"Breastfeeding in public" for incarcerated women: the baby-friendly steps.

Background: Women are the fastest-growing population in carceral facilities in Canada. Most incarcerated women are mothers, with above-average parity. The incarceration of women has implications not only for women's health, but for that of their children. For example, how is breastfeeding and access to human milk supported in the context of imprisonment? Both carceral and health services are publicly-funded and administered in Canada. Due in part to the well-documented ill-health burden of imprisoned women, health and carceral functions overlap in the spaces of confinement. This paper discusses "breastfeeding in public" in relation to imprisoned women: separated from the public, yet in publicly-funded spaces under public servant control. With increasing adoption of Baby Friendly Hospital Initiative (BFI) Ten Steps in Canadian health centres, there is a need to consider the health centre spaces precluded from its application and make visible the women and children affected. This paper uses the BFI Steps as a lens to consider the environment of confinement for the breastfeeding incarcerated person. The exclusion of breastfeeding and access to human milk for imprisoned women and children extends the punitive carceral function beyond the experience of incarceration and beyond the experience of the convicted mother. Discussion: Carceral facilities lack breastfeeding policies, foundational to breastfeeding support. Despite high fertility and parity among incarcerated women, carceral health care providers are not required to demonstrate maternity and reproductive health care specialization. The overarching mission of carceral institutions remains security, and support for breastfeeding among incarcerated women is hampered in spaces of conflict, punishment, surveillance and control. A minimal requirement to support exclusive breastfeeding is to promote the mother being with the infant and most incarcerated mothers are separated from their infants. Incarcerated women lack support, information, and community connections for extended breastfeeding beyond six months. Carceral facilities are not welcoming environments for breastfeeding families. Despite the incompatibility of breastfeeding with incarceration, BFI Step 10, coordinating discharge, demonstrates opportunity for improvement through community and health care provider engagement. Conclusion: Incarceration challenges the reach and applicability of the BFI Steps to enhance breastfeeding and to problematize the idea of breastfeeding "in public."

Maternal health outcomes for incarcerated women: A scoping review.

AIMS AND OBJECTIVES: To inform a systematic synthesis of what is known about the maternal health outcomes of incarcerated women, this scoping review uses a theoretical framework of intersectional feminism. BACKGROUND: Despite rising imprisonment of women, there is a lack of research, from a feminist perspective, on perinatal health outcomes among incarcerated women. DESIGN: Systematic scoping review using the Joanna Briggs Institute scoping review methodology. METHODS: In consultation with a medical research librarian, key databases and journals were searched for English and French-language articles published up to February 2018. Two authors independently screened titles and abstracts to identify articles for full-text review. Study quality was appraised using the McGill Mixed Methods Appraisal Tool. The study adheres to PRISMA-EQUATOR guidelines. RESULTS: Forty-five studies met the preset criteria and were reviewed in full text. In addition, 13 studies met consensus for inclusion. Method, setting, participants, sample, relevant outcomes and relevant findings were extracted from each study for synthesis. Included studies had varied methods and were published from 1989-2014. Participants included women imprisoned during the perinatal period up to six months postpartum. All studies were conducted in carceral contexts, with 12 based in the USA and one in Australia. Outcomes of interest included breastfeeding, operative deliveries, gestational complications, depression, stress, experiences, bonding and sterilisation. CONCLUSION: The research on maternal health outcomes pertaining to incarcerated women is limited. There is a need for in-depth examination of breastfeeding with this population. Researchers need to examine the prevalence and impact of carceral force, such as shackling, solitary confinement, strip-searching and restraints in pregnancy. There is a need for research that asks what health outcomes matter to the women themselves. RELEVANCE TO CLINICAL PRACTICE: Providers must be conscious of intersecting layers of discrimination and trauma incarcerated women experience and its impact on maternal health in the perinatal period and advocate for women.

Clinical Opinion Letters Regarding Breastfeeding and Neonatal Abstinence Syndrome for Child Apprehension Family Court Proceedings.

The accelerating reach of opioid use disorder in North America includes increasing prevalence among pregnant people. In Canada, the rate of Neonatal Abstinence Syndrome (NAS) rose 27% between 2012-2013 and 2016-2017, and it is estimated that 0.51% of all infants now experience NAS after delivery. Pregnant people are a priority population for access to opioid replacement therapy programs. Participation in such programs demonstrates significant commitment to self-care among pregnant people and concern for fetal and infant wellbeing. Participation in opioid replacement therapy often results in family surveillance by Child Protection Services and infant apprehension. Children of Indigenous descent are held in foster care at high and disproportionate rates.The Convention on the Rights of the Child principle of Best Interests of the Child governs family law and child access decisions. The value of breastfeeding for all children and in particular for children recovering from NAS can be a consideration in the Best Interest of the Child. Clinicians with expertise in lactation may support the breastfeeding dyad to remain together by preparing Clinical Opinion Letters for the court. This Insights into Policy presents a how-to description of the content of clinical opinion letters in such cases, including context and process considerations, client background, breastfeeding science, and factors specific to neonatal abstinence syndrome.

A critical review of human milk sharing using an intersectional feminist framework: Implications for practice.

OBJECTIVE: Driven by a growing body of research demonstrating the health benefits of human milk over substitute feeding preparations, the demand for human milk donations in North America is rapidly increasing. In the context of an increasingly institutionalized and commercialized human milk market, informal peer-to-peer milk sharing networks are commonplace. Race, class, gender and sexual orientation are intersecting aspects of identity and power that influence participation in breastfeeding and the domain of milk exchange. Using an intersectional feminist framework, we critically review studies of participation in milk sharing to examine the identities and socio-political circumstances of milk sharing participants. DESIGN, SETTING AND PARTICIPANTS: We use an intersectional feminist framework to conduct a critical review of the evidence pertaining to human milk sharing participants in North America. The search strategy included relevant databases (Pubmed, CINAHL) and hand-searches of key journals. We include research studies with participants in the United States and Canada and where participants milk shared as recipients or donors. FINDINGS: Of those studies that examine socio-political identities such as race and class, participants are largely white and high-income. Many studies did not examine socio-political identities, and none examine sexual orientation. Themes we identify in this review include: (1) Socio-political identities; (2) Milk sharing supports parental health; (3) Socio-political influences; (4) Resistance against institutionalization. IMPLICATIONS FOR PRACTICE: Maternity care providers can advocate for improved access to breastfeeding support and pasteurized human donor milk to address inequities. Maternity care providers can bring consciousness of intersecting socio-political identities to discussions with families about milk-sharing.

Policy and Legal Protection for Breastfeeding and Incarcerated Women in Canada.

Most incarcerated women in Canada are mothers. Because women are the fastest growing population in carceral facilities, protecting the rights of incarcerated women to breastfeed their children is increasingly important. There is considerable evidence that incarcerated women in Canada experience poor physical and mental health, isolation, and barriers to care. Incarcerated women and their children could benefit significantly from breastfeeding. This Insight in Policy explores policy and legal protection for breastfeeding in Canada as it relates to carceral facilities, considers key cases regarding breastfeeding rights among incarcerated women, and presents recommendations for policy development and advocacy. The Canadian Constitution and human rights legislation across Canada prohibits discrimination on the basis of gender and includes pregnancy and the possibility of becoming pregnant as a characteristic of gender. Some provinces note that breastfeeding is a characteristic of gender. Women's Wellness Within, a nonprofit organization providing volunteer perinatal support to criminalized women in Nova Scotia, conducted a scan of all provincial and territorial correctional services acts and the federal Corrections and Conditional Release Act: none mention breastfeeding. Protocols for breastfeeding during arrest and lockup by police were not available in any jurisdiction across Canada. International law, including the Convention on the Rights of the Child, the Nelson Mandela Rules, and the Bangkok Rules, have application to the rights of incarcerated breastfeeding women. The Inglis v. British Columbia (Minister of Public Safety) (2013) and Hidalgo v. New Mexico Department of Corrections (2017) decisions are pivotal examples of successful litigation brought forward by incarcerated mothers to advance breastfeeding rights. Improved application and understanding of existent law could advance breastfeeding rights.