It's a Piece that Helps Them Stay Connected to Their Child: Facilitators and Barriers to Lactation Support Programs in Seven State Prisons

Background: In the United States, 4% of incarcerated women are pregnant at the time of admission and women of childbearing age represent the fastest growing demographic in the carceral system. Biological mothers are typically separated from their infants between 24 and 48 hours after birth and infants are placed with alternative caregivers. Pumping breast milk is important for maternal and child health, however, there is little research examining programs aimed at supporting lactating people in state prisons. Objective: To explore the facilitators and barriers of implementing lactation support in seven state prisons. Methods: Repeat qualitative interviews were conducted with 46 subject matter experts associated with enhanced perinatal programs in seven, geographically diverse state prisons. Interviews were analyzed thematically using principles from the Exploration, Preparation, Implementation, Sustainment (EPIS) framework under the broad domains of facilitators and barriers to implementing lactation support in carceral settings. Results: Three main facilitators were identified: (1) protocols and processes that increased ease and access; (2) partnerships that supported programming; and (3) tailored support that recognized the specific needs of incarcerated individuals. Identified barriers include: (1) limited institutional support; (2) limited external support to protect and sustain programming; and (3) limited clarity on roles and responsibilities. Conclusion: Establishing formal protocols through collaborative partnerships with the Departments of Corrections (DOCs) and external community organizations is critical to ensure buy-in and commitment from stakeholders. Continued conversation with participants to adapt programming to meet maternal and infant health needs and goals is necessary for long-term success.