More than Breast Friends: Kinship and Muslim Milk Banks

Breastfeeding may seem like the most natural thing in the world, but for a percentage of women it can be terribly challenging — especially if they cannot produce enough milk or refrain from breastfeeding due to medical reasons such as severe illness, accident, HIV infection, or taking certain medications that can harm the baby through breast milk.

As I’ve mentioned in another post on breastfeeding in Guinea, it’s widely accepted by health organizations that breast milk is the optimal food for infants and, when done exclusively, helps guard against infant mortality. The World Health Organization recommends exclusive breastfeeding for the first six months of life and continued breastfeeding for up to two years. But in cases where the mother cannot breastfeed, the WHO’s recommended choice of alternative is breast milk from a healthy wet-nurse or from a human milk bank.

There are currently 13 milk banks in North America, almost 200 banks in Europe, 210 in Brazil, and several hospital neonatal and intensive care unit-affiliated banks worldwide. Recently in a two-minute video, the BBC covered a new government milk bank in a Muslim majority country — set to open in the port city of Izmir, Turkey.

“If successful, this pilot will help feed babies whose mothers have passed away and help mothers who cannot produce enough breast milk.”

Despite the fact that health authorities have taken special care to recognize and address the religious conditions necessary for a milk bank to work within an Islamic context, the BBC stresses that the project could, “face resistance as traditional Islam forbids marriage between people who have been fed with milk from the same woman.”

Rooted in the Qur’an (4:23), fostering sibling kinship through breastfeeding has a long tradition in Muslim communities. Classical and contemporary Islamic legal discourse outlines the many ways this kinship is established — and includes a number of varying conditions, such as requiring a family familiar wet-nurse or none at all, the nursling feeding directly from the breast or from a cup, and that feedings instating kinship range from a one time deal, to 10 sessions before the infant reaches the age of two (source). Once fulfilled, regardless of legal differences of opinion requiring the bond, a milk kinship is permanent and bars marriage between milk siblings.

Unlike other milk bank initiatives found in so-called “Western” countries, the program in Turkey has additional conditions to help ensure the quality of the milk. A soundbite from the Minister of Health, Mehmet Müezzinoğlu, explains that donors and recipients will be paired — so that the milk from a volunteering mother always goes to the same infant. The milk will also be tested, and only consumed with the approval of both the donating mother and the infant’s legal guardians.

Turkish media is also following this issue closely, highlighting the fact that this project plays a role in the Health Ministry’s aim to reduce infant mortality, listing the benefits of breast milk over substitutes like formula or cow’s milk, further detailing the conditions for donation and sibling registration by amending Citizenship law, and covering a recent statement from the Health Ministry celebrating the Turkish milk bank model as “a unique endeavour, distinct from models found in European countries.”

According to the Hurriyet Daily News, the Health Ministry also heard from Jewish and Christian community leaders, saying that they asked for the “opinions of religious groups in order to remove any worries on the part of the public, adding that they were aware of the risks in the project and that they would take criticisms very seriously.”

Despite the intention of the Turkish model to create a system that would safeguard religious sensitivities, some theologians argue that the milk bank system is incompatible with Islam and the government would have done better to set up a “wet nurse” program instead. One cleric even suggests the milk bank dilutes Islamic values.

Opposition to milk banks by theologians isn’t new. In 1983, the Egyptian theologian Yusuf al-Qaradawi gave a fatwa in response to a medical question presented by the Islamic Organization for Medical Sciences, who asked if it was permissible to establish milk banks to feed premature babies and infants whose mothers have died. He answered  yes, due to the juristic reasoning that milk banks do not facilitate nursing directly from the breast, the absence (or doubt) of a donor record means that kinship is void, and that overall, the banks have a noble aim that should be considered for the good of society.

His fatwa was opposed by other theologians at the time, based largely on the argument that milk banks are irrelevant in Muslim and Arab countries —  since Muslim women clearly breastfeed or have wet-nurses. And in a later fatwa by the International Islamic Fiqh Academy, it was deemed that “the establishment of milk banks should be prohibited in the Muslim world” and that “it is prohibited to feed a Muslim child from these banks.”

It took almost two decades before Qaradawi’s fatwa was fully supported, this time by the European Council for Fatwa and Research in 2004. The council argued that milk banks were now more widespread and that having access to milk through these banks was of great concern for Muslims minorities living in “Western” countries — something the previous ruling overlooked. (Please read Mohammed Ghaly’s riveting article explaining the history and finer details behind this legal discourse.)

What I find interesting in these discussions is reliance on the idealized image of the breastfeeding Muslim woman. Yes, Islam encourages breastfeeding for up to two years (or more), and the blessings and honour bestowed upon the role of the wet nurse extends back to the early life of the Prophet. But this notion that Muslim women are inherently nursing their children or relying upon wet nurses across the board, overlooks breastfeeding rates in Muslim countries over the last 40 years.

A quick snapshot illustrates the current breastfeeding rate is far below the global average with 24% of women exclusively breastfeeding in Saudi Arabia, 10% in Kuwait, 14% in Indonesia, and a shocking 1.3% in Turkey.

Globally there has been a decline in breastfeeding due in part to lifestyle changes, family dynamics, a lack of intrinsic pro-breastfeeding support in hospitals and by governments, and due to the aggressive marketing of formula companies. So while yes, Islam and Muslim culture encourages breastfeeding, it may not be able to actually support it. Which is why I feel it’s an amazing step to have a government in a Muslim country recognize the importance of breastfeeding, and at the very least attempt to support mothers in obtaining breast milk. Because women are already finding solutions to benefit themselves and their children despite popular religious concerns.

Over a decade ago, women with premature babies in the neonatal and intensive care unit of the Adan hospital in Kuwait requested donated milk for the health and well-being of their infants. The hospital complied and worked with the women on individual bases to come up with religiously sensitive, ethical and healthy solutions to their requests. And in other Muslim countries, women are forming “milk sharing” networks, “facilitating mother-to-mother connections for the purpose of providing human milk for human children.” These networks are currently active in Indonesia, Malaysia, Kuwait, Lebanon, Qatar, the United Arab Emirates, Saudi Arabia — and are giving mothers the opportunity to find support as well as healthy alternatives for their infants. Over Facebook!

As for the still emerging story out of Turkey, the pilot project may indeed face resistance due to religious opinion — but it would also be nice to hear more opinions from women, to learn if there are already milk sharing organizations, wet nurses and breastfeeding support groups, if the government is prepared to work with them, and what kinds of pro-breastfeeding supports and information campaigns are already in use in the country.