Artigos

Conteúdo (article):

MULHERES LACTANTES E A PERCEPÇÃO DO VALOR ÚTIL PARA O ALEITAMENTO MATERNO NO ESPAÇO PRISIONAL

LACTATING WOMEN AND THE PERCEPTION OF USEFUL VALUE FOR BREASTFEEDING IN A PRISON ENVIRONMENT

Marcia Vieira dos Santos
ORCID ID: http://orcid.org/0000-0002-1488-7314
ID Lattes: 1114658059243825
Escola de Enfermagem Aurora Afonso Costa, Universidade Federal Fluminense, Rio de Janeiro, Brasil
Email: marcias@id.uff.br

Valdecyr Herdy Alves
ORCID ID: http://orcid.org/0000-0001-8671-5063
ID Lattes: 5447343127674320
Escola de Enfermagem Aurora Afonso Costa, Universidade Federal Fluminense, Rio de Janeiro, Brasil
Email: herdy_alves@id.uff.br

Audrey Vidal Pereira
ORCID ID: https://orcid.org/0000-0002-6570-9016
ID Lattes: 2510148795147954
Escola de Enfermagem Aurora Afonso Costa, Universidade Federal Fluminense, Rio de Janeiro, Brasil
Email: avpereira@id.uff.br

Bianca Dargam Gomes Vieira
ORCID ID: https://orcid.org/0000-0002-0734-3685
ID Lattes: 6359217602166781
Escola de Enfermagem Aurora Afonso Costa, Universidade Federal Fluminense, Rio de Janeiro, Brasil
Email: dargam_bianca@id.uff.br

Diego Pereira Rodrigues
ORCID ID: http://orcid.org/0000-0001-8383-7663
ID Lattes: 8470989067617455
Universidade Federal do Pará, Centro de Ciências de Saúde, PA, Brasil
Email: diego.pereira.rodrigues@gmail.com


Tatiana Socorro dos Santos Calandrini
ORCID ID: http://orcid.org/0000-0003-2807-2682
ID Lattes: 9646872750954617
Escola de Enfermagem da Universidade Federal do Amapá, AP, Brasil
Email: calandrinitatiana@gmail.com

Rebecca dos Santos Alcicci
ORCID ID: https://orcid.org/0009-0008-0452-8888
ID Lattes: 3158930187077007
UNISUAM, Centro Universitário Augusto Motta, Rio de Janeiro, Brasil
E-mail: psirebeccaalcici@gmail.com

Raquel Ribeiro de Azevedo Costa do Carmo
ORCID ID: https://orcid.org/0000-0002-9150-177X
ID Lattes: 960323914440172
Escola de Enfermagem Aurora de Afonso Costa, Universidade Federal Fluminense, Rio de Janeiro, Brasil
Email: raquel_ribeiro@id.uff.br

RESUMO
Objetivo: Desvelar o valor útil acerca da amamentação para lactantes no ambiente prisional, a partir da dimensão axiológica de Max Scheler. Método: pesquisa qualitativa do tipo fenomenológica, desenvolvida em unidade prisional no Rio de Janeiro, onde foram entrevistadas sete lactantes. A técnica de coleta de dados foi a entrevista fenomenológica e, para análise e tratamento dos dados, utilizou-se a análise de conteúdo de Laurence Bardin. Resultados: o valor desvelado à luz de Max Scheler foi o valor útil, detectado a partir da carência das lactantes no momento vivido no ato de amamentar no espaço prisional, sendo identificadas duas categorias: apoio da unidade prisional como valor útil à amamentação e Rede de apoio como valor útil para amamentação. Conclusão: o espaço prisional materno-infantil é um valor útil à amamentação, porém se faz necessária uma transformação desse espaço em um ambiente legítimo, que deverá valorar a amamentação por meio do apoio da família da lactante e de amigos e profissionais de saúde e com a implementação de novos protocolos e políticas públicas específicas para a prática de amamentar no sistema prisional, as quais devem ser baseadas em evidências científicas e nos princípios do Sistema Único de Saúde de forma integral, universal e com equidade.
Palavras-chave: Saúde da mulher. Amamentação. Valores. Prisão.

ABSTRACT
Objective: To unveil the useful value of breastfeeding for lactating women in a prison environment, based on Max Scheler\'s axiological perspective. Method: This work was a qualitative, phenomenological study, developed in a prison unit in Rio de Janeiro, where seven lactating women were interviewed. The phenomenological interview was used for data collection, while Laurence Bardin\'s content analysis was used for data analysis and treatment. Results: The value revealed, in light of Max Scheler’s findings, was the useful value, which was detected through the needs and wants experienced by lactating women during the act of breastfeeding in a prison environment. Two categories were identified: Support from the prison unit as a useful value for breastfeeding and the support network as a useful value for breastfeeding. Conclusion: The maternal-child prison environment is a useful value for breastfeeding, but it is necessary to transform this space into a legitimate environment, which should value breastfeeding through the support of family, friends, and health professionals, as well as with the implementation of new protocols and specific public policies for the practice of breastfeeding within the prison system, which must be based on both scientific evidence and the principles of the Unified Health System (SUS) in an integral, universal, and equitable manner.
Key words: Women\'s health; Breastfeeding; Values; Prison.

INTRODUCTION
The Global Breastfeeding Scorecard suggests that all countries should invest in the practice of breastfeeding in order to contribute to the health of the general population. To achieve this, specific actions are needed, including the promotion of breastfeeding and support for it, in addition to legislation that protects breastfeeding¹.
Therefore, pregnancy, the postpartum period, and breastfeeding, when it comes to the penal system, are also relevant issues for maternal and child health, given that the Brazilian female population has been increasing in a scenario of inequality and is now a part of the excluded groups in society. Many of the incarcerated women lived in social vulnerability before prison and generally committed crimes without violence, almost always linked to drug trafficking2, which also occurs in other countries, including Canada, the USA, and Malawi3,4,5.
Despite the significant increase in the number of pregnant women in the prison system worldwide, many of the needs of this population are commonly neglected, which can trigger negative impacts on the health of the mother and child. Therefore, this is a matter of public health6.
According to the Penitentiary System’s Statistical Data, from January to June 2022, 164 pregnant women were deprived of their liberty in the Brazilian prison system; 93 breastfeeding women; 791 children inside Brazilian prisons, across various age groups: from 0 to 6 months (11.25%); from 6 months to 1 year (5.82%); from 1 to 2 years (7.71%); from 2 to 3 years (10.37%), and over 3 years (64.85%)7.
Therefore, the practice of breastfeeding has become an essential within prisons, since pregnant and breastfeeding women experience a greater risk of illness in prison, a place that affects women\'s quality of life, as it is unhealthy, causes stress, and can trigger physical and mental health problems in any individual2. Therefore, this public becomes more vulnerable, since, during the pregnancy-postpartum period, they require greater support from health services, along with psychological and social support, which makes this period in a woman\'s life fragile, given that, within prisons, the right to motherhood is impaired, just as their children are unable to live their childhood fully, which is a health problem8,9.
In Brazil, the majority of pregnant women deprived of liberty are pregnant at the time of imprisonment10; in the USA, 3% to 4% of all women in the prison system are pregnant11. In England and Wales, nearly 7% of all women prisoners are pregnant, and these countries perform a pregnancy test upon admission, however, not all US prisons have adopted this practice12.
By conducting an early recruitment of pregnant women, quality prenatal care is ensured; however, in Brazilian prisons, there is a deficit in health care during the pregnancy-postpartum period, and maternal-fetal complications may occur due to the precarious implementation of the women’s healthcare policy within the prison context13.
Therefore, the complexity of maternal and child healthcare issues increases in the prison environment when there are children involved, many of whom still require breastfeeding14. Therefore, the act of breastfeeding is a phenomenon in women’s prisons, as breastfeeding is linked to women\'s reproductive life and is influenced by various factors, depending on the situation in which they live, especially when these women live in the prison environment itself2-15.
Therefore, it is necessary to understand that breastfeeding does not only encompass the biological and rational factors, but also the experience of each woman\'s feelings. Hence, a breastfeeding woman is a person who carries established values, understanding that breastfeeding is situated in a universe of culturally transmitted and reproduced values, in which new values can also be added, depending on the experience of each breastfeeding woman16.
For Scheler, values are manifested in lived experiences, so the things that surround people have a certain value and cause the individual to make a choice and never remain indifferent16. When the things begin to have value, it becomes clear that, at that moment, there is a lack or a desire, resulting in the phenomenological experience, which a priori occurs through the emotional intuition of what has been experienced.
In this context, values represent aspirations and needs that the individual seeks to meet and, when they are not met, new desires will emerge that will be pursued until the desired value has been achieved. Once the value has been exhausted, it is then inserted into the culture of the day17.
From this perspective, to research the useful values of breastfeeding expressed by lactating women deprived of liberty, our study was based on the Theory of Values, as proposed by Max Scheler, which will make it possible to expand care processes in the field of reproductive health for women deprived of liberty, focused on the health of the mother and child.

OBJECTIVE
Reveal the perception of the useful value of breastfeeding, for lactating women, in the prison environment, based on Max Scheler\'s axiological dimension.

METHOD
Search type
This is a social, exploratory, descriptive study, with a qualitative approach, within a phenomenological framework, anchored in Max Scheler\'s phenomenology. This philosopher studies human ethics from ontological dimensions, seeking to find man\'s place in the universe, with his core interest focused on the meaning of life and its values17.
Values, for Scheler, appear in lived experience. Thus, the things that surround people\'s worlds have a certain value and cause the individual to make a choice, and never remain impassive about things in the world. When things begin to gain value, this demonstrates that, at that moment, a need or desire was fulfilled; hence, consciousness perceives the value that will lead to the desirable16. These values will be followed until the fulfillment has been exhausted, after which time, the same is inserted into the culture of the day17.
According to this concept, Scheler developed a pure, intuitive, and emotional phenomenology, based on the ethics of values18. In Scheler\'s axiology, the higher the values, the more long-lasting they become, since man\'s preference causes him to give priority to values19. In this light, values are related to each other in a hierarchical sense, never disconnected from the world of life, and are perceived by the emotional intuition that arises from the phenomenological experience20.
The main objective of Max Scheler\'s phenomenology was to rescue the value of the person, as the human being is the value of the source, with love being the core value of the individual21. Values are ranked in hierarchical categories in ascending order, the higher the values, the more long-lasting they become: a) sensitive values: the lowest values, to human sensitivity; b) vital values: considered average values, from two points of view – the first linked to the value of life and the second to the human emotional character; c) spiritual values: esthetic/moral, ethical, and intellectual values; and d) religious values: the value of holiness, the highest level22.
For Scheler, the useful value is an average value and its dimension seeks to attain the vital value. Health is a vital value, which, to be achieved, requires a valuing of useful care, consequently “any value of utility is a value for a vital essence” (Scheler, 2012, p. 158)23.
In our study, the criteria presented in the Consolidated Criteria for Reporting Qualitative Research (Coreq) were adopted, which seeks to attain the quality and transparency of the reporting of qualitative health research.

Research Scenario
The present study was carried out in the maternal and child prison unit, where lactating women deprived of their liberty are kept with their children, an institution linked to the State Department of Correctional Facilities of the State of Rio de Janeiro (Secretaria de Estado de Administração Penitenciária do Estado do Rio de Janeiro – Seap-RJ). To conduct this study, authorization from the Seap-RJ School of Penitentiary Administration (Escola de Gestão Penitenciária da Seap-RJ) was required. Authorization was granted in March 2020, but visitation in prison units in the state of Rio de Janeiro was suspended due to the COVID-19 pandemic.
Only in November 2020, with broad restrictions, the School of Penitentiary Administration and the prison institution’s management authorized the entry of some researchers into the scenario and informed that, at that time, Seap-RJ was only authorizing the entry into prison units of researchers who were employees, a situation that included the researcher of this investigation. At that time, most lactating women received the benefit of house arrest or provisional release. Only breastfeeding and pregnant women who had already been convicted and/or were awaiting court authorization for said release remained in the prison unit.
For these reasons, the interviews took place from November 2020 to May 2021. During the interviews, there were one or two infants at most in the prison per month. Thus, seven women participated in the study, representing 100% of the lactating women who were breastfeeding in the prison unit during the period of the field research.
Data collection was terminated due to a sufficient number of meanings, when the analysis, developed concomitantly, indicated that the meanings obtained responded to the objective of the research, that is, the data began to present redundancy; therefore, the inclusion of new participants was no longer necessary. Hence, the number of participants was not predetermined and totaled seven lactating women.
Recruitment was carried out by convenience, with an invitation to participate in the study and the application of the sample eligibility criteria, namely: lactating women who were breastfeeding in the Rio de Janeiro prison; breastfeeding women who had authorization from the prison management to participate in the research; and breastfeeding women who were physically and mentally fit to participate in the research. The women who met these criteria were sent to perform data collection, aimed at establishing a relationship of empathy and acceptance for the interview. The exclusion criteria were: legal reasons that prevented the breastfeeding woman from participating in the interview; transfer of the breastfeeding woman, during the interview period, to another prison unit and prison release; as well as women who, although they had their children in prison, were not breastfeeding.
To ensure privacy and confidentiality regarding the collected data, participants were identified by the letter M (initial of the word “Woman” (“Mulher”) in Portuguese), followed by an Arabic numeral (M1, M2, … M7), according to the order in which they took part in the interviews.

Ethical and legal aspects
This study, as recommended by Resolution no. 466/12 of the National Health Council, was approved by the Research Ethics Committee (CEP) of Universidade Federal Fluminense (UFF), according to Protocol no. 3,019,397, and received authorization from the State Department of Correctional Institutions by means of SEI-10015024.

Data collection technique
To understand a phenomenon, it is necessary to experience it; therefore, the researcher attempts to bring out the description made by the subjects themselves, understanding their inner selves and unveiling their meanings16. The phenomenological interview captures the subjectivity of the participants in order to understand the phenomenon, and the conduct of the interview is mediated by empathetic questions. There are two moments in the phenomenological interview that must be observed: in the first, the ontic occurs, which begins with the organization of the research up to the description of facts (subjective); the second, called the ontological stage, focuses on understanding the unknown, when the phenomenon is interpreted and the meanings are revealed. Thus, the researcher obtains an understanding of the research subject, that is, he/she understands the perspective of the other24.
To carry out the phenomenological interview, there is no specific number of participants, as the interviews must occur in parallel with the analyses and, as soon as it is possible to understand the investigated phenomenon, the interviews can be ended24. In this study, the phenomenological interview used only the following guiding question: “Talk about your experience as a woman who breastfeeds in prison.”
The meetings lasted an average of almost 2 hours, face to face, researcher – breastfeeding woman, and on her lap, her baby. The interview began with a presentation by the researcher and with the breastfeeding woman\'s acceptance to participate in the study. This acceptance took place through the signing of the Free and Informed Consent Form (FICF). Empathy between the researcher and the participant was constant, resulting from the researcher\'s practice in the prison environment and from maternal and child health.
Field diaries, with paper and pen, were used in the interview, given that, in prison units in the state of Rio de Janeiro, recording interviews is not allowed. At the end of the interview, the researcher gave feedback to the participant, and thanked her and her baby for their participation. The interviews ended by revealing the useful value in the perception of breastfeeding women deprived of their liberty, in the light of Max Scheler.

Data analysis and processing
To carry out the analysis and discussion of the research results, Laurence Bardin\'s content analysis concepts were used, starting as a pre-analysis, which is the phase in which the ideas are systematically organized. The material was then explored, and, finally, the result was processed25.
In this research, all stages were carried out in great detail, with homogeneity and exclusivity, and the data found were grouped by content convergence, based on Max Scheler\'s Theory, with the thematic core being the “Useful Value of Breastfeeding”.
To analyze the recording units and message encodings, the Qualitative Data Analysis Software (Atlas.ti, version 9) was used, a tool that aids the researcher in analyzing qualitative research data. The first stage included the processing of each participant’s answers in the software. The words/recording units were then classified by their frequency and were evaluated by the researchers according to the analytical objective of this study.
Shortly thereafter, the registration units were coded into thematic units, according to meanings, and grouped by codes, thus giving the authors the possibility to construct two categories, namely: category 01: support from the prison unit as a useful value for breastfeeding; and category 02: support network as a useful value for breastfeeding.

RESULTS
In this study, the unveiled value was the useful value of breastfeeding, considered to be an essential value to human life, understood through the emotional experience of women who breastfeed and not only through rational experiences16.
Thus, the useful value emerges from the needs and wants of lactating women during the act of breastfeeding in a prison environment, which was identified and presented in the following categories:

Category 01: Support from the prison unit as a useful value for breastfeeding
The maternal and child prison environment is used as a useful space for the health of the mother deprived of liberty and her baby by offering support for breastfeeding in the prison context, as demonstrated below by the participants:
“Here, children are healthier, you have more time for children; on the street, there\'s somewhere to run, he goes straight to the bottle. It\'s better for children here. Before, I didn\'t care about breastfeeding, no one ever stopped to explain it to me, my mind is clearer now, I really want to breastfeed.” M5
“Here I want to breastfeed, I didn’t even have this backing in the maternity ward. At the hospital, they only said to breastfeed because it is good for the child, otherwise they will be given artificial milk.” M3
It was found that the prison unit analyzed in this study offers support to the health of women and children because it has a physical structure that is different from other women\'s prisons, in addition to having professionals and a support network to care for women and children who stay in this space. In the participants’ statements, this is explicit:
“The place is well-structured, for other mothers, it is the best place, many are drug addicts, they had no food. Here they have medical care, social services. Without this structure, many children would not be alive and mortality would be higher.” M4
“The prison’s prenatal care is good, it has good resources, I performed USG, quick tests for syphilis, HIV, hepatitis, I performed urine and blood tests. The treatment is different.” M1

The prison is an unfamiliar environment, which awakens fear and insecurities in postpartum women; however, despite the difficulties encountered in this environment, women demonstrated that they need to adapt, seeking to protect their baby\'s stay with them. The prison unit offers institutionalized support, and breastfeeding is part of everyday life:
“I breastfeed all the time, she breastfeeds a lot, she already weighs 6kg or so, before I was scared, during the check-up routine the baby starts to sleep, now I\'m getting used to it”. M1
“My life changed completely, I was afraid of having another child, if I had this child abroad, I would already be in depression. After being here, I lost my fear of rejection, I met a lot of people here, a lot of history, I saw that having another child and breastfeeding here is not that difficult.” M5

The prison environment in which the breastfeeding women are with their children develops actions that protect and support breastfeeding within its space and removes possible existing barriers to safe breastfeeding in the unit. This fact can be seen in the participants’ statements:
“Today everything is different, the guards are wonderful, women don’t have to go through what I went through, I suffered violence during my first pregnancy. We are all very vulnerable here, except when we go out on the streets.” M4
“Where we are, we have humanized resources, but it’s a prison. It’s not a big deal, we can do everything alone, it would be worse if we didn’t have this.” M6

Category 02: Support network as a useful value for breastfeeding
The women deprived of liberty in the prison unit analyzed in this study demonstrate that they need the utility value, of family support, when they are in prison, as shown in the following statements:
“There is no comfort, the family should stay close, family support is everything” M1.
“We need family protection, the courts could control us on the street, the best thing is to be close to family. I\'m paying my punishment, where an epidemic can\'t have visitors, it\'s complicated, the family doesn\'t accompany us” M4.

When reporting the distance of family members, study participants reported that they miss their family’s support, especially their own mother, to accompany them when breastfeeding, as expressed in the following reports:
“I want my mother close to me, I need her to help me, she never leaves me.” M5
“My mother told me to breastfeed even if my breasts were bruised, I really miss her... Breastfeeding is good, it\'s cool, but I need help, I\'m afraid of drowning and suffocating, I had to learn everything on my own.” M3

Support from family members is very important for these women, as some reported, in their new reality in the prison system, the desire to leave the baby with the family during the prison period, counting on the utility value of family members to stay with their children.
“I\'m only going to breastfeed until he’s three months old, I prefer you take it home, my sister-in-law can take care of it. Next year, I will be with them (family) to spend the commemorative dates.” M4
“At the hearing, if I am sentenced, I will separate myself from my baby, I will look for the social worker to find out how to hand my baby over to my family, my mother and my husband.” M2

In fact, family support for the interviewees in this research is made difficult, since family members can only enter the prison unit during visiting hours, and this situation worsened during the pandemic, as visits were suspended for a period of nearly a year. Therefore, the breastfeeding women in this study, who experienced the pandemic in prison, sought support from other women and/or professionals at the prison unit, to breastfeed and feel safe. This is demonstrated in the following speeches:
“I miss my mother, she would be helping me, but we have the support of the girls and the doctor guiding us”. M2
“One woman helps another, they all have children out there, I want to learn everything, breastfeeding is good, you should never deny the breast.” M7

Family support is extremely necessary in the practice of breastfeeding, which is influenced by habits and culture experienced in the context where the individual lives. Thus, family and friends are important because they convey their knowledge, which contributes to breastfeeding. This culture of breastfeeding is highlighted by the lactating women who participated in this study.
“The family advises breastfeeding, everyone says it protects. I like it, everyone breastfed in my family.” M1.
“My family says it’s good, I know it’s good, but I’m not forced to breastfeed, they encourage me a lot.” M3
“My whole family breastfeeds until 9 months. When I call my family, they ask: ‘Are you breastfeeding the baby?’” They love breastfeeding.” M7
DISCUSSION
Utility, as a value for man, meets the needs and wants experienced in everyday life26. The vital value of breastfeeding involves acquiring useful support to achieve the fullness of breastfeeding, producing the well-being of the woman and the baby. Thus, when analyzing the results of the study, the useful value for the success of breastfeeding was revealed, based on actions to support breastfeeding processes in the prison environment12.
Support actions, as a useful value for breastfeeding, help the lactating woman face everyday problems in their needs and specificities, and can perform the act of breastfeeding as something pleasurable27. Thus, the support offered to women with regard to breastfeeding in the prison unit analyzed in our studied is relevant for the participants, and it is clear that, if some had not been in that environment, perhaps they would have already introduced complementary food for the child or even weaning might have already occurred.
Support from the prison institution is essential for adherence to breastfeeding, as women are able to breastfeed for longer, are less stressed when breastfeeding their babies, and broaden bonds with their children during the period of incarceration28. In this scenario, the study participants reported that, in the maternal and child space, they have access to prenatal services, and they expressed that, to a certain extent, this service is better in prison than outside. However, considering that, in the Brazilian public health network, it is difficult to access health services related to care for pregnant and breastfeeding women29, this fact may have influenced the response of these women. Furthermore, the results of prenatal care in the Brazilian prison context present low indicators regarding maternal and neonatal health30.
Another relevant topic concerning breastfeeding is that the prison environment is not suitable for children, yet the separation of the baby from its mother can be traumatizing. Therefore, a challenge found in the prison systems of several countries is the existence of children in this type of space4,28. Despite this conflict of whether or not to keep the child with his/her mother, one survey reported that, in relation to women prisoners who breastfed their children in prison, an increase in the mother-child bond was detected, and there was less criminal recidivism among these women, in addition to the fact that their children, when they reached preschool age, had fewer psychological problems4.
One solution to prevent children from being breastfed in the prison system would be for women to receive precautionary measures to breastfeed their children at home2,31. It is worth remembering that, even though the prison environment under study here has a structure that is different from other prisons, which offers a space for lactating mothers and their children, this place is still part of the prison system and produces suffering for women, families, and professionals. It is, therefore, insufficient to meet the needs of women and children, due to the negligence carried out by the State, to serve this public in its singularities2.
Therefore, to improve the care for mother and child, prison institutions attempt to support breastfeeding, a fact observed in this study when participants reported changes in the physical structure and in the care received by professionals. However, there are still major gaps to be filled, and it is necessary to expand the encouragement of breastfeeding in the prison space as determined by policies to encourage breastfeeding, with actions to promote this practice and protect these women, who are the protagonists of breastfeeding3.
Furthermore, the environment studied is a place that arouses a fear of the unknown, since, during this period, breastfeeding women find themselves emotionally decompensated, due to being in a prison environment, separated from family members, and due to the fear of being separated from their children4. Thus, the participants in the present study demonstrate that they are afraid of everyday life, of the prison routine, which is because they live in fear of what could happen to them and their children. However, despite this discomfort, breastfeeding in prison can serve as a protective factor for the mental health of these women while they are in prison3.
The interviewees expressed that the support network is essential for the period lived in prison. Thus, these women evaluate and value the importance of the family, and demonstrate their wants and needs and the fact that they need their family to support them inside the prison. Therefore, in the perception of research participants, the breastfeeding support network is a useful value. For Max Scheler, a useful value is a value that is good and pleasing to the senses23.
However, this family support does not exist in the prison unit analyzed in our study, since, in this location, family members only visit on the days and times stipulated by the institution, but are not authorized to accompany the lactating woman in her breastfeeding routine. As already explained, the absence of family members became more severe during the COVID-19 pandemic, due to the suspension of visits. The lack of support from family members during the pregnancy-postpartum period not only occurs in Brazilian prisons, but also in those in developed countries, such as the USA4, Canada3, and the United Kingdom28, and has also been reported in studies on the African continent, in Malawi and Mozambique5,32.
Therefore, the management of prison environments in different countries needs to comprehend that family support is essential during pregnancy, childbirth, and breastfeeding. This knowledge will provide support for the woman in her singularities, as well as provide security for those being cared for, which is therefore, considered to be an extremely important factor for the continuity of breastfeeding33.
Among the family members most cited as support by research participants are the child\'s maternal mothers and grandmothers, which is the support that lactating women deprived of their liberty miss most when breastfeeding. Therefore, the support of the mother (grandmother) is considered a useful value, as it benefits and prolongs the act of breastfeeding in prison. Some participants demonstrated trust and support from their family even when talking about their children\'s separation. At this moment, this support is considered a good value, as it will fulfill the needs of the woman and her child.
Furthermore, lactating women demonstrated, in this study, that the family tradition of breastfeeding is a factor that interferes with the woman\'s decision. Thus, breastfeeding is a practice that has culturally conveyed and reproduced values, and can add new values, depending on the experience of each breastfeeding woman. The decision to breastfeed or not is directly linked to values and beliefs that interfere positively or negatively in the practice of breastfeeding16.
For Scheler, culture involves customs, characteristics, and productions specific to a people, so culture adds values23 to the participants of a community. In this context, breastfeeding is considered a historical process, which has traditions and norms, linked to beliefs, cultures, and values that pass from the family to the individual. Hence, family knowledge is essential for actions to support, promote, and encourage breastfeeding34,35.
Therefore, to reinforce breastfeeding wherever the breastfeeding woman is, a family member must be allowed to stay with her during the pregnancy-postpartum period, which is a right that is already guaranteed in Brazil. However, in the present study, it was observed that the participants do not have this right guaranteed by the National Policy for the Promotion, Protection, and Support of Breastfeeding, which considers breastfeeding a collective good and determines that its beneficiaries shall not suffer any type of discrimination. Therefore, disadvantaged women and children must receive care according to their specific needs, seeking to guarantee the principle of equity35.
Another useful value presented by the participants were the companions, who were deprived of liberty and who were also breastfeeding in prison, especially during the period of the COVID-19 pandemic. It is important to remember that, during this period, visits were suspended. In this sense, the support of other women was very relevant to the practice of breastfeeding, as many lactating women, at the time of breastfeeding, when observing other groups of mothers breastfeeding, became stronger, which is a positive factor in increasing adherence to this practice and its continuity33.
Mothers who breastfeed in the maternal and child prison institution support each other when breastfeeding in the prison system, experiencing very similar situations. However, it is necessary to constantly evaluate this support from “companions” to identify if there is in fact any information that leads to early weaning, since incorrect opinions about breastfeeding can negatively influence this practice35.
Another subjective value that fills the woman\'s need, which is a useful value in the perception of breastfeeding women deprived of liberty, is the support that health professionals in the maternal and child prison offer to this public, by providing security for these women when breastfeeding their babies. This fact is important for the continuity of breastfeeding in this environment28,36.
However, based on the participants\' reports, it was observed that the guidance offered to breastfeeding women deprived of their liberty by health professionals is individualized and specific. Therefore, it is necessary for health professionals to encourage breastfeeding in the prison institution on a scheduled basis, with individual and collective health education actions that promote the encouragement of breastfeeding. The institutions in question must ensure that women receive support actions in the prison environment, where there must be a transdisciplinary team made up of health professionals prepared and scientifically updated on the subject in order to meet the needs of breastfeeding women deprived of liberty, babies, and family members, in addition to expanding knowledge throughout the penal institution35,36.
The support network made up of family, friends, companions deprived of liberty, and health professionals is important because the practice of breastfeeding is connected to beliefs, values and myths and, with this support network, the woman feels more empowered to make positive decisions regarding breastfeeding35,36.
It is important to note that this study is anchored in Max Scheler\'s axiology of values and brings some reflections and inferences to provide an axiological meaning to the needs of women who breastfeed in the prison environment. Such reflections can contribute to redirecting care practice in the area of breastfeeding, in turn producing useful care.

LIMITATIONS OF THE STUDY
As a limitation of this study, one can mention the fact that it was carried out during the COVID-19 pandemic. During this period, research in the field was suspended and, after release, the researcher had to be properly dressed (hat, cloak, mask, face shield). Other limitations found are linked to the prohibition of recording interviews and a certain concern with which health researchers are treated by professionals at the prison unit.

CONCLUSION
In conclusion, by revealing the needs of useful value for breastfeeding women, in the prison environment, based on Max Scheler\'s axiological dimension, this study proposes that specific protocols and public policies be implemented for the practice of breastfeeding in the prison system, which should be based on both scientific evidence and the principles of the Brazilian Unified Health System (SUS) in an integral, universal, and equitable manner for the mother and child binomial.
Therefore, it is up to the State to offer conditions that meet the specific demands and needs of pregnant and postpartum women deprived of their liberty, mainly with actions that encourage breastfeeding within this environment. It is understood that, by offering actions to support, promote and protect breastfeeding, prison institutions do not give privileges to the mother and child binomial in prison, but rather legitimize the citizens’ rights.

Supplementary material
This study is the result of the products of the thesis entitled “Lactating women and the axiological understanding of breastfeeding in the prison environment”, defended at Universidade Federal Fluminense. The research data is available in full at: https://app.uff.br/riuff/handle/1/23807.

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