THE MEANING OF BREASTFEEDING IN PRISON¹

ABSTRACT

Objective:

to understand the meanings of the breastfeeding experience attributed by incarcerated women.

Method:

this is a qualitative research, developed based on the principles of comparative data analysis, adopting open and axial coding, and Symbolic Interactionism as a theoretical reference. Data collection was performed through in-depth interviews with 27 mothers and three pregnant women in six penitentiaries in the State of São Paulo, which comprised of three sample groups.

Results:

the data analysis resulted in three themes: Seeking remission through motherhood, where breastfeeding is inserted as an element to promote the bond between mother and child and in the promotion of maternal well-being, but is inserted in a context of social conflicts and losses; Experiencing daily attachment and the expectation of separation, which reflects the possibility of breaking the mother and child relationship with the end of the child´s stay in the prison environment; Recognizing that there were losses, but that they were worth it, reveals the mother´s assessment of her decision to keep the child with her in prison.

Conclusion:

Breastfeeding is one of the basic care activities that incarcerated women can offer their children, it is also an encouraging experience that fosters child and maternal well-being which she experiences in a context of ruptures, conflicts and preoccupations with her personal losses and the penal condition.

DESCRIPTORS:
Prisons; Breastfeeding; Women’s health; Maternal and child health; Mother-child relationships; Nursing

RESUMO

Objetivo:

compreender os significados da experiência de amamentar atribuídos por mulheres privadas de liberdade.

Método:

trata-se de uma pesquisa qualitativa, desenvolvida por meio dos princípios da análise comparativa dos dados, adotando a codificação aberta e axial, e do Interacionismo Simbólico como referencial teórico. A coleta de dados foi feita por meio de entrevistas em profundidade, com 27 nutrizes e três gestantes, em seis penitenciárias do Estado de São Paulo, que compuseram três grupos amostrais.

Resultados:

a análise dos dados resultou em três temas: “Buscando a remissão pela maternidade”, onde a amamentação se insere como elemento de promoção vínculo entre mãe e filho e na promoção do bem estar materno, mas está inserida em um contexto de conflitos e perdas sociais; “Vivendo o cotidiano do apego e a expectativa da separação”, que reflete a possibilidade de ruptura da relação mãe e filho, com a conclusão do período de permanência regulamentar da criança no ambiente prisional; “Reconhecendo que houve perdas”, mas que valeu a pena, que revela uma avaliação materna sobre sua decisão de manter a criança junto a si na prisão.

Conclusão:

a amamentação é um dos cuidados fundamentais que a mulher privada de liberdade pode oferecer ao filho, e ainda, experiência alentadora que propicia o bem estar infantil e materno e que ela vivencia em meio a um contexto de rupturas, conflitos e preocupações com suas perdas pessoais e a condição penal.

DESCRITORES:
Prisões; Aleitamento materno; Saúde da mulher; Saúde materno-infantil; Relações mãe-filho; Enfermagem

RESUMEN

Objetivo:

comprender los significados de la experiencia de amamantar atribuidos por mujeres privadas de la libertad.

Método:

se trata de una investigación cualitativa, desarrollada por medio de los principios del análisis comparativo de los datos, adoptando la codificación abierta, axial y el Interaccionismo Simbólico como referente teórico. La obtención de datos se realizó por medio de entrevistas en profundidad con 27 nodrizas y tres gestantes en seis penitenciarias del Estado de São Paulo que formaron tres grupos de muestras.

Resultados:

el análisis de los datos resultó en tres temas: “Buscando la remisión por la maternidad” en que la lactancia materna se inserta como elemento de promoción del vínculo entre madre e hijo y en la promoción del bienestar materno, pero que está incluida en un contexto de conflictos y pérdidas sociales, “Viviendo el cotidiano del apego y la expectativa de la separación que refleja la posibilidad de ruptura de la relación entre madre e hijo con la conclusión del período de permanencia reglamentaria del niño en el ambiente de la prisión,” “Reconociendo que hubo pérdidas pero que valió la pena”, lo que revela una evaluación materna sobre su decisión de mantener al niño junto con ella en la prisión.

Conclusión:

la lactancia materna es uno de los cuidados fundamentales que la mujer privada de su libertad puede ofrecer a su hijo, y además, es una experiencia alentadora que propicia el bienestar infantil y materno que la madre vive en medio a un contexto de rupturas, conflictos y preocupaciones con sus pérdidas personales y la condición penal.

DESCRIPTORES:
Prisiones; Lactancia materna; Salud de la mujer; Salud materno-infantil; Relaciones madre-hijo; Enfermería

INTRODUCTION

The prison population has increased significantly in the last decade, in all parts of the World.¹ In Brazil, more than 600,000 people are imprisoned, 579,423 of which are in the penitentiary system, with the majority being in the city of São Paulo (219,053).² From 1990 to 2014, the number of prisoners increased by 575%, with 7% of the Brazilian prison population being women.² This situation is similar to what happens in other countries, such as the United States, where the number of women increased by 646% between 1980 and 2010, with an average of 6% to 10% of women being pregnant at the time of admission to the American prison system.³

In American prisons, an investigation carried out with pregnant women in 53 prison units shows that only 37.7% admitted women were examined for pregnancy; some prisons depended exclusively on the arrested woman to communicate such knowledge. The study shows that not all prison units allowed the mother to breastfeed and, in specific situations, the woman could be allowed to store her milk to feed the child who, by law, could not remain with her during the penalty.³

The particular condition of women in prisons, which especially covers their reproductive life, has led to the creation of The Bangkok Rules, developed by the United Nations, which recognizes the health needs of women prisoners and encourages member states to seek potential ways to serve them, especially in the context of the care of pregnant women and their children.⁴ In spite of the evaluation of damages and benefits to the children, the presence of babies with their mothers in a prison environment is a reality in some prisons and represents a great controversy. In Brazil, even if the child can stay with her mother in custody for seven years,⁵ the most common occurrence is that the child’s stay is limited to the exclusive breastfeeding period of six months.⁷ Although women are prisoners, they still have rights, and breastfeeding is one of them.

In this context, it is important to consider the perspectives of the incarcerated mothers in relation to the practice of breastfeeding, since few studies in the world offer elements about what it represents for the mother, motherhood and breastfeeding experienced within the penitentiary.^8-9 As for many women, it may be the only good thing that they can do for their children.¹⁰

Despite the social impulses to increase the general prevalence of breastfeeding, it is known that in some cultures breastfeeding while in prison is not common,¹¹ or even allowed.³ As a practice influenced by the motivation of mothers, the decision to breastfeed is also linked to the context in which it occurs,¹² especially when considering the prison environment - which may “... make the need to be close to their children conflicting”.¹³

Thus, the meanings that women ascribe to breastfeeding stem from this experience and the other elements with which they interact with in their surroundings, it is possible to question the mother´s interaction, in the breastfeeding process, with the elements found in the context of a prison unit, even if it is differentiated due to housing mothers and their children.

Thinking about the experience of breastfeeding women in diverse situations of life and contexts has led us to reflect on the many special moments that the mother and child may be subjected to at this stage, such as the reality of the mother in prison - an extreme combination of social, economic, and emotional aspects as well as so many other human dimensions that may be involved and potentially impact the health and well-being of children and their incarcerated mothers. Breastfeeding in prison has not been prominent in scientific research and a small amount of studies on this subject have been found in the main databases. Understanding the experience of incarcerated pregnant women in the company of their children demonstrates potential ways to protect breastfeeding in this scenario of vulnerability. Thus, the objective of this study was to understand the meanings of breastfeeding experiences attributed by imprisoned women, aiming to situate this practice in the context of the lives of those incarcerated in prisons.

METHOD

This qualitative study was developed using the principles of comparative data analysis, adopting open and axial coding according to Strauss and Corbin,¹⁴ aiming to provide a reflexive and in-depth construction of a given reality. Along with the evolution of the research, the application of theories contributes to the interpretation of the data, and from this perspective, Symbolic Interactionism was adopted,¹⁵ which allows to investigate the interactions and the relationships between them, seeking, in this association, a conceptual ordering that exposes the experience of breastfeeding women within the prison context.

Due to the presence of foreign women in penitentiaries,² we only included mothers and pregnant women fluent in the Portuguese language in this study so that the language did not compromise the quality of the collected data.

The investigation was performed in six female penitentiaries in the State of São Paulo (Brazil), which were selected as they allow mothers to be with their children during the breastfeeding period: Capital Female Penitentiary, Sant’Anna Female Penitentiary, Pirajuí Female Penitentiary, Tupi Paulista Penitentiary, Tremembé II Female Penitentiary, and the Dr. Marina Cardoso de Oliveira de Butantan Penitentiary Progression Center. Women who stayed with their children during the breastfeeding process, regardless of breastfeeding method, and three pregnant women who were in the same prison context were included in the study

The selection of women was based on the inclusion criteria and the principles of theoretical sampling, which allows the identification of the participants who can best contribute to the development of certain concepts. Thus, the sequential inclusion of the women sought data that could give consistency to emerging categories and responses to the hypotheses generated by data analysis, resulting in the formation of sample groups. The collection was conducted until no new information was added or was able to modify the elaborated concepts.

Three participant groups were composed: the first group consisted of 14 women whose infants were between four and six months of age, as their long-term experiences with breastfeeding in that context allowed the emergence of potential categories of analysis; the objective of the 2nd group was to broaden the understanding and decision-making process of the woman regarding staying with her child in the prison during and after pregnancy. This group was formed by three pregnant women; the third group consisted of 13 women with babies between zero and three months of age, aiming to give density to the concepts already elaborated regarding their evaluation of their decision to keep the child with them in prison, the perspective of compulsory weaning and the expectation of probable separation.

Thus, the group of pregnant women consisted of the hypothesis that the women began to think about the decision to keep the child with them in the penitentiary during pregnancy, anticipating situations that they believed they had to live with. The third group consisted of women in the first trimester of the postpartum period, based on the hypothesis that the intense suffering presented by them, due to the weaning process, increased when the child was closer to six months of age, therefore suffering increased with the passing of time, due to weaning and the future separation from the child.

The data were collected from February 2014 to May 2016. A previous visit was made to the prison units with the objective of personally meeting the managers and the women who would meet the research inclusion requirements, as well as to insert the researcher in the environment in which the women and their children reside, so that it was possible to understand them and to directly observe the context in which they lived.

The interviews were recorded with the consent of the participants and performed by the researcher. They were scheduled for the day and time when the nursing mothers and pregnant women were available and permitted to participate, therefore preserving the dynamics of the units’ functioning, as well as the availability of the prison professionals that could aid in the transit of the researcher to the internal dependencies.

After creating a trusting environment an initial question was introduced: tell me about your experience of breastfeeding. The interviews were further developed with new questions which did not follow a fixed script but were led by the researcher and the women as they described their experiences. The interviews with the pregnant women began with the following question: what do you think it will be like to breastfeed your child? As the research developed, the data analysis generated the composition of categories and the hypotheses which were to be explored with the next interviewees until no further data relevant to the set of categories appeared in the statements.¹⁴

The interviews were transcribed in full by the researcher, and the lines were numbered to facilitate the codification. During the analysis process reflection records that arose during the reading of the interviews were used as well as memorandums, the Code Notes, Theoretical Notes and Operational Notes in the search for elements that would support the understanding of the phenomena under study.¹⁴ These records were made when necessary - in or out of the research field, highlighting potentially important events in the composition of the incarcerated woman´s experience, whose reflections and interpretations directed the search for more evidence.

Data analysis was performed according to the theoretical assumptions of Strauss and Corbin,¹⁴ by means of a constant comparison, concomitantly with the collection, through open coding, with the aim of giving meaning to the incidents that emerged from the discourse of the participants. Data were repeatedly analyzed line by line, with the aim of understanding the identified incidents so that they could then be encoded substantively based on the thoughts of the women.

With a sufficient number of generated codes, it was possible to analyse them and let categories that highlight their respective relevancies emerge. Next, the codes were compared and grouped in a new conceptual codification that received other names according to similarity patterns, passing through a consolidation process of categories and subcategories, configuring the axial and selective coding, generating a conceptual ordering when data saturation was reached after the 30th interview.

As a procedural method of constant analysis, the research can be completed in different stages as the results obtained answer the research questions. Thus, for this study, we identified categories and subcategories that indicated the sufficiency of theoretical contents emerging from the data, in order meet the objectives of this study.

The study complied with ethical standards and was approved by the Research Ethics Committee of the University of São Paulo School of Nursing (CAAE: 20894313.2.00005392) and the Penitentiary Administrative Secretariat (CAAE: 238.132.2.0000.5563).

RESULTS

By keeping the child with her in the prison context, the woman experiences a possibility of rebuilding her affective and social universe, evolving the construction of a bond with the child as the product of an appropriation of care with the child, breastfeeding and her maternal role; this “maternalized” day-to-day life leads to the recovery and reaffirmation of ties with other important people, such as family, and with herself, although concomitant to the experience of attachment construction, this woman lives with the expectation of new ruptures, with the end of the child´s stay in prison.

Seeking remission through motherhood

This first theme presents the woman´s reflexive attitude about her reality, provoked by the daily experience of dealing with the elements that compose, for her, hostile situations and a hostile environment potentially causing social and affective ruptures with the social objects that emerge both within and outside the institution. For these women, the child represents the opportunity to develop a genuine relationship in the prison context, as a child represents the minimization of their suffering and the filling of emotional gaps and affective bonds that they lose due to being in prison. The intensity of the relationship between mother and child makes the woman perceive the child as her universe, source of happiness, pleasure and completeness, feelings that make her feel that she is not serving time; making it possible to change paradigms and experience both the present and a future for their child as well as feeling motivated to make plans.

For the woman prisoner, breastfeeding is a form of protection both for her and for the child. For her, it is an instrument which make her feel protected in the sense of self - appreciation and acceptance, which allows her to perceive herself in her full capacity to breastfeed and in the performance of her maternal role. Ah, for me, when my children are feeding, it´s a way for them to love me [...] love more, that type of affection (E2). Affectionately and emotionally nourished, it reinforces their beliefs about the value of breast milk and its benefit to the health of the child. Children who breastfeed up to six months of age are smarter than those who are bottle fed [...] there are babies who are six months old, who are bottle-fed, and they do not roll [...] (E1).

Thus, the mother realizes that she is living a new model of motherhood that represents the concrete experience of incarcerated motherhood as a chance to be a mother, insofar as she feels able to live fully for her child, without obstacles, and no longer just for her. Here we have the chance to give motherly affection, take care of him [...] because I do not have to live for me anymore, I can live for him, I can do everything for him to be well (E6).

This frequent interaction with the child as the sole caregiver results, from the perspective of the woman, both in the intense attachment to the child, and in the feeling of completeness by living exclusively with the child, enjoying motherhood and leading her to reflect on her previous maternal experiences and her daughter’s experience, provoking the desire to be a better mother. [...] I think I’m more attached to her because she’s in here (E8). Living with the child and spending their time on the demands of child care causes the woman to feel the daily burden of her imprisonment less and encourages the family to come together. Thus, taking care of the child seems to make her time in prison easier. [...] it seems that I’m not even in prison, the day goes by and we don’t even realise it, and we do so many things with these children in here (E5) my son gives me strength [...] I miss his brothers; the affection, because he is very affectionate (E27).

Experiencing attachment daily and the expectation of separation

The second theme represents a context in which the mother experiences the coexistence of the evolution of her attachment to the child and the evolving feeling of loss - due to the future separation when the child turns six months of age. It reveals the emotional fragility of the mother who, despite being content, due to the presence of the child beside her and breastfeeding, coexists with the timeless and frequent threat of separation from the child at the end of the six months.

The knowledge that she will have to separate herself from her child is a milestone in the life of the imprisoned mother, revealing a growing suffering over time and the daily search for alternatives to remain with the child. She experiences the threat of separation with every day that goes by [...] they’re going to take my girl, I do not know what I’m going to do without her [...] I am only starting to realize that now, [...] they’re going to take my daughter away from me at any moment now (E18). The feeling and expectation of loss causes the suffering that is reaffirmed when they see other women prisoners hand over their children and this makes them anticipate the pain of separation ... I experience this every day, feeling this pain, thinking about the time that my child won’t be here anymore (E3).

Although she is aware of the amount of time that the child will stay with her inside the prison, there is a specific moment that signals the approaching separation, this occurs when the institution informs the women that it is time to start weaning the child. The weaning process represents the submission of the woman to the designs of the legal rules, and with it, the loss of the child. It brings an act of progressive detachment from the child that will be definitive when the child leaves the mother´s arms. The true beginning of the separation is perceived by the women when the institution decides that they need to wean the child. The woman starts to feel obliged to wean in a situation where, apparently, because she is subject to prison rules, there is no other choice. Thus, a symbolic distancing occurs - the impending separation of mother and child. In this perspective, the mother perceives being constantly reminded by people that they need to start weaning as the announcement of their separation from their child [...] she keeps saying (penitentiary agent) to hand over the child all the time, it´s a lot of pressure, my heart even starts to accelerate (E4).

Faced with institutional obligation to wean the child, the woman experiences a dichotomous situation, in which she now perceives and recognizes the need to wean, but on the other hand, starts to consider the losses for the child and for herself.

Thus, she is reluctant to wean, considering that weaning does, in fact, facilitate the child’s separation. They cling to the hope that maintaining breastfeeding will help them to stay with the child longer, avoiding separation. The mother persists in breastfeeding hoping that something, maybe a miracle, will change her penal situation and there will be no need to wean, and consequently no need to be separated from the child.

In addition to her suffering related to the risk of loss, the incarcerated mother also thinks about what the weaning means for the child. By trying to keep the child close to her and continuing to breastfeed, she interprets the interruption of breastfeeding as a source of suffering for the child, because she perceives that her child is looking for and accepting the breast. The manifestations of the child are interpreted as expressions of attachment to the breast: weaning represents a loss for the child. Thus, continuing to breastfeed would be a way to avoid further suffering for the child. I know that he will suffer when he leaves ... but I can´t watch my son suffering here in my arms, wanting to feed and saying no to him (E4).

In this scenario, they also identify the difficulty of adapting the children to the other foods offered in the institution and consider that this is also suffering and a risk to child´s health. And another thing, all the children here start to vomit when they stop breastfeeding, because of the strong milk that they provide, that milk that comes to us, but even putting water, it´s doesn’t help... We don´t get the milk formula all the time (E3).

However, she recognizes that at some point her child will have to consume other foods, so the adaptation may be worse if the child is not weaned in time for her to be part of the child´s transition and be present to help the child cope with this situation. Thus, anticipating the child’s suffering makes her choose interrupting breastfeeding so that she is responsible for preparing her child for the new reality, in the imminence of the separation she analyzes the best option or the least offensive option for the child, and seeks to convince herself that weaning is the best (suffering) for the child Because if I just breastfeed her, she will get there to wherever she is going, and she will not want to eat ... She will suffer more (E2).

For this mother, continuing to breastfeed can cause suffering to the child, and dealing with this process becomes even more intense when she realizes that this situation would be unnecessary if she could remain with her child. Faced with the prospects of so many losses, she seeks ways to prevent any situation that results in the separation from her child, from preventing the child from getting sick and being taken to receive medical attention as well as maintaining a good relationship with the other prisoners so that there is no reason for them to take her child from the unit. Even if the mother starts to think about the child being discharged at six months of age, she looks for possible ways that might allow the child to stay with her longer or for them to leave the prison system together, avoiding separation altogether. I see the possibility of leaving with her because I’m going to confess, I’ll tell the judge the truth (E8); I already wrote to the Mothers of the Prison Project [...] and they said that it is possible to stay up to two years (with the child). But these things take time, here you must wait for everything (E4).

When the child leaves the prison, the mother faces an objective reality of concrete losses. Objectively, her routine changes and she loses the right to remain in the special unit and must return to the normal facilities of the penitentiary. She also feels the loss of the child in her day-to-day life, no longer having anybody to occupy herself with or to dedicate herself to affectively. Thus, she feels an emptiness, and experiences a new condemnation by having her joy replaced with despair, anguish, want and solitude, feelings that lead her to foresee the loss of courage and strength to face imprisonment. In addition to her feelings, a harsh reality is projected into the future, especially among women whose family members are not responsible for the child and the child is referred to social services. This situation can result in the definitive loss of child custody: I ​​am suffering [...] They came to say that she cannot stay and that she goes to a foster family because my family did not want to take her (E28).

Recognizing the losses, but that it was worth it

The third theme represents the set of elements that she identifies in this context, which brought advantages to her and the child, but which also undermined the child’s natural rights. Throughout the process of building the relationship with the child and, at the same time, the evolution of the feeling of loss due to the child’s future departure, the mother starts to evaluate her and her child´s experience in the unit. It exposes the interventions of the contextual conditions that qualify her interactional experience with the other actors and which interfere in the quality of the child’s experience. She acknowledges that there were losses for the child but considers that these are not enough for her to give up her child.

Together with the losses that women feel the children suffer, is their interpretation of depriving the child from living with the family, harming the child by keeping the child with her in prison. I suffer seeing that he isn´t living his brothers, and his father? As much as they visit us here it is not the same thing (E29).

Moreover, she recognizes the losses to the child by subjecting the child to the material and resource limitations of the prison environment and the submission to fixed institutional norms, such as the locking of the cells twice a day and being exposed to the smoking habits and conflicts between the prisoners. From the mother’s point of view, this condition represents a punishment for the child as it makes everything more difficult and threatens their well-being. Thus, because she feels constrained to provide other conditions to care for the child, the woman constantly re-evaluates her decision to keep the child with her. When she arrives at four o’clock in the afternoon, we see how upset she is. The way she looks at you to say, ‘I want to go outside’. There is nothing I can do, and at the same time I do not want to hand her over (E27).

However, even in this context of loss, she does not give up on her child because she believes that for the child, it is still better to be with the mother, despite the challenges and limitations that are faced in the prison environment. The mother also believes that keeping the child, in that environment, could be rewarded by the possibility of being released from the institution together. It´s better to be with the mother even going through this. It´s no use, nothing that happens will make me give up my child [...] I will not give up and leave him before I have to (E28).

While seeking to find justifications for the child’s permanence in the prison with her, the mother may feel guilty at the end of this experience for having exposed the child to losses to some degree, but they also seek to lessen this feeling by projecting the future of the child and the benefits for the child outside the prison environment. The mother seeks comfort when faced with the anguish caused by the threat of permanent separation from the child. This represents a way to make sense of the future separation from the child, giving the child a better chance outside of the prison: we must think that it is best for him. Staying with me until I get released will be bad for him, he will suffer, and I can’t make him suffer [...] No, let him leave that is the best for him (E1).

The women evaluate that the experience of breastfeeding and caring for the child in prison, despite all the difficulties, allowed them to dedicate themselves to the child and give the care and love that the child needed. Although she recognized the limiting environment, she believed it was worth it, both for her and for her son. It was all he needed, care [...] love, affection, breastfeeding (E12); as much as it will be painful to hand him over him, take him away, but it was worth it (E6).

DISCUSSION

It is possible to perceive that the imprisoned woman in the company of her child seeks to overcome the emptiness throughout their period of coexistence, which results in sadness and solitude caused by the situation of being incarcerated. Such feelings are eased by the presence of the child, but strongly re-emerge due to the necessary discharge of the child from the prison system. It is in this scenario that the woman constructs her maternal experience in the penitentiary, in which her experience of breastfeeding is inserted.

The meaning of the breastfeeding experience for the imprisoned woman is mixed with simply being able to be with the child in that context and represents a means of protecting the child and herself from a hostile environment by the unique affective bond. The elements of interaction with the child, identified by her, are important in the construction of the maternal bond. The theoretical model of weighing up the risks and benefits¹⁶ demonstrates that the mother, by identifying benefits for the child and not identifying risks for herself, relies on her ability to breastfeed and perceives this practice as an act that goes beyond providing nutrition via the breast milk, but represents an emotional benefit that contributes to the child’s development and affection between mother and child.

Despite the recognition of the nutritional properties of breastmilk and its importance to the health of the infant, breastfeeding is, for imprisoned women, a unique manifestation of affection, love and affection that nourishes them emotionally.^17-18 This facet can be understood in our study when the mother seeks to breastfeed to protect the child, prioritizing their needs and the protection provided by the nutritional benefits of breast milk, especially in the prison context.

The significance of breastfeeding for the imprisoned woman is also understood through the evaluation she makes of elements identified in her daily life, which evoke feelings in her that support her actions in relation to breastfeeding. In this way, the woman perceives herself equally protected, in that she feels valued, close to her child and complete when breastfeeding. For authors of a study with free women outside of the prison context, the various feelings that emerge during the breastfeeding period are influenced by the context in which they live, which may lead them to experience insecurity regarding the act of breastfeeding, especially in primiparous women.¹⁹ This insecurity does not appear in the discourses of imprisoned women because they are attentive to other elements that substitute the difficulties of breastfeeding and make breastfeeding valuable for them and their children.

The woman realizes that she is experiencing, together with the child, a bonding process, in which by breastfeeding, she feels loved and important to the child. Likewise, breastfeeding represents the only link between mother and child and a means by which the mother feels recognized, which is a necessity of the human being.²⁰ In addition, the sense of completeness experienced by the imprisoned woman while breastfeeding was also found in another study with imprisoned women in the company of their children, in which the interviewees report feeling “ more like mothers.”^{18: 296}

The appreciation felt by the mother when breastfeeding her child is a feeling associated with the woman’s self-esteem by demonstrating the respect she feels for herself, impacting all the dimensions of her life.²¹ This becomes especially important in the prison context where the woman breastfeeds her child, as when the mother has high self-esteem she can perceive and attend to the needs of the child and develops self-confidence to face her condition. The results of a study with pregnant women are similar to these findings,²² in which pregnant prisoners identify breastfeeding as the main and exclusive element of maternal identity, a care that could be performed only by them and therefore makes them special.

Another concept that deserves to be discussed concerns the paradigm of “being a mother”, which also gains new meanings from the reality that the imprisoned woman experiences with the child in prison. In this experience she finds herself involved in a relationship with her child that allows her to live a new model of motherhood, based on the exclusive dedication and affective exchange that perhaps she could not experience with the other children. Being a mother in prison, where the woman lives for the child, can represent a unique opportunity to feel like a mother, but also leads the woman to reflect on the performance of her maternal role with her other children, perceiving their faults. For some authors,²³ the women report having learned to be mothers in prison and recognize this experience as an opportunity to care for their children without having to worry about other domestic activities, which facilitates dedication to breastfeeding.

The quality of the relationship between mother and child causes the woman to make the child her universe, her source of happiness, pleasure and fulfilment, emotions that provoke the feeling that even though she is serving her time in prison, she feels as though her punishment is diminished. The presence of the child during the incarceration reduces the suffering, as being with the child, makes the days easier and keeps family around, representing, above all, a safe emotional support for coping with the anguish that results from idleness, these results are confirmed by several authors.^19,23-24

Even in prison, faced with the perception of adverse conditions, the women find an opportunity to transform and to meet their own needs in the relationship with the child, maintaining affective ties and bonds with the outside world, as the imprisoned woman, according to authors, feels abandoned and faces difficulties in maintaining affective-sexual relationships due to prison regulations - such as body inspections of companions and medical examination requirements - as well as social and gender issues.²⁵

For the imprisoned woman, being pregnant while incarcerated lessens the loneliness and longing for other children, favouring the maintenance of bonds and creating a possibility of obtaining benefits or improved prison conditions.²⁵ Our results indicate that the imprisoned woman seeks to fill the gaps left by their children’s absence during her imprisonment, which is also highlighted in other investigations,^23,26 especially for those whose ties with their children had already been broken outside the walls by virtue of their lifestyle.

In this process of being a mother in prison, the emotional well-being of the woman is a fragile and constantly threatened composition, faced with the “almost non-negotiable” disconnection of the child after the successful experience of affective construction. There is an effort to try to harmonize these two worlds, living with the child, but living every day with the expectancy of living without the child - resulting in negative feelings.

The mother must live with feeling complete and the fear of losing the bond with the child, which ascribes another punishment and returns the void now filled. It is also necessary to consider that, in addition to losing the bond, the mother suffers due to the possibility of permanently losing her child and not obtaining legal custody when she is released because, according to other studies, she is ashamed to present herself to the child as an ex-prisoner or because of the real difficulties of reintegration into society, fixed housing and employment.^25-27

Maintaining a bond between mother and child during incarceration and after the child’s removal from the prison system is important as it gives the imprisoned woman confidence in relation to family relationships. In a study of 210 women in a women’s penitentiary in the United States, it was found that the quality of their relationship with their child’s caregivers is essential so that they can regain custody of their children after serving their sentence. For the authors, closer family contact is perceived to impact on reintegration into society and lower incidences of criminal reoffences.²⁸

The emotional stability perceived by the woman, which according to them results from motherhood and breastfeeding, is compromised when she begins to think about the idea of ​​compulsory weaning, which represents the symbolic break of the bond between mother and child and announces the forthcoming separation. As for free women outside of the prison context, prolonging breastfeeding represents a way of maintaining the relationship with the child, maintaining emotional exchanges, closeness and allowing the woman to feel important and needed.

In this context, as breastfeeding is as a strong link which is capable of creating a greater connection,²⁹ the woman suffers when weaning is requested, which she seeks to mitigate by examining the circumstances of her penal condition, and then act by refusing or agreeing to stop breastfeeding in advance, before the child is handed over to another person at six months of age. In this way, weaning is perceived as a break in the bond and causes the woman to feel uncertain about what is best for the child, and her actions are defined based on what may be most damaging to the child; in her point of view, weaning can cause suffering, but refusing to wean also causes suffering. In a study conducted in Brazil,¹⁸ mothers see weaning as the loss of an important part of themselves and regret having to discard the breastmilk which is so important to their children.

The experience that the woman has with the child, integrally involved with the aspects of motherhood, allows the mother to frequently evaluate her interactions in this context and in a way, clarifies the losses which the child is exposed to, especially regarding the delay of presenting the child to the world outside the walls of the penitentiary. The mother keeps the child a prisoner, concretely or symbolically, and experiences the limitations of the prison environment and deprives the child of a free life outside the walls with other important people and the family, like an extension of her sentence to her child.²⁵

The recognition of the losses is also perceived in a study carried out in Portugal with 20 imprisoned mothers, in which the arrested participants report that they are strongly related to the issues of relationship conflicts between detainees.²⁴ The mothers ‘dissatisfaction with the child’s presence with them in the prison refers to inadequate paediatric health care, whose triage system for identifying the need for emergency care, sometimes falls under the responsibility of the security guards of the prison unit, which creates tension in between the women prisoners and the agents.²⁵

Nevertheless, when the date to hand over their child approaches, the participants evaluate their experience of staying with the child in the prison, which is done by means of identifying and appreciating the perceived benefits to the infants, allowing them to feel that it was worth having followed their development and breastfeeding them. The results of the Portuguese study, as well as a study performed in Brazil, show that despite the benefits, being a mother with a child in prison also represents suffering for the mother simply because they are imprisoned and because of the uncertainty regarding the future and protection of their children.^24-25 However, breastfeeding depends on the nursing mother’s social values, which can influence or compromise maternal behaviour. ³⁰

The emerging themes in this work demonstrate that, for the mother in prison, the sense of security she experiences in the special unit being with the child, is completely lost with the separation from her child and her agony of separation begins symbolically and, concretely with the request to wean the child. Thus, this research encourages health professionals of the prison system to build opportunities for these women to regain their sense of security after the child is released, through acceptance and understanding which can help to rebuild the relationship that incarcerated women have with their social environment.

CONCLUSION

Category - Seeking remission through motherhood, talks about the construction of a relationship between mother and child, which for the mother, represents a way of tolerating and coexisting with the hostile and conflicting environment of the penitentiary. Breastfeeding represents an alternative for the well-being of the child and the mother, as it also represents the security of keeping the child close to her.

Category - Experiencing attachment daily and the expectation of separation, shows that, by experiencing the crisis of weaning and separation from the child, the woman also experiences the possibility of other losses, especially the bonds with her world of reference and with herself. The opportunity to care for and live with the child is recognized by the mother in the Category - Recognizing the losses, but that it was worth it, despite the perceived losses and damages. In addition to the biological and emotional significance, breastfeeding is a instrument used to ensure the right to keep the child close to you. Although many issues still need to be elucidated, due to the limitations of the study and the access difficulties, it was possible to highlight the experiences of women continuously living between the construction and ruptures of social ties.

• 1
  Article extracted from dissertation - Breastfeeding in the prison environment: the experience of incarcerated women in penitentiaries in the State of São Paulo, presented Escola de Enfermagem, Universidade de São Paulo (USP), in 2016. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001

REFERÊNCIAS

• ¹
  Walmsley R. World prison population list. 11th ed. Institute for Criminal Policy. 2016 [cited 2016 Jul 22]. Available from: http://www.prisonstudies.org/sites/default/files/resources/downloads/world_prison_population_list_11th_edition.pdf
  » http://www.prisonstudies.org/sites/default/files/resources/downloads/world_prison_population_list_11th_edition.pdf
• ²
  Ministério da Justiça (BR), Departamento Penitenciário Nacional. Levantamento Nacional de Informações Penitenciárias. Infopen Junho 2014. Brasília (DF): DEPEN; 2014.
• ³
  Kelsey C, Medel N, Mullins D, Forestell C. An examination of care practices of pregnant women incarcerated in jail facilities in the United States. Maternal Child Health J [Internet]. 2017 [cited 2017 Jul 22]; Available from: https://www.ncbi.nlm.nih.gov/pubmed/28236159
  » https://www.ncbi.nlm.nih.gov/pubmed/28236159
• ⁴
  Regras de Bangkok: regras das Nações Unidas para o tratamento de mulheres presas e medidas não privativas de liberdade para mulheres infratoras. Brasília (DF): Conselho Nacional de Justiça; 2016 [cited 2017 Jul 22]. Available from: http://www.cnj.jus.br/files/conteudo/arquivo/2016/03/a858777191da58180724ad5caafa6086.pdf
  » http://www.cnj.jus.br/files/conteudo/arquivo/2016/03/a858777191da58180724ad5caafa6086.pdf
• ⁵
  Senado Federal (BR). Constituição da República Federativa do Brasil. Brasília (DF): Senado Federal; 1988.
• ⁶
  Brasil. Congresso Nacional (BR). Lei n.º 7.210, de 11 de julho de 1984: institui a Lei de Execução Penal. Brasília (DF): Congresso Nacional; 1984.
• ⁷
  World Health Organization. Infant and Young child feeding [Internet]; 2016 [cited 2017 Jul 22]. Available from: http://www.who.int/mediacentre/factsheets/fs342/en/
  » http://www.who.int/mediacentre/factsheets/fs342/en/
• ⁸
  Santa Rita RP. Crianças em ambiente penitenciário: uma análise da experiência brasileira. Vox Juris [Internet]. 2009 [cited 2016 Jul 22]; 2(1):203-20. Available from: http://www.ugf.br/editora/pdf/voxjuris_2/artigo7.pdf
  » http://www.ugf.br/editora/pdf/voxjuris_2/artigo7.pdf
• ⁹
  Shamai M, Kochal RB. “Motherhood starts in prison”: the experience of motherhood among women in prison. Fam Process [Internet]. 2008 [cited 2016 Jul 22]; 47(3):323-40. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18831310
  » http://www.ncbi.nlm.nih.gov/pubmed/18831310
• ¹⁰
  Oliveira VS. Presidiária do Amapá: percepção sobre a importância de amamentar. Macapá [Internet]. 2011 [cited 2016 Jul 22]; 1(2):127-41. Available from:http://periodicos.unifap.br/index.php/estacao/article/viewArticle/262
  » http://periodicos.unifap.br/index.php/estacao/article/viewArticle/262
• ¹¹
  Mariano GJS, SIlva I, Andrews A. Amamentação em ambiente prisional: pespectivas das enfermeiras de uma penitenciária feminina irlandesa. Rev Iberoam Educ Invest Enferm [Internet]. 2015 [cited 2016 Jul 22]; 5(3):15-24. Available from: http://www.enfermeria21.com/revistas/aladefe/articulo/169/
  » http://www.enfermeria21.com/revistas/aladefe/articulo/169/
• ¹²
  Camarotti CM, Nakano AMS, Pereira CR, Medeiros CP, Monteiro JCS. Perfil da prática da amamentação em grupo de mães adolescentes. Acta Paul Enferm [Internet]. 2011 [cited 2016 Jul 22]; 24(1):55-60. Available from: http://dx.doi.org/10.1590/S0103-21002011000100008
  » http://dx.doi.org/10.1590/S0103-21002011000100008
• ¹³
  Monteiro EMLM, Silva ARS, Nascimento CAD, Maia AFLD, Araújo PDA, Santos SM. Aleitamento materno no sistema penitenciário. Rev Enferm UFPE [Internet]. 2011 [cited 2016 Jul 22]; 5(8):1970-8. Available from: http://www.revista.ufpe.br/revistaenfermagem/index.php/revista/article/viewArticle/1925
  » http://www.revista.ufpe.br/revistaenfermagem/index.php/revista/article/viewArticle/1925
• ¹⁴
  Strauss AL, Corbin J. Basics of qualitative research. London (UK): Sage; 1998.
• ¹⁵
  Blumer H. Symbolic Interactionism: Perspective and Method. London (UK): University of California Press; 1969.
• ¹⁶
  Silva IA. Amamentar: uma questão de assumir riscos ou garantir benefícios. São Paulo (SP): Editora Robe; 1997.
• ¹⁷
  Araújo ANV, Moura LB, Ferreira Neto EA, Bispo TCF. Percepção de mães presidiárias sobre os motivos que dificultam a vivência do binômio. Rev Enferm Contemporânea. 2014; 3(2):131-42.
• ¹⁸
  Rios GS, Silva AL. Amamentação em presídio: estudo das condições e práticas no Estado de São Paulo, Brasil. Bol Inst Saúde [Internet]. 2010 [cited 2016 Jul 22]; 12(3). Available from: http://periodicos.ses.sp.bvs.br/scielo.php?script=sci_arttext&pid=S1518-18122010000300014&lng=pt&nrm=iso
  » http://periodicos.ses.sp.bvs.br/scielo.php?script=sci_arttext&pid=S1518-18122010000300014&lng=pt&nrm=iso
• ¹⁹
  Merel C, Bortoli CFC, Massafera GI, Silverio M, Bisgnin, P, Prates LA. Feelings and maternal experiences associated with the breastfeeding process. J Nurs UFPE [Internet]. 2015 [cited 2016 Jul 22]; 9(8 Supl):9343-51. Available from: http://www.revista.ufpe.br/revistaenfermagem/index.php/revista/article/view/7806/pdf_8615
  » http://www.revista.ufpe.br/revistaenfermagem/index.php/revista/article/view/7806/pdf_8615
• ²⁰
  Zimerman DE. Os quatro vínculos: amor, ódio, conhecimento e reconhecimento, na psicanálise e em nossas vidas. Porto Alegre (RS): Artmed; 2010.
• ²¹
  Lana APB. O livro do estímulo à amamentação: uma visão biológica, fisiológica e psicológica comportamental da amamentação. São Paulo (SP): Atheneu; 2001.
• ²²
  Huang L, Atlas, R, Parvez F. The significance of breastfeeding to incarcerated pregnant women: an exploratory study. Birth [Internet]. 2012 [cited 2016 Jul 22]; 39(2):145-55. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23281863
  » https://www.ncbi.nlm.nih.gov/pubmed/23281863
• ²³
  Melo DC, Gauer G. Vivências da maternidade em uma prisão feminina do Estado do Rio Grande do Sul. Saude Trans Soc [Internet]. 2011 [cited 2016 Jul 22]. Available from: http://periodicos.incubadora.ufsc.br/index.php/saudeetransformacao/article/view/654
  » http://periodicos.incubadora.ufsc.br/index.php/saudeetransformacao/article/view/654
• ²⁴
  Freitas AM, Inácio AR, Saavedra L. Motherhood in prison: reconciling the irreconcilable. The Prison Journal. 2016; 96(3): 415-36.
• ²⁵
  Diuana V, Ventura M, Simas L, Larouzé B, Correa M. Direitos reprodutivos das mulheres no sistema penitenciário: tensões e desafios na transformação da realidade. Ciênc Saúde Coletiva. 2016; 21(7): 2041-50.
• ²⁶
  França MHO. Tráfico, prisão e maternidade: um estudo sobre mulheres encarceradas. [Tese]. João Pessoa (PB): Universidade Federal da Paraíba. Centro de Ciências Humanas, Letras e Artes; 2013.
• ²⁷
  Gomes ABF, Santos MBS, Neri HF, Oliveira MFL, Uziel AP. Reflexões sobre a maternidade no sistema prisional: o que dizem técnicas e pesquisadoras. In: Anais do XV Encontro Nacional da ABRAPSO [Internet]. 2009 [cited 2016 Jul 22]. Available from: http://www.abrapso.org.br/siteprincipal/images/Anais_XVENABRAPSO/366.%20reflex%D5es%20sobre%20a%20maternidade%20no%20sistema%20prisional.pdf
• ²⁸
  Barnes SL, Stringer EC. Is motherhood important? Imprisoned women’s maternal experiences before and during confinement and their post release expectations. Feminist Criminology [Internet].2014 [cited 2016 Jul 22]; 9(1): 3-23. Available from: http://journals.sagepub.com/doi/abs/10.1177/1557085113504450?journalCode=fcxa
  » http://journals.sagepub.com/doi/abs/10.1177/1557085113504450?journalCode=fcxa
• ²⁹
  Siqueira FPC. O significado da amamentação na construção da relação mãe e filho: um estudo interacionista simbólico [tese] São Paulo (SP): Universidade de São Paulo. Escola de Enfermagem; 2012.
• ³⁰
  Alves VH, Rodrigues DP, Gregório, VRP, Branco MBL, Souza RMP, Alves CMCSH. Reflexions about the value of breastfeeding as a health practice: a nursing contribution. Texto Contexto Enferm [Internet]. 2014 [cited 2016 Jul 22]; 23(1):203-10. Available from: http://www.scielo.br/pdf/tce/v23n1/pt_0104-0707-tce-23-01-00203.pdf
  » http://www.scielo.br/pdf/tce/v23n1/pt_0104-0707-tce-23-01-00203.pdf

Publication Dates

• Publication in this collection
  08 Nov 2018
• Date of issue
  2018

History

• Received
  14 Mar 2017
• Accepted
  22 Aug 2017