REVIEW PROTOCOL

Breastfeeding in prison: a scoping review protocol

Marcia Vieira dos Santos1, Valdecyr Herdy Alves1, Diego Pereira Rodrigues2, Marli Rodrigues Tavares1, Juliana Vidal Vieira Guerra1, Giovanna Rosario Soanno Marchiori3, Tatiana do Socorro dos Santos Calandrini4, Paolla Amorim Malheiros Dulfe1

1Fluminense Federal University, Niterói, RJ, Brasil

2Federal University of Pará, Belém, PA, Brasil

3Federal University of Roraima, Boa Vista, RR, Brasil

4Federal University of Amapá, Macapá, AP, Brasil

ABSTRACT

Objective: to identify and map in the scientific literature actions to promote, support, and protect breastfeeding in the prison system. Method: first, a scoping review protocol was developed through searches in Lilacs, BDENF, VHL, Medline, SciELO, and Capes Portal of Journals. The PCC mnemonic was decomposed into P for population: breastfeeding, C for concept: actions to promote, protect and support breastfeeding, and C for context: the prison system. Articles will be selected using the Rayyan QCRI software. The review team will consist of two reviewers who will work independently. In case of disagreement or doubts, the participation of a third reviewer will be requested.

Descriptors: Prisons; Breast Feeding; Health Promotion.

INTRODUCTION

The United Nations Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders also called the Bangkok Rules, suggest the development of laws and policies that, among other guidelines, protect breastfeeding within the prison context. Brazil participated in the elaboration of these Rules and their approval. Therefore, complying with them is an internationally assumed commitment(1).

Based on the Bangkok Rule, Brazil issued Law No. 12,403 on May 4, 2011, and, in Article 318, it is provided that the judge can order house arrest for pregnant women when they are in their seventh month of pregnancy or if the pregnancy is high risk. However, since 1984, the Penal Execution Law (PEL) guarantees women deprived of their liberty rights within prisons, which were further expanded in the Brazilian Constitution of 1988(2).

In 2014, the Ministry of Justice created a specific policy for women deprived of their liberty, called the National Policy of Attention to Women in Situation of Freedom Deprivation and Egresses from the Prison System (PNAMPE in Portuguese, 2014) with maternal and child health as one of its goals. This policy (PNAMPE) also establishes that breastfeeding women deprived of their liberty have an adequate place with activities to promote, protect and support breastfeeding within the prison(3). Another benefit guaranteed to women occurred through Habeas Corpus Coletivo nº. 143.641/SP on 2018, which grantees house arrest or precautionary measures to pregnant and breastfeeding women, with provisional detention only for extreme cases(2).

In recent decades, the female population has grown significantly within the Brazilian prison system, from 6,000 women in 2000 to 42,000 in 2016, representing a great rise in the female inmates compared to the male population in this context(4).

However, the system has not kept up with this sudden increase, and only 7% of Brazilian prisons are specific to women. Of these, only 14% of female prisons have adequate environments for the mother to stay with the children for up to six months or 18 months; the age varies according to the authorization of each Brazilian state. Currently, Brazil occupies the fourth position among the countries with the highest number of incarcerated women(4).

Thus, pregnant and lactating women deprived of their liberty are part of the vulnerable population and have specific needs within Brazilian prisons. Despite being an environment with several difficulties for the coexistence of mother and child, breastfeeding is part of the prison scenario, and the breastfeeding phenomenon integrates into the daily life of female prisons(2,5). Therefore, the theme is relevant and must be discussed since most women incarcerated are in the reproductive phase, and pregnancy, breastfeeding, and child care are part of these women's lives within prisons(2).

Despite several governmental acts supporting breastfeeding in the Brazilian penal system, there are still weaknesses in meeting the needs of pregnant and lactating women, making them more vulnerable when deprived of their liberty(2,6). Therefore, a study in this area will help to acquire new knowledge about breastfeeding in the prison environment, identifying priority health actions, and evaluating equity related to mother-child as a right guaranteed by the Unified Health System (SUS in Portuguese).

It is necessary to deepen the mapping of studies investigating the structuring of breastfeeding in this environment. Therefore, this review aims to identify and map in the scientific literature actions to promote, support, and protect breastfeeding in the prison system.

METHOD

The scoping review methodology, which is used to map the knowledge available in the literature, identify gaps and expand the study on a given theme(7), will be used to identify and map actions carried out within the prison environment to support, promote and protect breastfeeding.

Eligibility criteria

This exploratory review will consider studies with a qualitative and quantitative approach, and the following study designs will be included: letters to the editor, case studies, experience reports addressing the theme of breastfeeding in the prison system, theses, dissertations, and articles available in full and free of charge in the databases, at the time of the search. The languages ​​used in the research will be English, Portuguese and Spanish. There will be no time restrictions to cover additional articles on the subject. The exclusion criteria will be duplicate articles, abstracts, and expert opinions or articles that do not meet the objective of this review.

Data selection

Descriptors in English, Portuguese and Spanish will be used, with quotation marks for the exact identification of the term, and, for the respective combinations, the Boolean operators OR and AND will be used to obtain the largest number of articles possible to answer the guiding question.

Registration

This scoping review has been registered in the Open Science Framework (OSF) with the identifier DOI 10.17605/OSF.IO/ZAJR8, available at https://archive.org/details/osf-registrations-zajr8-v1.

Review question

The review question is: What actions protect and support breastfeeding in the prison environment?

Acronym

P – Breastfeeding;

C – Promotion, protection, and support actions;

C – Prison system.

The terms were organized into mapping to facilitate the development of the search strategy, as shown in Figure 1.

Source: Prepared by the authors, 2020.

Figure 1 - PCC mapping to identify terms and organization of the search strategy. Niterói, RJ, Brazil, 2020

Data sources

The research took place in October 2020 in the following databases: Latin American and Caribbean Health Sciences Literature (Lilacs), Nursing Database (Bdenf in Portuguese), Regional Portal of the Virtual Health Library (VHL), Pubmed, Medical Literature Analysis and Retrieval System Online (Medline), Scientific Electronic Library Online (SciELO), Capes Portal of Journals, Web of Science, Clarivate Analytics, Scopus, and Cinahl. Theses and dissertations from the Brazilian Institute of Information in Science and Technology will also be searched, and manual searches will be carried out on Google and Google Scholar.

Search strategies

The preliminary search strategy will initially be tested in two databases, with a narrow search for published and unpublished studies (gray literature), using the title, abstract and indexing terms. After the limited searches, Nursing Database (BDENF via Bireme) and Lilacs will be searched on the topic studied. The keywords and indexing terms identified in this search step will be included and adapted for each database or information source. Reference lists of all selected information sources will be considered for additional studies. In this phase, a librarian from the Federal University of Rio de Janeiro will support the literature search.

Data processing

The studies found in the searches will be downloaded or exported to a reference manager (Ryyan), and from there, the review team, composed of two reviewers, will remove duplicates and, independently, make the initial selection through title and abstract screening(8). Subsequently, the pre-selected studies will be read carefully, and a virtual meeting will be held to deliberate the studies considered.

Reasons for excluding evidence sources that do not meet the inclusion criteria will be recorded and reported in the scoping review. Any disagreement between reviewers at any stage of the selection process will be resolved upon the participation of a third reviewer. The results and the criteria of the included studies will be reported in full at the end of the scoping review. The results will also be presented using the Preferred Report Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (Prisma-ScR) flow diagram(9).

Data will be extracted from the studies by two reviewers independently, and a framework will be created to extract data from the selected articles. In a table, the following information will be presented: methods, objectives, phenomenon of interest, context, sample size, and results.

Data analysis

The evidence will be analyzed through thematic analysis as follows: the articles will be mapped according to the relevance of actions to promote, protect and support breastfeeding within the prison system. The result of this analysis will occur in a descriptive and discursive manner, based on scientific knowledge and public policies.

In this way, the scoping review will highlight the importance of national and international actions to promote, protect and support breastfeeding within the prison system to guarantee the rights of inmates who breastfeed and their children.

CONFLICT OF INTERESTS

The authors have declared that there is no conflict of interests.

REFERENCES

1. Conselho Nacional de Justiça (BR). Regras de Bangkok: Regra das Nações Unidas para o tratamento de mulheres presas e medidas não privativas de liberdade para mulheres infratoras [Internet]. Brasília (DF): CNJ; 2016 [cited 2022 Feb 5]. Available from: https://www.cnj.jus.br/wp-content/uploads/2019/09/cd8bc11ffdcbc397c32eecdc40afbb74.pdf

2. Conselho Nacional de Justiça (BR). Manual Resolução nº 369/2021. Substituição da privação de liberdade de gestantes, mães, pais e responsáveis por crianças e pessoas com deficiência [Internet]. Brasília (DF): CNJ; 2021 [cited 2021 Oct 10]. Available from: https://www.cnj.jus.br/wp-content/uploads/2022/01/manual-resolucao-369.pdf

3. Santos MV, Alves VH, Pereira AV, Vieira BDG, Rodrigues DP, Marchiori GRS, et al. Protection to breastfeeding in prison space: Integrative Review. Research, Society and Development. 2020;9(9):e555997692. http://dx.doi.org/10.33448/rsd-v9i9.7692

4. Santos T. Levantamento Nacional de Informações Penitenciárias - INFOPEN Mulheres [Internet]. 2. ed. Brasília (DF): Ministério da Justiça e da Segurança Pública, Departamento Penitenciário Nacional; 2017 [cited 2020 Out 10]. Available from: http://antigo.depen.gov.br/DEPEN/depen/sisdepen/infopen-mulheres/infopenmulheres_arte_07-03-18.pdf

5. Simas L, Batista VM, Ventura M. Women, motherhood and the punitive system: limits and possibilities of custody hearings in the state of Rio de Janeiro. Rev Bras Ciênc Criminais [Internet]. 2018 [cited 2021 Jan 10];149:455-89. Available from: https://www.academia.edu/37959544/Mulheres_maternidade_e_o_sistema_punitivo

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6. Silva JB, Moraes MN, Brandão BMLS, Freitas WMF, Souto RQ, Dias MD. Women in deprivation of liberty: narratives of obstetric un(assistance). Rev Min Enferm. 2020;24:e-1346. http://dx.doi.org10.5935/1415.2762.20200083

7. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. Adelaide (AUS): JBI; 2020 [cited 2021 Jan 10]. Available from: https://synthesismanual.jbi.global/. https://doi.org/10.46658/JBIMES-20-12

8. Johnson N, Phillips M. Rayyan for systematic reviews. J Electron Resour Librariansh. 2018;30(1):46–48. https://doi.org/10.1080/1941126X.2018.1444339

9. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467-73.  https://doi.org/10.7326/m18-0850  

Submission: 03/07/2022

Approved: 07/12/2022