Breastfeeding Behind Bars: Breaking the cycle of ... - Unicef UK

BREASTFEEDING BEHIND BARS:
BREAKING THE CYCLE OF
MOTHERING LOSS AND LESS THAN
OPTIMAL INFANT FEEDING
Carol Bartle
New Zealand
Photo Carol Bartle Argentina 2007

Mothers and Babies Behind Bars – Nursery
Programmes
‣ Provide secure housing spaces within correctional
facilities where incarcerated women can stay with
their babies
‣ Women complete their sentences while being the
primary caregiver
‣ Aim to establish a foundation that protects future
child development
(Byrne, Goshin & Blanchard-Lewis 2012)

A Human Rights Framework
Universal Declaration of Human Rights
Article 16:3
‣The family is the natural and fundamental
group unit of society and is entitled to
protection by society and the state
Article 25:2
‣Motherhood and childhood are entitled to
special care and assistance

International Covenant on Economic, Social
and Cultural Rights
Article 10:2
‣ Special protection for mothers during a
reasonable period before and after childbirth
Article 10:3
‣ Special measures of protection and assistance
should be taken on behalf of all children

International Covenant on Economic, Social
and Cultural Rights
Article 12
‣ The rights to the highest attainable standard of
physical and mental health. The provision for
the healthy development of the child

Convention on the elimination of
discrimination against women
Article 12
‣States Parties shall ensure to women appropriate
services in connection with pregnancy, confinement
and the post-natal period, granting free services
where necessary, as well as adequate nutrition
during pregnancy and lactation

United Nations Convention on the Rights of the
Child
54 articles
Provision rights
‣ Minimum standards of family life and access to
parental care, health, education, physical care,
play, recreation, culture and leisure
‣ This covers the rights of children with parents in
prison to have contact

United Nations Convention on the Rights of
the Child
Preamble
‣ Childhood is entitled to special care and assistance
‣ Recognises that children are living in difficult
conditions globally
Article 3
‣ The best interests of the child shall be the primary
consideration

United Nations Convention on the Rights of
the Child
Article 6
‣ State parties shall ensure to the maximum extent
possible the survival and development of the child
Article 24
‣ The rights of the child to the enjoyment of the
highest attainable standard of health

United Nations Convention on the Rights of
the Child: Article 2
‣ All rights apply to all children without
exception
‣ It is the State's obligation to protect children
from any form of discrimination and to take
positive action to promote their rights

United Nations Convention on the Rights of
the Child: Article 2
‣ States Parties shall respect the right of the child
who is separated from one or both parents to
maintain personal relations and direct contact
with both parents on a regular basis, except if it
is contrary to the child's best interests

United Nations Convention on the Rights of
the Child: Article 9
‣
The child has a right to live with his or her parents
unless this is deemed to be incompatible with the
child's best interests
‣
The child also has the right to maintain contact with
both parents if separated from one or both

Breastfeeding and feeding rights
1. Infants have the right to be free from hunger,
and to enjoy the highest attainable standard of
health
2. Infants are entitled to good food, good health
services, and good care
3. Mothers have a right to breastfeed
4. Infants have the right to be breastfed if their
mothers choose to breastfeed
5. George Kent

Mother-Baby Nursery Programmes
NEBRASKA NURSERY PROGRAMME
Main Goals are to:
‣ Provide opportunity for bonding between the
inmate mother and her infant from birth until
approx 18 months of age
‣ Facilitate the change of the inmate mother to a
responsible parent

NEBRASKA NURSERY PROGRAMME
‣ Aid in the development of realistic expectations
the inmate mother has for herself and her infant
‣ Provide for prenatal and infant health
‣ Provide intervention in breaking the cycle of
generational abuse and incarceration

NEBRASKA NURSERY PROGRAMME
‣ Providing prenatal parenting education, infant
care and development education, developing and
coordinating community resources available to the
mother during incarceration and on release
‣ Hoped for results include reduced recidivism and
decrease in child abuse and neglect

Photo – Credit Libby Robins, New Zealand
Used with permission

Principles guiding the establishment of
Mother/baby Units in the UK
‣ To enable the mother/baby relationship to
develop whilst safeguarding and promoting the
child’s welfare
‣ The best interests of the child is the primary
consideration at every level of policy making as
well as when considering individual situations

Principles guiding the establishment of
Mother/baby Units in the UK
‣ The environment where infants are accommodated
should be designed to meet their needs
‣ Breastfeeding has significant benefits for both
mother and child and it should be encouraged
and facilitated

Identified barriers to mother-infant contact
‣ Geographical location
‣ Inability to afford transport
‣ Unwillingness of caregivers to transport infants
‣ Inhospitable visiting rooms
‣ Parent reluctance for contact
Seymour, C. Children with parents in prison: Child
Welfare Policy, Program and Practice Issues

Infants and children outside the prison
‣ Often experience multiple caregivers
‣ Erratic care giving
‣ Disrupted placements
‣ Loss of mothering and breastfeeding
‣ Reintegration is likely so this causes further
disruption

Infant attachment
‣ Secure infant attachment may be facilitated by
participating in a prison nursery programme
‣ Concern that mothers with background of
disorganised attachment themselves will be
incapable of providing the scaffolding necessary to
support secure attachment in their infants – despite
good intentions

So what could positively contribute to the
development of secure attachment?
‣ Alternatives to incarceration whenever possible
‣ Non –separation of mother and baby
‣ Well supported and appropriate nursery –
mother/baby programmes – that continue postrelease
‣ Breastfeeding protection, promotion and support

‣ Prison Nursery Programmes aim to prevent separation
of mother and baby, allow maternal bonding in ways
that are impossible through visitation and prepare the
inmate mother to fulfil parental obligations when she
is released
‣ Participation in PNPs – can reduce criminal behaviour
and be cost saving
Gilad & Gat, The Invisible Victims (2012)

‣ Lower rates of recidivism
(Kaufmann 2006)
‣ Preservation of the mother-child bond and
emotional and financial costs of foster care
avoided
(Goshin & Byrne 2009)

Oxytocin
‣ Oxytocin is present at significantly elevated levels
in women around childbirth and during
breastfeeding
(Macdonald & Macdonald 2010)

Oxytocin
‣ Associated with social behaviours
‣ Oxytocin appears to increase trust and social
interaction and reduces response to social stress -
reduced levels of anxiety
‣ Stimulates maternal interaction and attachment
Uvnas-Moberg et al 2001 Applied Animal Behavior Science

Oxytocin
‣ Increasing the expression of oxytocin receptors
enhances maternal care behaviour in rodents
(Francis et al 2000)
‣ The same process- enhanced oxytocin activity- may
play a part in human offspring's attachment feelings
toward their parents
(Gordon et al 2008)

Mentalization
‣ The fundamental human capacity to understand
behaviour in relation to mental states such as
thoughts and feelings – capacity to understand
the baby’s needs and communications
‣ This is the basis of healthy relationships and selfawareness

Mentalization - and oxytocin
‣ Oxytocin appears to perform a mediating function
between mentalization and attachment
(Heinrichs & Domes 2008)
‣ “A rapidly accumulating body of empirical findings
has suggested that oxytocin specifically improves
performance in mentalizing tasks”
(Domes et al 2008; Guastella, Mitchell, Dadds 2008)

Mentalization – oxytocin and breastfeeding
‣ Women who are breastfeeding appear to be less
physiologically reactive to stress, which may be
accounted for by the stimulation of the nipple as
well as the close social contact, both of which
increase oxytocin release
(Amico, Johnson & Vagnucci 1994)

v
Mentalization – oxytocin and breastfeeding
‣ Increased resilience to stress may account for the
epidemiologic observation of reduced likelihood
of child maltreatment in mothers who breastfeed
(Strathearn, Mamun, Najman & O’Callaghan 2009)

Mentalization – oxytocin - mothering
‣ Oxytocin’s mentalization-enhancing function
presents a powerful opportunity for the mother to
optimize her understanding of and focus on the
mental state of her infant by close observation of
the infant's expression
(Fonagy, Luyten & Strathearn 2011)

Mentalization – oxytocin - mothering
‣ Oxytocin concentrations during early pregnancy and
during the postpartum period are strongly associated
with maternal bonding as suggested by indicators such
as positive affect, gaze, affectionate touch, and
frequency of monitoring the infant as well as thoughts
related to attachment
Feldman, Weller, Zagoory-Sharon, and Levine (2007)

“I cannot think of a more important relationship
than a mother and child. Being a mother takes
whatever selfish motives you have as a person
away and forces you to realise there are much
greater things to invest in …”
Quote from a Correctional Unit Supervisor in the US
From L Robins, Mother and Baby Prison Units (2012)

The importance of mothers – proximity &
contact
‣ Maternal milk, touch, smell, body heat and
biological rhythms provide a set of bio-behavioral
regulators for the infant’s autonomic, feeding and
anxiety management systems

Depression and infant feeding
‣ Breastfeeding supports optimal feeding
interaction behaviours which may impact
positively on later cognitive and physical
development
Field, Diego, Hernandez-Reif, Figueiredo, Ezell & Siblalingappa (2010) Depressed mothers
and infants are more relaxed during breastfeeding versus bottle feeding interactions. Infant
Behaviour and Development.

NEW ZEALAND
Corrections (Mothers with Babies) Amendment Act)
‣ Raised the upper age limit of children to two years
and enabled women of all security classifications
and accused prisoners to participate

NEW ZEALAND
Corrections (Mothers with Babies) Amendment Act
‣ Section 81C of the Amendment Act states that the
Chief Executive must ensure the prison has
adequate facilities to accommodate and provide
a healthy and supportive environment for the child

Mothers and Babies Unit 2012
Christchurch NZ
‣ Prison officer education – covers a range of topics
related to infant & young child development,
nutrition, breastfeeding, pregnancy, infant &
young child rights & parenting
‣ Important for staff understanding and acceptance
of the programme

Evaluation of the Mother-Baby Unit
(Hungerford & Elliot-Hohepa 2012)
‣ Supportive environments for mothers and their
parenting
‣ Concern about accessing continued support on
release
‣ “Fishbowl parenting” difficult at times
‣ Being given advice by staff and other inmate mothers
also described as stressful and difficult at times

Evaluation of the Mother-Baby Unit
(Hungerford & Elliot-Hohepa 2012)
‣ All babies born while their mothers were in prison
have been breastfed
‣ Mothers said they are breastfeeding longer than
they would have on the outside
‣ The Mother-Baby Unit described as helping them
to bond with their babies

Rebecca Project for Human Rights 2010
‣ In the US - out of 51 states, prison nursery
programmes documented as being available in 13 –
only 3 offer therapeutic programmes
‣ Age range between 1 and 3 years
‣ More women behind bars than at any other point in
US history – overwhelmingly for non-violent offenses
(Increase of 430% since mid 1980s)
‣ “Most of these women, unseen and largely forgotten
are mothers”

UK Mother and Baby Units
‣ Nine units
‣ Holloway is the longest standing – purpose built unit
from 1992
‣ Corston Report 2007 – generated due to the deaths
of six women at Styal Prison
‣ Some argue that mothers being separated from
their children and anxiety about their well-being is
linked to the high rates of self harm in prisons

Rainsbrook Secure Training Facility
‣ Staff members include a breastfeeding specialist
(possibly IBCLC)
Bronzefield Prison Surrey
‣ When mothers are working they can return to the
unit to breastfeed or the infant can be taken to
the mother

Policies are essential
‣ Otherwise there are staff practice variations
‣ Uncertainty about what’s appropriate – one person’s
common sense is not another’s (particularly when it
comes to breastfeeding)
‣ Breastfeeding visitors, women on probation…

Caring for mothers who are prisoners in a postnatal
ward (appendix in a Breastfeeding Policy)
‣ All consumers are entitled to receive the same
standard of health-care regardless of their legal
status
‣ A person does not lose their human rights when
imprisoned Bastick & Townhead (2008). Women in prison: A commentary on the UN
standard minimum rules for the treatment of prisoners. Geneva, Quaker United Nations.

Caring for mothers who are prisoners in a
post-natal ward
‣ Women who are prisoners will be offered
uninterrupted skin-to-skin contact with their infants
after birth for a period of at least one hour and
assisted as necessary with the first breastfeed

Caring for mothers who are prisoners in a
post-natal ward
‣ Individual assessment will include breastfeeding
support and assistance, and teaching hand
expression of breastmilk and may include short
and long-term expressing information, breast-care
information and possibly suppression of lactation
information in some situations (lactation
management)

Caring for mothers who are prisoners in a
post-natal ward
‣ Individual care may include creation of some
private time for a mother and infant, if this is
acceptable to the custodial agency, and if
there are no security or risk issues or other
adverse circumstances

Caring for mothers who are prisoners in a
post-natal ward
‣ If a mother returning to custody and being
separated from her infant, wishes to provide
breastmilk for her infant, this should be supported
and facilitated wherever possible in recognition of
the ‘best interests of the child’* being a primary
consideration
*United Nations Convention on the Rights of the Child. (1989). Article 3.

Caring for mothers who are prisoners in a
post-natal ward
‣ Breastfeeding is important for health,
psychological, emotional and mother-infant
bonding/attachment protection and
enhancement and it should therefore be
supported

New Beginnings Programme
Anna Freud Centre
‣ Entirely attachment-based
‣ Based on principles delineated as conducive to
mentalization
‣ Structure: Structured around topics which are
attachment “triggers” such as
• How does my baby get to know his world?
• Making choices: what do I want to hand down to my
child and what do I want to prevent him/her from
experiencing?
• Separations and how we manage them
• Observations of Parent Sensitivity, Parent Intrusiveness

New Beginnings Programme
1. To increase the mother’s knowledge base about
infant development
2. To enhance the mother’s confidence in her ability
to parent her baby
3. To enhance the mother’s capacity to think about
her infant’s needs and communications
4. To increase the mother’s responsiveness to her
infant’s positive and negative feelings
Anna Freud Centre

New Beginnings Programme
5. To increase pleasurable interactions between
mother and baby
6. To support the mother in preparing to say
goodbye to her baby if this is necessary
Anna Freud Centre

Advocacy is about
Representation* for vulnerable people – infants and
young children, pregnant, recently birthed and postbirth
mothers
Empowerment* – appropriate education, instilling
confidence, skills, ability, increasing capacity
Enabling* - development, growth, opportunity,
strengthening and making ‘it’ possible
Raising status* – valuing babies, mothers and parents
and taking action*
*Gary Melton, 1987

Advocacy is about
Raising the status of breastfeeding
‣ Valuing breastfeeding, babies and mothers
‣ Ensuring that breastfeeding (and keeping mothers
and babies together) is on the agenda
‣ Policy development

“One Chance, One Opportunity, One Bond”
(Quote from an ex-inmate Christchurch Women’s Prison NZ)
From Robins, L. Mother and Baby Prison
Units: An investigative Study. Winston
Churchill Memorial Trust (2011)

‣ “The potential for rehabilitating the mother inmate
far exceeds the costs to the state or the taxpayer”
(Carlson 1998)
‣ Incarcerated women’s goals for their babies were
simple and straightforward – they wanted the best
for their babies. Being in prison did not make them
bad mothers (Gabel & Girard 1995)
‣“Pregnancy, birth and motherhood offer
opportunities for growth in understanding and
maturation”
(Kitzinger, 2000 Mothers and babies behind bars)

“The mere presence of the mother not only ensures the infant’s
well-being but also creates a kind of invisible ‘hothouse’ in which
the infant’s development can unfold”
“For a baby the environment is the mother”
Hofer in Gallagher 1992
THANK YOU
canterburybreastfeeding@gmail.com
Photo credit Cheryl Hanna-Truscott

References
Amico, J., Johnson, J. M., & Vagnucci, A. H. (1994). Suckling induced
attenuation of plasma cortisol concentrations in postpartum lactating women.
Endocrinology Research, 20: 79-87.
Bastick & Townhead (2008). Women in prison: A commentary on the UN
standard minimum rules for the treatment of prisoners. Geneva, Quaker United
Nations.
Byrne, M. W., Goshin, L., & Blanchard-Lewis, B.(2012). Maternal separations
during the re-entry years for 100 infants raised in a prison nursery. Family
Court Review, 50,(1):77-90.
Carlson, J. (1998). Evaluating the effectiveness of a live-in nursery within a
women’s prison. Journal of Offender Rehabilitation,Vol 27(1/2) 73-85.
Convention on the elimination of discrimination against women. (1979)
Feldman, R., Weller, A., Zagoory-Sharon, O., & Levine, A. (2007). Evidence
for a neuroendocrinological foundation of human affiliation: plasma oxytocin
levels across pregnancy and the postpartum period predict mother-infant
bonding. Psychol Sci, 18.(11):965-970.

References
Field, Diego, Hernandez-Reif, Figueiredo, Ezell & Siblalingappa (2010) Depressed
mothers and infants are more relaxed during breastfeeding versus bottle feeding
interactions. Infant Behaviour and Development.
Fonagy, P., Luyten, P., Strathhearn, L. (2011). Borderline personality disorder,
mentalization, and the neurobiology of attachment. Infant Mental Health Journal
Volume, 32, Issue 1: pages 47–69.
Francis, D. D., Champagne, F. C., Meaney, M. J. (2000). Variations in Maternal
Behaviour are Associated with Differences in Oxytocin Receptor Levels in the Rat.
Journal of Neuroendocrinology, 12,(12):1145-1148.
Gabel, K., & Girard, K. (1995). Long-term care nurseries in prisons: A descriptive
study, Part V No 14 in Children of Incarcerated Parents, Gabel, K & Johnstone, D
(eds), Lexington Books, USA, 237-254.
Gilad, M., & Gat, T. (2012). The Invisible Victims. ASU Law Journal.
http://asulawjournal.lawnews-asu.org/?p=399
Gordon, I., Zagoory-Sharon, O., Schneiderman, I., Leckman, J. F., Weller, A., and
Feldman, R. (2008). Oxytocin and cortisol in romantically unattached young adults:
associations with bonding and psychological distress. Psychophysiology 45, 349–352.

References
Goshin, L. S., & Byrne, M. W. (2009). Converging streams of opportunity for prison
nursery programmes in the United States. Journal of Offender Rehabilitation,
48:271-295.
Guastella, A. J., Mitchell, P. B., & Dadds, M. R. (2008). Oxytocin increases gaze to the
eye region of human faces. Biol Psychiatry, 63(1):305.
Heinrichs, M., & Domes, G. (2008). Neuropeptides and social behaviour: Effects of
oxytocin and vasopressin in humans. Progress in Brain Research, 170: 337–350.
HMS Prison Service. (1999). Report of a Review of Principles, Policies and Procedures
on Mothers and Babies/Children in Prison, July, Tactica Solutions, U.K.
HMS Prison Service. (1999). Report of a Review of Principles, Policies and Procedures
on Mothers and Babies/Children in Prison, Response and Action Plan, December.
Gallagher, W. (1992). Motherless child. The Sciences, 32:12-15.
Hungerford, R., & Elliot-Hohepa, A. (2012). Formative evaluation of mothers with
babies units in prison. Momentum Research & Evaluation. Independent evaluation on
behalf of the Department of Corrections, New Zealand.
Kaufman, K. (2006). Prison nurseries: New beginnings and second chances. In R.
Immarigeon (Ed) Women and girls in the criminal justice system. Policy issues and
practice strategies, (pp. 201-207). Kingston NJ, Civic Research Institute.

References
Kent, G. (2001). Breastfeeding: A human rights issue? Development, The Society for
International Development, London, Sage Publications.
Kitzinger, S. (2000). Mothers and babies behind bars, in Gender and Criminal Justice in the New
Millennium, Chicwada-Bailey, R (ed),
Macdonald, K., & Macdonald, T. M. (2010). The peptide that binds: A systematic review of
oxytocin and its prosocial effects in humans. Harvard Review of Psychiatry, 18(1), 1–21).
Melton, G. B. (1987). Children, politics, and morality: The ethics of child advocacy. Journal of
Clinical Child Psychology, 16, 357-367.
International Covenant on Economic, Social and Cultural Rights. (1966). The New Zealand
Political Source Book 3rd Edition, Levine, S & Harris, P (eds). Dunmore Press, 1999, Palmerston
North, New Zealand, 522-526.
Robins, L. (2012). Mother and Baby Prison Units: An investigative Study. Winston Churchill
Memorial Trust Scholarship, 2011.
Seymour, C. (1998). Children with parents in prison: Child Welfare Policy, Program and
Practice Issues, 77,(5):469-493.
Strathearn, L., Mamun, A. A., Najman, J., O’Callaghan, M. J. (2009). Does Breastfeeding
Protect Against Substantiated Child Abuse and Neglect? A 15-Year Cohort Study. Pediatrics,
123, (2):483-493.

References
The Anna Freud Centre New Beginnings Programme.
http://www.annafreud.org/pages/new-beginnings-programme-for-mothers-andbabies-in-prison.html
The Corston Report. (2007). A report by Baroness Jean Corston of a review of women
with particular vulnerabilities in the criminal justice system. Home Office, UK.
The Rebecca Project for Human Rights. (2010). Mothers behind bars: A state by state
report card and analysis of federal policies on conditions of confinement for pregnant
and parenting women and the effect on their children. National Women’s Law Centre.
United Nations Convention on the Rights of the Child. (1989). The New Zealand
Political Source Book 3rd Edition, Levine, S & Harris, P. (eds) Dunmore Press, 1999,
Palmerston North, New Zealand 532-534.
Universal Declaration of Human Rights. (1948). The New Zealand Political Source Book
3rd Edition, Levine, S & Harris, P (eds) Dunmore Press, 1999, Palmerston North, New
Zealand 509-512.
Uvnas-Moberg, K., Johansson, B., Lupoli, B., & Svennersten-Siaunja, K. (2001).
Oxytocin facilitates behavioural, metabolic and physiological adaptations during
lactation. Applied Animal Behaviour Science, 72, [3], 225-234.