Balancing Health and Faith

Sindh Health Minister Dr. Azra Pechuho inaugurated Pakistan’s first Shariah-compliant Human Milk Bank and Early Childhood Centre in Karachi, launched in collaboration with UNICEF. The facility was aimed to provide donor milk to vulnerable infants, promote breastfeeding, and ensure Shariah compliance by maintaining detailed donor and recipient records.

Pakistan’s groundbreaking Human Milk Bank at Sindh Institute of Child Health & Neonatology (SICHN) has been suspended following a revised fatwa. The institute now seeks further guidance from religious authorities, reflecting the complex interplay between medical innovation and religious compliance.

Globally, it is acknowledged that breast milk is essential for ill and premature babies, reducing risks of sepsis and necrotizing enterocolitis (NEC)– a life-threatening illness almost exclusively affecting neonates. A Cochrane review of 1017 premature infants showed significantly higher NEC and feeding intolerance rates in those fed formula. Though formula-fed babies gained weight faster and showed short-term growth benefits, these did not last. Thus, use of human milk fortifiers might negate these short-term gains. Global organizations like WHO and UNICEF promote human milk banks, emphasizing their importance in infant health and encouraging worldwide expansion.

Providing human milk is crucial for giving all children a healthy start, though some mothers and babies face challenges in this endeavour. It falls on the shoulders of religious leaders, healthcare professionals, and government officials to step in and offer their support. While human milk banks provide a promising solution, their adoption necessitates a nuanced understanding of Islamic principles, allowing these initiatives to thrive within Muslim communities

Historically, human milk sharing has ancient roots, with evidence in the Code of Hammurabi from 1790 BC. This practice, known as wet nursing, involved breastfeeding by relatives or strangers and was believed to pass on traits from the wet nurse to the child. Prominent historical figures, including the Prophet Muhammad (S.A.W), were wet nursed. By the 13th century, wet nursing was a lucrative job for European women. The first human milk bank opened in Vienna in 1909, followed by others in Boston and Germany. Despite fluctuations in popularity due to formula milk and AIDS fears, milk banks have seen a resurgence, supported by advances in pediatric medicine and safety protocols.

The proliferation of milk banks has reached extensive parts of Europe and North America, along with numerous non-Muslim-majority countries. However, this expansion is notably less prevalent in Muslim-majority regions due to the concept of milk kinship. This kinship is established when a child is breastfed by a woman other than their biological mother, creating a bond akin to that of siblings, which then forbids marriage between these milk siblings and their biological kin.

The interpretations of this practice vary between Sunni and Shia Muslims: The Shia school of thought mandates direct breastfeeding with a minimum of ten feeds, whereas the Sunnis accept any method and quantity of milk. Since 1985, the International Islamic Fiqh Academy has prohibited the establishment of Western-style milk banks to prevent unintentional marriages among milk kin.

Muslim nations have introduced innovative milk banking methods. In Kuwait and Malaysia, a peer-to-peer donation model is being tested, connecting two to three families to supply unpasteurized donor human milk (DHM) to preterm Muslim infants. Before the donation, families meet to ensure compatibility, discuss religious considerations, and address the prohibition of marriage between the donor’s children and the recipient infant, reflecting a culturally sensitive approach to this vital healthcare service.

Other Muslim countries like Turkey, Saudi Arabia, and Bangladesh are considering similar models pending Islamic authority approval. Iran has conventional milk banks with religious backing, stating no kinship occurs without direct breastfeeding. The European Council for Fatwa and Research (ECFR) decreed that milk from conventional banks does not establish kinship due to the anonymous and pooled nature of donations. Despite this, many Muslim parents refuse donor milk due to kinship concerns. Consequently, the ECFR mandates traceability of milk donations for 30 years to verify kinship.

In a milk sharing programme for Muslim nations, strict guidelines are crucial. Each child should ideally have only one donor, and mixing donors’ milk must be avoided. Proper labelling for full donor identification is essential, and both parties should consent to identity disclosure. Donor information might be added to the child’s birth certificate. Mothers are primarily responsible for breastfeeding, with the programme supporting preterm infants. The aim is to encourage mothers to produce their own milk quickly, minimizing the need for multiple donors. Prolonged milk sharing is reserved for children whose mothers cannot breastfeed due to medical issues or death. Additionally, if a donor predominantly has children of one gender, their milk should preferably be given to recipients of the same gender.

Providing human milk is crucial for giving all children a healthy start, though some mothers and babies face challenges in this endeavour. It falls on the shoulders of religious leaders, healthcare professionals, and government officials to step in and offer their support. While human milk banks provide a promising solution, their adoption necessitates a nuanced understanding of Islamic principles, allowing these initiatives to thrive within Muslim communities.