Breastfeeding in Correctional Settings (2018)

The majority of incarcerated women are of reproductive age. Some women enter jails, prisons, and juvenile facilities already pregnant and then give birth while in custody, and others have recently given birth and are breastfeeding their infants. While postpartum women represent a small proportion of the incarcerated population, they and their newborns have unique needs that the correctional facility should address. One of those needs is accommodating breastfeeding for postpartum women who want to provide their infants with breast milk.

Breastfeeding and breast milk have many short-term and long-term benefits for both the infant and the mother. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend exclusive breastfeeding for the first 6 months of life, except in women with medical or physical conditions that prohibit breastfeeding, then introduction of other foods along with breast milk until at least 12 months (American Academy of Pediatrics, 2012). The Agency for Healthcare Research and Quality conducted a comprehensive analysis of scientific literature that concluded that, compared to infants fed commercial formula, breastfed infants have fewer incidents of respiratory tract infections, ear infections, GI tract infections, necrotizing enterocolitis, sudden infant death syndrome, infant mortality, allergic disease, celiac disease, obesity, diabetes, childhood leukemia, and lymphoma (Breastfeeding and Maternal and Infant Health Outcomes, 2007).

For the mothers, improved health outcomes include less postpartum blood loss, less postpartum depression, and greater postpartum weight loss (American College of Obstetricians and Gynecologists [ACOG], 2013). Breastfeeding is also protective against later development of breast and ovarian cancer, cardiovascular disease, diabetes, and other conditions (ACOG, 2013). Psychological benefits include improved bonding between mother and child, which is particularly important when the mother is incarcerated (ACOG, 2013).

Whether or not they are breastfeeding, postpartum women may experience several breast-related medical issues that correctional health staff must be prepared to address. For instance, pain from breast engorgement, blocked milk ducts, and mastitis may require frequent breast milk expression as part of medical care.

There are very few contraindications to breastfeeding. Many women in custody have substance use disorders. Breastfeeding is safe and encouraged for women who are taking methadone or buprenorphine as there are benefits to their infants. However, breastfeeding is discouraged among women who are actively using illicit substances. Breastfeeding is also safe for women with hepatitis C, but is not recommended for HIV-positive women (American Academy of Pediatrics, 2013). Most common medications are safe with breastfeeding, although women should consult with their providers. While smoking is not a contraindication to breastfeeding, it can reduce a mother’s milk supply. In addition, exposure to tobacco smoke is harmful to children.

Proper nutrition is essential for breastfeeding mothers. They should receive a well-balanced diet with additional calories, no more than three caffeinated beverages a day, increased fluid intake, and supplementation to ensure appropriate intake of vitamins and minerals, including calcium and Vitamin D.