOI: 10.1590/0104-07072018003030017
https://doi.org/10.1590/0104-07072018003... ; Stella et al., 2016STELLA, C.; SEQUEIRA, V. C.; ROSA, T. L. Mothers and babies in a Brazilian prison: a study exploring the impact of prison conditions. Forensic Research & Criminology International Journal, Oklahoma, v. 2, n. 3, p. 104-110, 2016. DOI: 10.15406/frcij.2016.02.0005
https://doi.org/10.15406/frcij.2016.02.0... ), without considering related socio-emotional aspects. In the work by Santos et al. (2018SANTOS, R. M. A. et al. Diagnósticos de enfermagem de mães encarceradas. Revista da Escola de Enfermagem da USP, São Paulo, v. 52, e03338, 2018. DOI: 10.1590/s1980-220x2017024503338.7
https://doi.org/10.1590/s1980-220x201702... ), the standardized application of nursing diagnoses, according to the NANDA-I taxonomy²2North American Nursing Diagnosis Association NANDA International Inc. (NANDA-I)., classified all situations as risk of interrupted breastfeeding and impaired mother-child bonding, poor knowledge about breastfeeding, ineffective sexuality pattern and poor recreational activity.

Despite findings on the high participation of imprisoned mothers in educational activities developed by nurses on breastfeeding (90%) (Cavalcanti et al., 2018CAVALCANTI, A. L. et al. Born in Chains: perceptions of Brazilian mothers deprived of freedom about breastfeeding. Pesquisa Brasileira em Odontopediatria e Clínica Integrada, João Pessoa, v. 18, n. 1, 2018. DOI: 10.4034/pboci.2018.181.69
https://doi.org/10.4034/pboci.2018.181.6... ), Guimarães et al. (2018GUIMARÃES, M. L. et al. Promoção do aleitamento materno no sistema prisional a partir da percepção de nutrizes encarceradas. Texto & Contexto - Enfermagem, Florianópolis, v. 27, n. 4, e3030017, 2018. DOI: 10.1590/0104-07072018003030017
https://doi.org/10.1590/0104-07072018003... ) highlighted the stressful effects of authoritarian rules imposed by the prison system that reduce the decision-making power of breastfeeding women and increase their resistance to implementing strategies. Still, the exploratory research by Santos et al. (2022cSANTOS, M. V. et al. Breastfeeding booklet in prison institutions: initiative for promotion, protection and support. Revista Brasileira de Enfermagem, Brasília, DF , v. 75, n. sup. 2, e20210214, 2022c.) concluded that, for managers and health professionals from several Brazilian states, a booklet on breastfeeding in prison proved to be a tool that strengthens the practice, guaranteeing rights, alleviating anxieties, and valuing breastfeeding women, in addition to reaching family members with relevant information.

Demétrio (2014DEMÉTRIO, F. A crise das práticas nutricionais em saúde-doença-cuidado e a possibilidade de construção de uma nutrição clínica ampliada e compartilhada. In: SOUZA, M. K. B.; TAVARES, J. S. C. (Org.). Temas em saúde coletiva: gestão e atenção no SUS em debate. Cruz das Almas: EDUFRB, p. 167-203, 2014.) reflects on how health professionals with excessively biomedical perspectives are more authoritarian, oblivious to the subjectivity of subjects and uncommitted to social transformations. The inconsistency between the reports of imprisoned women and professionals working in such institutions seems to diagnose this scenario, which is exacerbated by the unilateral definition of the minimum period of EBF by the penitentiary administration, varying up to four months in São Paulo (Rios and Silva, 2010RIOS, G. S.; SILVA, A. L. Amamentação em presídio: estudo das condições e práticas no Estado de São Paulo, Brasil. Boletim do Instituto de Saúde, São Paulo, v. 12, n. 3, p. 293-299, 2010.; Santa Rita, 2006SANTA RITA, R. P. Mães e crianças atrás das grades: em questão o princípio de dignidade da pessoa humana. 2006. 162 f. Tese (Mestrado em Política Social) - Universidade de Brasília, Brasília, 2006.) and six months in the state of Rio de Janeiro (Santa Rita, 2006SANTA RITA, R. P. Mães e crianças atrás das grades: em questão o princípio de dignidade da pessoa humana. 2006. 162 f. Tese (Mestrado em Política Social) - Universidade de Brasília, Brasília, 2006.). In Rio Grande do Sul, it was found that the child could remain with their mothers until the age of 3, with compulsory withdrawal after this period (Santa Rita, 2006SANTA RITA, R. P. Mães e crianças atrás das grades: em questão o princípio de dignidade da pessoa humana. 2006. 162 f. Tese (Mestrado em Política Social) - Universidade de Brasília, Brasília, 2006.), but in a unit in João Pessoa (PB) almost 70 % of women practiced EBF for only two months (Cavalcanti et al., 2018CAVALCANTI, A. L. et al. Born in Chains: perceptions of Brazilian mothers deprived of freedom about breastfeeding. Pesquisa Brasileira em Odontopediatria e Clínica Integrada, João Pessoa, v. 18, n. 1, 2018. DOI: 10.4034/pboci.2018.181.69
https://doi.org/10.4034/pboci.2018.181.6... ). With the above in mind, the overall progression of EBF indicators in the “world outside prison” does not seem to be consistent behind bars, with a relevant cross-over through professional activity and the inevitable transfer of sentences (judged or not) to the children.

In a second layer of analysis, attention must also be paid to the position of researchers, as well as their means and methods of scientific production within the scope of EBF in prison. Recent analyses of available evidence continue to highlight propositions based on greater professional support to overcome this problem, circumscribing the need for specialized actions to promote, protect and support breastfeeding in prisons (Santos et al., 2022aSANTOS, M. V. et al. Promoção, proteção e apoio ao aleitamento materno no espaço prisional: uma scoping review. Ciência & Saúde Coletiva , Rio de Janeiro, v. 27, n. 7, p. 2689-2702, 2022a. DOI: 10.1590/1413-81232022277.19432021
https://doi.org/10.1590/1413-81232022277... ).

In the USA, for example, Paynter et al. (2019PAYNTER, M. J. et al. Maternal health outcomes for incarcerated women: a scoping review. Journal Of Clinical Nursing, Boston, v. 28, n. 11-12, p. 2046-2060, 2019.) indicated that the topic is understudied due to the physical situation of the imprisoned woman, which generally prevents contact with the baby to participate in a breastfeeding relationship. According to the study, fewer than 12 prisons in the country have a program that allows the mother to reside with her baby, despite reports that imprisoned pregnant women wanted to be able to breastfeed and felt that the practice could help develop agency and self-esteem.

In Brazil, despite existing regulations (Santa Rita, 2006SANTA RITA, R. P. Mães e crianças atrás das grades: em questão o princípio de dignidade da pessoa humana. 2006. 162 f. Tese (Mestrado em Política Social) - Universidade de Brasília, Brasília, 2006.; Oliveira; Teixeira, 2014OLIVEIRA, E. F.; TEIXEIRA, M. C. O Direito Fundamental das Presidiárias e seus Filhos ao aleitamento materno. Revista do Curso de Direito, São Bernardo do Campo, v. 11, n. 11, p. 68-101, 2014. DOI: 10.15603/2176-1094/rcd.v11n11p68-101
https://doi.org/10.15603/2176-1094/rcd.v... ; Ventura et al., 2015VENTURA, M.; SIMAS, L.; LAROUZÉ, B. Maternidade atrás das grades: em busca da cidadania e da saúde. Um estudo sobre a legislação brasileira. Cadernos de Saúde Pública , Rio de Janeiro, v. 31, n. 3, p. 607-619, 2015. DOI: 10.1590/0102-311x00092914
https://doi.org/10.1590/0102-311x0009291... ), reports characterized prison environments as hostile to the physical and mental health of the mother-baby binomial. There was no evidence in this review that prison units had any positive influence or protection from the stigmas of prison punitivism, as assistance to EBF was consistently subjected to the typical dynamics of surveillance and punishment in these environments.

To this end, research in the field of maternal and child health were mostly limited to the development of interviews and focus groups, systematic observation, and the application of structured or semi-structured questionnaires, for thematic analysis of conditions, feelings, and perceptions of imprisoned women about breastfeeding. Sudbury (2005SUDBURY, J. (Ed.). Global lockdown: race, gender, and the prison-industrial complex. New York: Routledge, 2005.) questions how such means of research may simply replicate the discourse of responsibility and language of correction that incarcerated people learn (and sometimes internalize) as they are processed by the system. The physical environment was certainly identified among the main barriers to promoting breastfeeding (Santos et al., 2022aSANTOS, M. V. et al. Promoção, proteção e apoio ao aleitamento materno no espaço prisional: uma scoping review. Ciência & Saúde Coletiva , Rio de Janeiro, v. 27, n. 7, p. 2689-2702, 2022a. DOI: 10.1590/1413-81232022277.19432021
https://doi.org/10.1590/1413-81232022277... ), but linked to the need for investment from the State, with staff training and the creation of specific spaces and breastfeeding rooms. These studies naively seem to suggest better prisons. Among the questions and analyses of the reviewed studies, there was no movement by researchers to take an in-depth look at the prison environment that surrounds pregnant and postpartum women and their children.

For an analysis with an alternative theoretical-political framework on EBF practices in this context, normalization or even the defense of a more “inclusive” structure in prison must be questioned head-on. It is necessary to understand how racist and patriarchal structures reverberate in the prison system, in a permanent form of punishment on certain bodies (Davis, 2018DAVIS, A. Estarão as prisões obsoletas? 2. ed. Rio de Janeiro: DIFEL, 2018.), and how the field of health and nutrition can ally itself with impunity to these structures. The participants in the research reviewed here reflect the sociodemographic profile of the female prison population in the country. According to Germano, Monteiro and Liberato (2018GERMANO, I. M. P.; MONTEIRO, R. A. F. G.; LIBERATO, M. T. C. Criminologia crítica, feminismo e interseccionalidade na abordagem do aumento do encarceramento feminino. Psicologia: Ciência e Profissão, Brasília, DF , v. 38, n. 2, p. 27-43, 2018. DOI: 10.1590/1982-3703000212310
https://doi.org/10.1590/1982-37030002123... ), in a macrostructural context, the scenario of mass incarceration of these women is the result of a set of processes, from the rise of neoliberal policies reducing the welfare state, the consolidation a global policy of the war on drugs, and the feminization of poverty, added to the general phenomenon of the criminalization of poverty, which encourages the penalization of the poorest sections of the population. It is possible to observe how these phenomena intersect and perpetuate each other to induce penal selectivity³3Theory from which it is understood that the recognition of a criminal is also the result of social labeling, in addition to the deviant condition (Ganen, 2019). Thus, it is possible to commit acts defined by law, but not be criminalized, thanks to the arbitrary selection of the penal system by specific groups, reproducing social standards. and incarcerate these women. While the spotlight is on the personal failings of poor and Black women or the technical inadequacies of one prison or another, the political and economic interests that drive the expansion of prisons remain hidden (Sudbury, 2005SUDBURY, J. (Ed.). Global lockdown: race, gender, and the prison-industrial complex. New York: Routledge, 2005.), so that they can be framed as a black hole into which the detritus of contemporary capitalism is deposited (Davis, 2018DAVIS, A. Estarão as prisões obsoletas? 2. ed. Rio de Janeiro: DIFEL, 2018.).

In the research on reproductive rights, it has been recognized that the 1988 Federal Constitution innovated by guaranteeing that imprisoned women could stay with their children during the breastfeeding period (Santa Rita 2006SANTA RITA, R. P. Mães e crianças atrás das grades: em questão o princípio de dignidade da pessoa humana. 2006. 162 f. Tese (Mestrado em Política Social) - Universidade de Brasília, Brasília, 2006.; Oliveira; Teixeira, 2014OLIVEIRA, E. F.; TEIXEIRA, M. C. O Direito Fundamental das Presidiárias e seus Filhos ao aleitamento materno. Revista do Curso de Direito, São Bernardo do Campo, v. 11, n. 11, p. 68-101, 2014. DOI: 10.15603/2176-1094/rcd.v11n11p68-101
https://doi.org/10.15603/2176-1094/rcd.v... ), ensuring the individual, free, and responsible exercise of reproduction, and by determining the State’s duty to promote conditions and resources for this exercise, in conjunction with civil society. The right to breastfeeding must presuppose the recognition of imprisoned women as subjects of rights and understand the mother-child bond as much broader than just the act of feeding the child, or a place to simply shelter their children due to the lack of family conditions (Ventura et al., 2015VENTURA, M.; SIMAS, L.; LAROUZÉ, B. Maternidade atrás das grades: em busca da cidadania e da saúde. Um estudo sobre a legislação brasileira. Cadernos de Saúde Pública , Rio de Janeiro, v. 31, n. 3, p. 607-619, 2015. DOI: 10.1590/0102-311x00092914
https://doi.org/10.1590/0102-311x0009291... ).

However, the Federal Constitution and the Penal Enforcemen Law do not define a minimum period for the child to remain with the mother who is serving a prison sentence (Santa Rita, 2006SANTA RITA, R. P. Mães e crianças atrás das grades: em questão o princípio de dignidade da pessoa humana. 2006. 162 f. Tese (Mestrado em Política Social) - Universidade de Brasília, Brasília, 2006.). In the last 20 years, with the increase in the female prison population, there has been an increase in legislation and regulations on the subject, but state scenarios can vary widely, given the low (if any) specific regulations on the matter in some places. On the other hand, even with more incorporated state legislation on the practice of breastfeeding in prisons, as is the case in São Paulo, the established standards may not respond satisfactorily to the needs of prisoners and their children, as rights defense entities point out.

The study by Simas (2015SIMAS, L. et al. A jurisprudência brasileira acerca da maternidade na prisão. Revista Direito GV, São Paulo, v.11, n.2, p.547-572, 2015. DOI: 10.1590/1808-2432201524
https://doi.org/10.1590/1808-2432201524... ) identified that the rulings by the Federal Supreme Court (STF), Supreme Court of Justice (STJ), and courts of justice have moved towards reaffirming the discourse of security and maintaining order. Several violations were highlighted by Santa Rita (2006SANTA RITA, R. P. Mães e crianças atrás das grades: em questão o princípio de dignidade da pessoa humana. 2006. 162 f. Tese (Mestrado em Política Social) - Universidade de Brasília, Brasília, 2006.), Diuana et al. (2016DIUANA, V. et al. Direitos reprodutivos das mulheres no sistema penitenciário: tensões e desafios na transformação da realidade. Ciência & Saúde Coletiva, Rio de Janeiro, v. 21, n. 7, p. 2041-2050, 2016. DOI: 10.1590/1413-81232015217.216
https://doi.org/10.1590/1413-81232015217... ), Nunes, Deslandes and Jannotti (2020NUNES, L. R. C.; DESLANDES, S. F.; JANNOTTI, C. B. Narrativas sobre as práticas de maternagem na prisão: a encruzilhada da ordem discursiva prisional e da ordem discursiva do cuidado. Cadernos de Saúde Pública, Rio de Janeiro, v. 36, n. 12, e00215719, 2020. DOI: 10.1590/0102-311x00215719
https://doi.org/10.1590/0102-311x0021571... ) in the analysis of institutional actions, with decisions that resulted in the reaffirmation of gender morality. Even though the granting of a Habeas Corpus order is possible in cases of unavailability of a suitable place for the right to breastfeeding to be respected, as is the case in almost all prisons, there are still opposing positions, due to the clash of rights (Oliveira and Teixeira, 2014OLIVEIRA, E. F.; TEIXEIRA, M. C. O Direito Fundamental das Presidiárias e seus Filhos ao aleitamento materno. Revista do Curso de Direito, São Bernardo do Campo, v. 11, n. 11, p. 68-101, 2014. DOI: 10.15603/2176-1094/rcd.v11n11p68-101
https://doi.org/10.15603/2176-1094/rcd.v... ).

It can therefore be seen that these legal instruments and their mechanisms and conceptions of fundamental rights are inadequate and insufficient to meet demands (Colombaroli; Braga, 2014COLOMBAROLI, A. C. M.; BRAGA, A. G. M. A cadeia feminina de Franca sob a ótica da visita íntima. Revista de Estudos Empíricos em Direito, São Paulo, v. 1, n. 2, p. 122-139, 2014. DOI: 10.19092/reed.v1i2.38.
https://doi.org/10.19092/reed.v1i2.38.... ), particularly in the practice of EBF. Although crimes committed by women are less violent, the layers of exclusion to which they are exposed are remarkable (Germano; Monteiro; Liberato, 2018GERMANO, I. M. P.; MONTEIRO, R. A. F. G.; LIBERATO, M. T. C. Criminologia crítica, feminismo e interseccionalidade na abordagem do aumento do encarceramento feminino. Psicologia: Ciência e Profissão, Brasília, DF , v. 38, n. 2, p. 27-43, 2018. DOI: 10.1590/1982-3703000212310
https://doi.org/10.1590/1982-37030002123... ). Furthermore, from an intersectional perspective it is important to mention that, although race is declared as a predominant characteristic in studies with imprisoned women, none of the articles reviewed found results that related these women’ possibilities of EBF to the racial issue.

According to Dina Alves, a thinker of the Brazilian abolitionist movement, the Brazilian legal system can be considered as a (re)updating of the slave order on which the country was built. The patriarchal-punitive system had-and still has-one of its main targets in the body of Black women, which can be illustrated not only in their experience as Black domestic servants in the kitchens of White elites- most well-known image-but also in prison statistics (Alves, 2017ALVES, D. Rés negras, juízes brancos: uma análise da interseccionalidade de gênero, raça e classe na produção da punição em uma prisão paulistana. Revista Cs, Cali, n. 21, p. 97-120, 2017. DOI: 10.18046/recs.i21.2218
https://doi.org/10.18046/recs.i21.2218... ).

Although EBF is a widely recognized practice for promoting the health of populations and the well-being of generations, there is a profound contradiction between this recognition and the technical, legal, and academic apparatus when placed in relation to the prison context. In a sense, what is revealed is precisely a profound contradiction whose effect is the lack of guarantees for the rights of incarcerated women and their children. On the one hand, the training and performance of health professionals regarding EBF practices in the prison context are in absolute disagreement with the principles of fundamental rights and universal access to health implied in the promotion of EBF. However, on the other hand, there is no legal or programmatic provision in the field of health and nutrition, including the academic production analyzed, to protect EBF and its actors from the widely known and described violations of the prison system.

As a result, breastfeeding within the prison context is generally impacted and used by the punitive power of the State, represented in the prison apparatus. This, as has been shown, is updated from time to time in the most heavily patriarchal and racist forms of the social context. So, what relationships can and should the health and nutrition field build, in terms of rights, with this apparatus? What forms, approaches and questions should be safeguarded when the academic field investigates health and nutrition, such as the promotion of EBF, in the prison context?

Final considerations

With the growth of the prison population over the last 20 years, there has been an increase in studies on the subject since 2010, mainly focused on the Center-South of Brazil. This article analyzes academic works in the areas of health and law on the practice of breastfeeding in prison, and reflects on the dynamics of academic knowledge production in the field of health and nutrition, in relation to the punitive power of the State. From a penal abolitionist and intersectional perspective, the findings highlighted analyses about the conditions of exclusive breastfeeding in prisons that do not question the practical and historical forms of imprisonment, especially regarding Black, female, and poor bodies. These perspectives persist over time, even with advances in legislation and guidance in the Dietary Guidelines for Brazilian Children Under 2 Years of Age.

The review found a scenario of studies that set out to learn about mothers’ experience, focusing only on noting the hostile situation for the practice of EBF and for women’s health, without more critical and purposeful approaches to changing the reality presented. Similarly, surveys of the main laws that support the reproductive rights of women in prison analyzed institutional actions and case law regarding the practice of breastfeeding, without any major points towards questioning as to the effectiveness of the penal system in re-socializing these women.

Even though there are studies that present testimonies of health team professionals, there is a lack of research that seeks to listen to prison and health agents more broadly. This could help to explain and understand their views on EBF practices, given that according to various studies, they are involved in deciding how long breastfeeding women and their babies stay together in prison. Furthermore, there is a noticeable lack of proximity to the principles of the Brazilian Unified Health System (SUS), especially integrality and particularly through conceptions of humanization in health.

Finally, there is a need for more in-depth and broader studies on breastfeeding in prisons, using different approaches to qualify the discussion and enable better parameters to support the proposition of public policies by society and the State. The production and use of scientific evidence, combined with anti-racist, anti-punitive, and pluralistic feminist perspectives can favor better health protection for countless women, closer ties with their children, family and social coexistence, respect, and the preservation of exclusive breastfeeding without harm to their babies’ development. The analysis developed here allows us to envision that, in terms of promoting and guaranteeing rights to health and food, especially for people in contexts suffering from precariousness and extreme illness, it is still necessary to stretch the limits of the imagination and ethical alliances in the political-academic field of health beyond the bars of surveillance and punishment.

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