IBJ Advocacy

Last year, Illinois Birth Justice was inspired to return to its roots. Years ago, the work that became IBJ began with advocacy for lactation support for a new mother in an Illinois state prison. During the winter of 2019, a similar request for help began a new chain of events. This three-part piece describes: S.’s Story; Research into Lactation Policies in County Jails: The UIC – UMN Collaboration; and recent developments at Cook County Jail.

S.’s Story

In January 2019, Melanie Eader, the Illinois Department of Human Services WIC Breastfeeding and Peer Counselor Coordinator, asked me to help advocate for S., a woman who was exclusively breastfeeding her one-year-old baby and had been sentenced to 90 days at a downstate jail. S.’s goal was to continue breastfeeding her baby, but the jail told her that while she would be allowed to pump, she would have to discard the milk, despite having family willing to pick up her milk daily.

As soon as I heard about S.’s situation, I began researching policies and practices around lactation, pumping, storing and sharing mothers’ milk in correctional facilities in the U.S. I hoped that providing examples of jails that allowed mothers to pump milk and family members to pick up that milk would improve S’s chances of reaching her goal.

Advocating for S.

I recruited several advocates for S. who got to work quickly. Dr. Amber Price, a pediatrician, breastfeeding medicine specialist, and international board-certified lactation consultant, called the county’s sheriff’s office and was initially told that S.’s milk would be discarded. But after she explained how important this would be for S. and her baby, they agreed to freeze the milk. Ashley Lovell, director of the Alabama Prison Birth Project, shared policies from correctional facilities in Alabama, Nevada, Oregon, and Colorado that allow milk to be picked up or shipped. Tutwiler Prison in Alabama allows staff from the Birth Project to pick up and ship milk weekly. Amy Meek, a reproductive rights attorney from the Illinois ACLU, actively advocated for S. over a period of months. She said, “I’m still hoping we can overcome the resistance to somebody picking up the milk. I’m hopeful that if the folks at this county jail learn that there is ample precedent for permitting someone to pick up the milk, it might shift their outlook.” Finally, Allison Lowe-Fotos, a Policy Manager with the Ounce of Prevention Fund and a child development expert, advocated to allow S. to breastfeed her baby while in custody by sharing information about the impact on the infant of having his mother suddenly disappear while he had been nursing frequently.

While awaiting a hearing, S. expressed her appreciation for our efforts:

We made it to a year breastfeeding on Sunday, it’s a great badge of honor I will always carry! I refuse to let my previous awful choices that I made before being pregnant result in my son being forced to wean or not be able to get his liquid gold. You ladies have definitely shined some light in these dark times for me. This has inspired me to look into helping moms in similar situations and even maybe look into being lactation counselor/consultant after I can put this behind me, you have definitely been one of my inspirations! I knew this is all bigger than my son and I am so glad I decided to stand up for him to get his milk.

Months later, after her hearing and just before leaving her home to begin serving time in jail, S. wrote:

It’s getting very close to my intake date of Sept. 1st and the depression/anxiousness is really full force of not being able to provide my son with milk and ultimately losing my supply if I’m not able to pump in there at all. My son and I are losing so much with me being gone I can’t imagine not being able to nurse him the time I get home. It’s hard to know what I am able to do and sadly I feel lost…I will forever be grateful on how helpful you have been in this awful situation.

Last Minute Success

S. entered the jail on September 1, 2019, and months passed with no communication. The ACLU attorney made additional inquiries, but she did not receive any response from the jail. After 90 days passed, knowing that S.’s sentence was completed, I emailed her again. She replied, and I was thrilled to learn that she was permitted to pump and give her milk to her baby every day. She wrote:

At the very last minute when being processed in the jail they decided that it would be okay for my family to pick up milk daily. It was definitely a rocky start at first. I could tell that they never had a pumping mom in there or if they did it was years ago since no protocol was set in place. Which sadly this day and age shouldn’t have been the case. At first it seemed like I was being punished for wanting to pump, after a few days I showed them I could be trusted with my pump stuff which resulted in them just leaving my stuff with me. My supply took some major hits. However, I was at least able to pump enough for my son to get it once a day.

I will forever be grateful for everything you all helped my family with, in this hard time. This makes me want to jump to action for any other mothers fighting this fight in the system!

Exploring Lactation Policies in County Jails: The UIC – UMN Collaboration

S.’s situation inspired IBJ to start exploring lactation policies in county jails across the country and to advocate for breastfeeding and pumping in county jails. This led to a research collaboration between the Schools of Public Health at the University of Illinois at Chicago and the University of Minnesota, with funding provided by both institutions through the federal Centers of Excellence in Maternal Child Health. Ellen Mason, MD, of UIC’s School of Public Health and an IBJ board member, recruited and advised Nadezh Mulholland, a graduate student in the School of Public Health. At the University of Minnesota are Rebecca Shlafer, PhD, MPH, of the School of Public Health and Department of Pediatrics in the medical school; Sara Benning, MLS, of the Center for Leadership Education in Maternal and Child Public Health, the University of Minnesota School of Public Health; and Ally Timm, a graduate student in the School of Public Health. Both MPH students collaborated to research policies and practices regarding breastfeeding, pumping, and storage of mother’s milk in county jails in Illinois and Minnesota. They also participated in the December 2019 conference of the Association for Justice-Involved Females and Organizations in Atlanta.

Ally Timm organized the findings from interviews conducted by Nadezh Mulholland and herself: “Lactation Practices in Minnesota and Illinois Jails: Implications for health of justice-involved mothers and their children.” To see the report and listen to a narrated poster, visit: https://www.sph.umn.edu/events-calendar/research-day/rd-2020/ally-timm/.

One common barrier that was identified by the graduate students was a concern about the safety of storing expressed milk. We hope to make additional progress by helping county jails overcome the barriers that many of them have to lactating women pumping and storing their milk. Providing accurate information to overcome barriers and to support safe storage of mother’s milk may help reduce resistance, so IBJ shared several resources and handouts with the students to provide staff at the Illinois and Minnesota county jails, including guidelines from the Occupational Safety and Health Administration, the CDC, and others.

Being able to pump milk for her baby can provide the incarcerated mother a significant connection to her infant and can instill a sense of purpose and pride. It promotes mother-baby attachment and has lifelong implications for the health of both. Breastfeeding can significantly improve health outcomes for mothers and babies throughout the lifespan and can reduce health care costs and rates of infant mortality.

The position statement of the American College of Obstetricians and Gynecologists States “Given the benefits of breastfeeding to both the mother and the infant, incarcerated mothers wishing to breastfeed should be allowed to either breastfeed their infants or express milk for delivery to the infant. If the mother is to express her milk, accommodations should be made for freezing, storing, and transporting the milk.” The National Commission on Correctional Healthcare’s position statement is: “Wherever possible and not precluded by security concerns, correctional facilities that house pregnant and postpartum women should devise systems to enable postpartum women to express breast milk for their babies and to breastfeed them directly”. Practices to support this goal can be seen at the National Commission on Correctional Health Care’s web site.

“Punishing women has created intended or unintended punishment of their children. The children, or forgotten victims, suffer the consequences of their mother’s incarceration with negative impact on their physical and mental health as well as their social and emotional adjustment. Breastfeeding and/or providing breast milk is one way to “mother in jail,” allowing a woman to stay connected with her child even while separated during her incarceration. Bonding through breastfeeding is sometimes the only way that a loving connection can be formed when the mother is in prison.” (See the Michigan Breastfeeding Networks’s Guide to Breastfeeding and Incarceration.)

County Commissioner Maggie Hart says “It’s important to think about this as a public safety initiative. There are mountains of evidence that show having a child can be a very powerful motivator for change, so when inmates can stay connected with their families, their risk of recidivism goes down,” she said. “When we identify evidence-based public practices that support that (recidivism) goal, it’s worth investing.”

Yet the challenges for incarcerated women who want to breastfeed or pump are daunting and can be insurmountable. However, there has been recent progress in overcoming barriers. “At least 10 jails and five state prison systems have or have experimented with policies allowing inmates access to a breast pump, milk storage and/or physical access to nurse their child.” (“MDC among first to have inmate breastfeeding policy” **) A Santa Fe judge ruled in 2017 that mothers incarcerated in state prisons — like all New Mexico mothers — have a fundamental and protected right to breastfeed their infants and a Corrections Department policy banning them from doing so violates the state constitution.

The Michigan Breastfeeding Network has a breastfeeding and incarceration toolkit. The guide can be used:

• To advocate for change for women in prison to breastfeed their children and provide pathways for such action.
• To provide guidance to prisons in order to create policies/programs that enable and encourage incarcerated mothers to breastfeed.
• To inform and educate women in the penal system about breastfeeding.

 One goal of Illinois Birth Justice is to create a “rapid response team” when breastfeeding mothers are in custody. The aim would be to work with partners statewide to: support a woman’s ability to maintain her milk supply during separation from her child and to facilitate providing this milk to the baby, whenever possible. Another aim would be to support breastfeeding, if a caregiver is able to bring the child to visit the mother.

 The Alabama Prison Birth Project, “a nonprofit that works to improve the health of babies born to incarcerated women, partnered with Tutwiler to design lactation rooms and provide pumping equipment for moms separated from their babies. Mothers pump breastmilk in the room, then label and store their milk in a freezer. Once a week, a representative from Alabama Prison Birth Project picks up the milk and distributes it to each child’s caregiver.” See “Incarcerated Women in Tutwiler Can Now Pump Breastmilk for Their Babies” in the Breastfeeding and Incarceration folder in the Annotated Bibliography at https://www.illinoisbirthjustice.org/resources/.

 I spoke with the director of the Alabama Prison Birth Project – and with Melanie Eader, the acting breastfeeding coordinator at IDHS. There are 10 regional breastfeeding task forces in Illinois, supported by IDHS. IBJ is promoting the participation of representatives of all task forces to provide advocacy and support for breastfeeding or pumping mothers in county jails across the state. As support for pumping has recently increased at Logan Correctional Facility, IBJ has also suggested partnering with members of the breastfeeding task force in that region to retrieve and distribute mothers’ milk to the families of breastfed babies.

Doula support is another intervention whose efficacy is well-established. One perspective is that ‘you have to nurture the mother so she can nurture the baby’. When women feel nurtured during their childbearing, they are able to extend that care to their infants, which is particularly important for women who have had difficult lives. Researchers at the University of Minnesota studied the impact of doula support on breastfeeding intention and initiation among mothers participating in a prison-based pregnancy and parenting support program, The Minnesota Prison Doula Project. Six doulas were paired with mothers and met at least six times. Mothers attended additional weekly support groups. Women who discussed breastfeeding with their doula were seven times more likely to initiate breastfeeding than women who did not discuss breastfeeding with their doula. (“Breastfeeding Among Incarcerated Mothers in a Prison Pregnancy and Support Group” http://www.rebeccashlafer.com/wp-content/uploads/2012/07/breastfeeding-poster-SRCD-2015.02.22.pdf)

Opposition to access to breast pumps and storage of mother’s milk may be based on numerous practical barriers, some of which include: costs – equipment, staff time required to accompany mothers to medical area; lack of policies & procedures; logistical and financial – pumping equipment & supplies; safe storage & transport of milk; informational – lack of understanding about the physiology of lactation; additional staff time and inexperience re: how to obtain, set up, and use pumps and how to store milk.

Strategies to overcome resistance can include: sharing policies and experiences of correctional facilities who have implemented these programs; soliciting testimonials from corrections administrators who have changed policies in their facilities (e.g. an associate warden and a director of two facilities in Minnesota, who spoke with members of IBJ); identifying resources (including volunteers from regional breastfeeding task forces, La Leche League, doulas, and others) willing to donate products and services. Information about prison lactation programs is provided in the Michigan Breastfeeding Network’s Guide to Breastfeeding and Incarceration. Another long-term strategy is to advocate for legislation. (This would be the subject of another document.)

Let’s aim to change the (false) narrative from: She’s a bad person and unfit to be a mother. Those women don’t breastfeed. Her milk is unsafe. To: Pregnancy and birth can be transformational. She needs – and deserves – support. Her milk is just what her baby needs.

One woman with lived experience said: “No matter how broken down she is, no matter how society views her as a mother because of her drug addiction… being able to bond with her kids can change her whole life around her. It can change her whole life in that setting… No matter how bad, no matter how beat down she seems to be… I mean you could look at her as hopeless, and as a piece of trash that can be thrown away, but really she’s not given the right opportunity. I was that woman. I was that person that today I’m not. Given that bond with my kids, I’m not anymore.”

The impact of doula support on women’s experiences of childbirth and birth outcomes has been well documented. Doulas can reduce complications, interventions, and health care costs. Doulas increase the likelihood of safer, healthier and more satisfying births and help improve the long-term health of women and infants.

The unfamiliar environment of a hospital is stressful and intimidating.  But for an incarcerated woman, a visit to the hospital to deliver can be a terribly lonely and frightening experience. The doula can act as a buffer – a nurturing and protecting presence – for these vulnerable mothers in such a harsh environment.

Doulas have been shown to be effective in enhancing maternal self-esteem and reducing rates of postpartum depression. Using one-on-one support and prenatal and parenting groups for women who are incarcerated, doulas help their clients create social support. Doula support has been shown to help women cope with the emotions commonly experienced by these mothers, caused by separation from their infants: depression, anxiety, grief, and shame.

Incarcerated mothers typically have only brief contact with their newborns before being separated. They are often fearful and depressed about separation from their infants after birth. Many consider the separation from their newborn to be the most traumatic aspect of incarceration. The presence of the doula is a vital element of postpartum support, especially at the time of separation. The doula helps the mother grieve during this time of intense trauma. A study of doula support by the Minnesota Prison Doula Project found that at 12-weeks postpartum women reported significantly fewer depressive symptoms, more confidence as parents, more support from other women at the prison, and more support from prison staff. This prison doula project is the most well-researched and documented program. (See: https://www.mnprisondoulaproject.org/ and https://www.ostarainitiative.org) The Minnesota Prison Doula Project also works with correctional facilities to encourage increased frequency of visits of children, and to provide play equipment, books, toys, and enhancements of the environment to make time spent by mothers and their children as enjoyable as possible.

The essence of the doula’s work is building a trusting relationship with her client. Being non-judgmental is an underlying principle. Doulas help their clients feel they have someone on their side, which gives them hope and raises their aspirations. Doulas are the only support some inmates have.  One woman interviewed about her experience said, “Having someone who believes in me, that’s huge for people who have made so many mistakes that they doubt their own ability to change. One prison doula project was evaluated using surveys completed by 40 medical providers and correctional officers who were present at the hospital births. All were positive and indicated that the women appeared satisfied with the doula services. “All interviewees expressed the importance of relationship building.  Those interviewed, who were formerly incarcerated, linked relationship building to successful transition out of prison.  As health paraprofessionals, doula services provide an opportunity to intervene by offering support and advocacy, making information available regarding health and recovery resources, as well as aiding in the reintegration into the community with their families.”

The women’s words also support their positive experiences: “I would have been absolutely petrified if I had been by myself.” “It helped me have a positive experience even though I was in custody. There was a guard standing at the door, she let me forget he was there.” “The doula gives steady support and values you. Makes you feel good all over.” “I would do anything to help support this (doula) program. You need somebody to support you, not just an officer staring at you.” “I felt like there was somebody on my side.”

Doulas are also a way to reduce health disparities and improve health equity. Women of color face disproportionate rates of maternal and infant mortality in the United States. Black women and other women of color are more likely to experience racial discrimination and receive lower quality care within the healthcare system. A doula’s presence empowers women to ask questions of their providers and get information they may not get otherwise.

Preterm births in Illinois are on the rise, accounting for nearly 1 in 8 babies born. Preterm birth or low birth weight is the 2nd leading cause of all infant deaths during the first year of life, and preterm birth is the leading cause of infant deaths among African-American infants. Infants born before 37 weeks incur medical costs 10 times higher than full-term infants. Some research has shown that women with doula care had 22 % lower odds of preterm birth. The By My Side Birth Support Program in New York City offers free doula services for mothers in predominantly black and brown Brooklyn neighborhoods and has demonstrated a profound impact. From 2010 to 2015, mothers receiving doula support had half as many preterm births and low-birth-weight babies as other women in the same community. See “Why America’s Black Mothers and Babies are in a Life or Death Crisis” in the Black Maternal & Infant Health folder in the Annotated Bibliography at https://www.illinoisbirthjustice.org/resources/.

Marianne Bullock, Founder of the Prison Birth Project, who had lived experience of incarceration, said, “We know that becoming a parent is an opportunity for people to transform themselves. We know this is true because we have only ever had one person, in 5 years of our work — deliver with us and reoffend and return to jail. Treating women with respect and support and like human beings during all times – and especially during the critical time of birth means they feel empowered and go on to make good choices for themselves, their families and communities.”

Regarding confronting opposition: A careful and deliberate approach to creating a prison doula project is necessary. At least two such programs have been dissolved by a warden or sheriff. Other programs have successfully earned the trust and enthusiastic support of corrections officials/administrators, as they observed positive outcomes not only for their population of pregnant women and new mothers – but also for the corrections officers working with them. It requires time, patience, and persistence to establish trust and prove that doulas are effective – and a win-win intervention for everyone.

Because Department of Corrections administrators have the power to allow or banish these programs, it is important to also pursue a long-term goal of legislation to provide justice-involved women access to doulas. This has been done in Minnesota and Washington.

The UN advocates for non-custodial measures for pregnant women caught in the justice system. In 2010, the United Nations General Assembly adopted Rules for the Treatment of Women Prisoners known as the Bangkok Rules.[i]  Because the original UN Standard Minimum Rules for the Treatment of Prisoners were adopted in 1955, they did not contemplate the reality of women in custody.[ii] They did not consider how society has different expectations of women, and women often conform to those expectations.

The vast majority of adult women are mothers at some point in their lives and are responsible for the care and sustenance of their children.  Women also have different physical and psychological needs than men.  At Logan Correctional Center in Illinois, for instance, over 90 percent of women prisoners have been victims of violence at some point in their lives.[iii]

Globally, the incarceration of women has increased exponentially in recent years, and within the UN, representatives began calling for a declaration or document that considered this reality. The Standard Minimum Rules adopted in 1955 were for “all” prisoners, but this really meant contemplated only men’s realities, and therefore men’s needs were the standard considered in the development of the rules.  “Gender neutral” most often means “masculine” in history.

I had the opportunity to participate in the preparatory process of the Bangkok Rules.  At the Intergovernmental Expert Group meeting in Bangkok, members of nongovernmental organizations from around the globe met with UN country delegates and specialists from the United Nations Office on Drugs and Crime (UNODC) to craft a Resolution regarding the treatment of women in prison or serving non-custodial measures.  The United States Government actively participated with representation from the diplomatic corps and from someone from the field of criminal justice.

Why does this matter in a conversation about doulas for incarcerated women?  Unfortunately, the Bangkok Rules did not have the foresight to consider involvement of doulas, but the Rules recommend that whenever possible, the priority for engaging women in the criminal justice system should be through non-custodial measures like probation, community service, bond, or pre-trial release.

The Bangkok Rules remind us of the UN’s attention to the “impact of parental detention and imprisonment on children” and, the UN’s call to States to “identify and promote good practices in relation to the needs and physical, emotional, social and psychological development of babies and children affected by parental detention and imprisonment.”[iv] Women prisoners are considered a “vulnerable group” that has specific needs and requirements when incarcerated.[v]  They are often accused of or sentenced for nonviolent crimes, and many of them do not “pose a risk to society.”[vi]  Holding all of this in consideration, the UN Bangkok Rules recommend that when a woman is pregnant or a child’s sole or primary caretaker, a State should prioritize noncustodial measures whenever possible or appropriate, reserving incarceration only for those whose offense is serious or violent.[vii]

So, with regards to pregnant women, or women with small children, the State should consider all measures possible- therapeutic counseling and courses for victims of domestic and sexual abuse, probation, house arrest, community service, treatment if she is interested, and any other more creative options, before choosing the last resort of incarceration.

When a pregnant woman is incarcerated, the Bangkok Rules advocate for special considerations of health and diet, a healthy environment and regular exercise for the physical and mental health of the mother and the health of the baby.[viii]  Furthermore, the Bangkok Rules hold that women prisoners should not be discouraged from breastfeeding their children, unless some specific health reason indicates that she should not.[ix]  Finally, the UN Bangkok Rules recommend that States pay attention to the needs of incarcerated women who have recently given birth, but their babies are not with them in prison.[x]

For twenty years, I have advocated for and with women prisoners.  In Brazil, I watched judges grant house arrest for pregnant women, with an order to report back after the first six months of their babies’ lives, and the women did.  If we advocate for what is best for the children, for the women, for society, and for our future, our first choice should not be incarceration. Incarceration should only be what we turn to after considering all other options.  Twenty years of advocacy has taught me that, and a collection of specialists from all over the globe, including the United States agrees.

While I wait for that to become reality though, and pregnant women are still incarcerated, and still need support, education, and coaching, there’s Illinois Birth Justice.  We advocate so that pregnant women who are incarcerated have access to doulas, and are accompanied in their pregnancy, labor, delivery and post-partum by qualified, supportive civil society representatives. Doulas increase the health of the pregnancy, of the mothers and their babies, and guarantee that even when incarcerated, women have a health advocate that they know is looking out for them.

[i] United Nations Rules for the Treatment of Women prisoners and Non-custodial Measures for Women Offenders, 2010 (The Bangkok Rules), G.A. Res. 65/229, U.N. Doc. A/RES/65/229 (Mar. 16, 2011), available at https://www.unodc.org/documents/justice-and-prison-reform/Bangkok_Rules_ENG_22032015.pdf.

[ii] United Nations Standard Minimum Rules for the Treatment of Prisoners (Aug. 30,1955), ECOSOC Res. 663 C/XXIV (Jul. 31, 1957), available at: https://www.unodc.org/pdf/criminal_justice/UN_Standard_Minimum_Rules_for_the_Treatment_of_Prisoners.pdf

[iii] Maggie Burke, Illinois Department of Corrections Women And Family Services Coordinator, Acting Warden Of Logan Correctional Center, Panel presentation: An In-depth Look at Pathways and Experiences of Justice-Involved Women from the Inside Out (Nov. 18, 2016). (Stating that 75% of the women prisoners at Logan had been victims of sexual abuse or assault; 90 percent were at some point victims of violence, and 80 percent had suffered physical abuse at the hands of a domestic partner).

[iv] The Bangkok Rules, supra note 1, at 2.

[v] Id.

[vi] Id.

[vii] Id. at Rule 58.

[viii] Id. at Rule 48 ¶ 1.

[ix] Id. at Rule 48 ¶ 2.

[x] Id. at Rule 48 ¶ 3.

Recently, the Civitas ChildLaw Center’s Policy Institute at the Loyola University Chicago School of Law assisted IBJ in a number of research initiatives related to the IBJ mission. The Policy Institute seeks to improve the lives of children and families through systems reform and legislative advocacy. Policy Institute faculty promote the increased use of interdisciplinary collaboration, public-private partnerships, and child development principles in fashioning policies related to children and families. In the Fall of 2016, two Loyola University Chicago law students worked with Policy Institute faculty to research and analyze laws related to incarcerated pregnant women in Illinois and nationwide. Their work will inform IBJ’s advocacy efforts to support incarcerated pregnant women and new mothers before, during, and after birth.

The following are links to these articles: 
50 State Survey of State Regulations for Incarcerated Pregnant Women
Illinois Law
Medicaid Funding for Doulas
States with Prison Doula Efforts
The Rebecca Project