Abstracts from The Academy of Breastfeeding Medicine 23 rd Annual International Meeting San Francisco,California November 14–17,2018

1 USLCA, Yuba City, California, USA

Category: Advocacy

Background: Background: Between 1980 and 2014, the number of incarcerated women increased by more than 700%; women represented approximately 9% of the correctional population in 2012, a substantial increase over the last 30 years. Around 6% to 10% of incarcerated women are pregnant. Pregnancies among incarcerated women are often unplanned and high-risk and can be compromised by lack of prenatal care, and other co-occurrences. Lack of appropriate medical treatment leaves these women and their babies at risk for lifelong health problems. Breast milk is known to have numerous benefits for newborns and mothers, but incarceration makes it difficult for infants and postpartum women to receive those health benefits. Also, mother–infant attachment is crucial for the infant's psychological development and the mother's mental health, especially in the immediate postpartum period.

Objective(s): Objectives: 1. Discuss current figures and statistics of incarcerated females, lactation accommodation difficulties for pregnant and breastfeeding mothers, and benefits to mother-baby dyad with respect to incarceration, residential programs and probation. 2. List three state or federal current or proposed legislation which address pregnancy, breastfeeding and incarceration (California AB 2507, New Mexico SB 293/HB 277, congressional Senate bill 1524 – DIA). 3. List three prisons or jails which have a lactation accommodation policy and summarize major points of the policy (City of San Francisco jail- California, Sutter County jail-California, Coffee Creek Correctional Facility-Oregon, Department of Corrections-Michigan).

Materials/Methods: Case Reports: Reviews, complaints and litigation of incarcerated pregnant women indicate these mothers are often not supported in access to prenatal and postpartum care. Several accounts and testimonies of incarcerated pregnant women will be presented and summarized, as well as the subsequent efforts of the mother, family and legal system to ensure adequate medical care for the dyad, including the provision of breast milk. Prison and jail policies and protocols are often non-specific and do not include lactation management. Some federal and state mandates have addressed incarcerated pregnant mothers and new directives and proposals have been introduced and approved.

Results: Discussion: Currently, the number of females incarcerated is nearly eight times higher than in 1980. The split of incarceration of females is fairly even between jail and prisons and 3–4% of those female inmates are pregnant at any given time. Approximately 60% of women in state prisons have a child under the age of 18. Eighty percent of women in jails are mothers and most of them are primary caretakers of their children. In most states, incarcerated women and their infants are separated two to three days after the birth. Maintaining lactation for these mothers is very difficult, though some state prisons and local jails allow “pump and pick up” programs so that the incarcerated mother's milk can be the source of food for the baby. However, these programs are limited. Some successful correctional facilities provide nursery programs that allow the mother and baby dyad to remain together in the facility for a period of time and these programs promote infant health and development, improve mother-child attachment and reduce recidivism. One such program is Bedford Hill Correctional Facility in the state of New York, in existence for over 100 years. Some states have proposed legislation requiring correctional facilities to have in place procedures that promote lactation accommodation through “pump and pickup” policies which support sustaining breastfeeding during prison or jail time. One state, New Mexico, presented such a bill, with the support of New Mexico legislators; however, the bill was vetoed by the governor. California has introduced bill AB 2507, which would require all correctional facilities in the state to provide lactation accommodation for inmates. This bill is currently in committee. Finally, congressional Senate Bill 1524 or Dignity for Incarcerated Women Act is an active bill that addresses health care for pregnant women in jails and prisons. The bill requires the correctional facility to provide necessary health care products for free – one of which could be a breast pump. Several jails and prisons have developed lactation accommodation policies which support and protect the breastfeeding dyad by allowing mothers better access to their breastfeeding infant and/or allow mothers access to a breast pump and time to express milk. The policies typically have a process by which the milk can be transferred to a family member or caregiver and then be fed to the baby. Some correctional staff have been supportive of the process, others have raised concerns over safety and security procedures and lack of staff and facilities to ensure the policy is adhered to. Currently, only a few California jails and correctional facilities have lactation accommodation policies in place. Medical professionals and their associations can be influential in encouraging more policy development with respect to support of quality care of the pregnant and breastfeeding mother who is serving jail or prison time. Both the mother and baby benefit. The treatment of a jailed pregnant or postpartum mother deserves special attention because of the demoralizing situation and stressfulness of incarceration. This includes an appropriate prenatal diet and medical care, as well as the awareness of custody staff as to their role in maintaining human dignity. The Eighth Amendment, “due process clause” and the efforts of Chief Justice Warren are often cited as a resource for standards of decency in the case of these women. Subsequently, the health of the mother and her child should be paramount.

Conclusions: The WHO recommendations on breastfeeding, the US Surgeon General's Report: Call to Action to Support Breastfeeding, the AAP, ILCA, and others, advocate breastfeeding as the optimum health for a newborn baby. The IBCLE endorses the broad human rights principles affirming that every human being has the right to the highest attainable standard of health and the Professional Code of Conduct states that IBCLC's provide services that protect, promote and support breastfeeding and collaborate with other members of the healthcare team to provide unified and comprehensive care, which should include incarcerated mothers and mothers on probation.

41. PREDICTORS OF BREASTFEEDING INTENTIONS AND IMMEDIATE POSTPARTUM BREASTFEEDING PRACTICES OF CHINESE AMERICAN PATIENTS AT AN INNER-CITY HOSPITAL