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Milk Banks

By:
Anke Iman Bouzenita
Source:
The Encyclopedia of Islamic Bioethics What is This? A comprehensive reference work covering the major issues in Islamic bioethics, including medicine, clinical practice, genetics, theology, and Islamic law.

Milk Banks

This article discusses the concept and reality of human milk banks and their reception among Muslim scholars and communities. It offers insight into Islamic discourse on the topic and future perspectives in the field.

Milk banks are institutions which collect human breast milk from eligible donors on a voluntary or paid basis. The primary recipients of milk banks are prematurely born or critically ill infants in neonatal intensive care units who cannot receive breast milk from their own mothers for various (mainly medical) reasons or due to an initial lack of maternal milk supply. Human milk is generally medically preferred to milk formula due to its higher quality of nutrients and better tolerance by the infant. Feeding has thus been linked causally to increasing survival rates of preterm babies.

Different procedures and standards may apply in regard to the health screening of potential donors and their milk, the methods of expressing (extracting), pasteurizing and further processing, and the storage and distribution of milk. Usually, milk from several donors (exact numbers may vary) is pooled and not labeled by name of donor, so that recipients do not consume the milk of one donor only, and donor and recipient remain unknown to one other. Milk banks are costly and labor intensive because of the necessary thorough screening for communicable diseases and harmful substances.

Human milk banks were reportedly first established in the Western Hemisphere, with the first such institution in Vienna in 1909. Following the realization of the health benefits of human milk and its superiority over milk formula, a number of milk banks opened in the 1970s. However, the 1980s witnessed a decrease in the popularity of milk banks and many facility closures due to the risk of HIV infections. With the advent of enhanced screening methods in the 1990s and onward, there has been renewed interest and a resulting surge in the number of milk banks. There are currently hundreds of milk banks worldwide, concentrated mainly in Europe, North America, and Brazil.

Reception in the Islamic World

In Muslim-majority countries anonymous human milk banks in this form have not been introduced to date. However, pilot discussions in Egypt have taken place in the public arena, and Turkey allegedly has a program that has not yet been implemented.

There are several religious and cultural inhibitions among Muslims regarding the use of donor milk from unidentified sources. According to Islamic law, breastfeeding (al-riḍāʿah) of anyone other than the nursing mother’s biological child establishes a foster relationship resembling the blood relationship in vital aspects such as the prohibition of marriage (taḥrῑm) between the breastfed infant, the wet nurse, and a specified number of other persons. This prohibition includes, but is not limited to, the wet nurse’s own children, her mother, grandmother, and siblings; her own husband and her husband’s close relatives such as his children from other women, his siblings, and parents. Marriage is also prohibited between different foster children nursed by the same woman. The consideration of foster relations in a legal system in such a way is culturally unique and needs to be understood as a framework for discussing the possible reception of milk banks in the Islamic world.

Although the topic may have come to public awareness earlier (the first related fatāwā are recorded from as early as 1963, with then-acting Mufti of Egypt Aḥmad Huraydī arguing for permissibility), milk banks forcefully entered the scene of Islamic bioethics in 1983. They were first discussed in a conference of the Kuwait-based Islamic Organization for Medical Sciences (IOMS) on reproduction, and subsequently in the Second Meeting of the International Islamic Fiqh Academy (IIFA) in Saudi Arabia in 1985. The IOMS has taken a careful approach, recommending that the establishment of milk banks in the Islamic world be avoided or, if established, bottles of such milk must be clearly labelled with the origin (name and particulars of the donor), as well as the name of the intended recipient. The IIFA, on the other hand, preventively declared milk banks—and the feeding Muslim children from them—to be impermissible. Furthermore, in 2004 the European Council for Fatwa and Research (ECFR) declared milk banks permissible for the care of infant children of Muslims residing in non-Muslim countries.

Among contemporary scholars of Islamic law, there exists ample difference of opinion as to the permissibility of human milk banking. The divergent views of contemporary scholars refer back to the legal rulings on breastfeeding and foster relations as stipulated by classical scholars, with different emphases, and may be summarized as follows: Advocates of the introduction and use of milk banks generally draw support for their argument from the concept of necessity (ḍarūrah). Giving credit to some (occasionally solitary) views of classical scholars of fiqh, advocates argue that the use of milk banks does not establish taḥrῑm (prohibition of marriage) on the grounds that: there is no direct suckling from the breast; the milk is pooled and the origin of the donor(s) is unknown; the minimum requirement of five independent nourishing feedings cannot therefore be established; and the milk may be pasteurized (equivalent to boiling), or dried and reconstituted (equivalent to dilution). All these Islamic legal criteria render anonymous human milk banking different from direct nursing by a foster mother as discussed by classical scholars of Islamic law. As far as the advocates of milk banks are concerned, the foster bond is not established through using anonymous milk banks.

Opposing views argue that the juristic evidence is weak. They state that the majority of classical fiqh scholars see no difference between the methods by which the milk reaches the infant’s stomach, be it through direct or indirect feeding. This group of scholars sees that the foster bond is established, as the rationale of prohibiting marriage (‘illat al-taḥrīm) lies in the fact that the infant is nurtured through this milk. Regardless of the method of delivery—be it through suckling, bottle- or spoon-feeding, the mouth, nose, or even the ears—the foster milk nourishes the child. Furthermore, these scholars argue that the concept of “unknown origin” does not rule out the establishment of the foster bond, as the situation was brought about intentionally. These voices also mention that some legal schools see the bond established through one feeding only. A case for necessity is negated as long as viable alternatives exist. In addition, opponents see human milk banks as expressive of a Western, un-Islamic context and lifestyle, and therefore unsuitable for the Muslim world.

While some neonatal care units in non-Islamic countries have communicated the permissive 2004 ECFR decision to their Muslim patients with some success (Toronto 2011), others rely on a strategy that may prove a more workable alternative for the Islamic world by establishing contact between the milk donors and the families of the recipients, thereby identifying the future foster bonds and capturing the health benefit for the infant. Successful attempts at this are reported from Adan Hospital in Kuwait in 2000, and the Duchess of Kent Hospital in Sabah, Malaysia in 2009 and 2010.

Perspectives and Alternatives

Bringing donor and recipient together through neonatal care units of established hospitals, while avoiding anonymous milk banks, effectively corresponds to the traditional practice of having wet nurses in the Islamic world. Such a practice could be used for the benefit of premature infants and other babies whose mothers cannot feed them, while accounting for the requirements of Islamic law with regard to the foster system. With the rapid emergence of social networks, peer-to-peer milk sharing is increasingly being practiced in many countries and may begin to demonstrate its potential in the Islamic world as well.

Bibliography

  • ʿAwaḍī, ʿAbd al-Raḥmān al-. “Al-Islām wa-al-Mushkilāt al-Ṭibbiyah al-Muʿāṣirah. Awwalan: al-Injāb fῑ Ḍawʿ al-Islām” [Islam and contemporary medical problems. First: reproduction in the light of Islam]. Proceedings of the Third IOMS Conference, May 1983, 2d. (1991): 30–89.
  • Ghaly, Mohammed. “Milk Banks through the Lens of Muslim Scholars: One Text in Two Contexts.” Bioethics 26, no. 3 (2012): 117–127. A commendable introductory reading on the contemporary Islamic legal discussion of milk banks and the background thereof.
  • Ḥajāḥijah, Jābir Ismāʿῑl al-. “Bunūk al-Ḥalῑb fῑ Ḍawʿ al-Fiqh al-Islāmῑ: Dirāsah Fiqhiyah Muqāranah” [Milk banks in the light of Islamic law: a comparative Islamic legal study]. Al-Majallah al-Urduniyah fῑ al-Dirāsāt al-Islāmiyah 9, no. 4 (2013): 163–178. A comprehensive scholarly discussion of the most important aspects related to breastfeeding and milk banking as viewed by Muslim scholars.
  • Ho-Torng Hsu, et al. “Human Milk Donation is an Alternative to Human Milk Bank.” Breastfeeding Medicine 7, no. 2 (April 2012): 118–22. The paper reports on the trial carried out at the Duchess of Kent Hospital, Sabah, Malaysia, to align human milk donation with Islamic principles.
  • Majallat Majmaʿ al-Fiqh al-Islāmῑ Journal of the compendium of Islamic fiqh[] 2, no. 1 (1986): 385ff. This issue contains the discussions of Dr. Yūsuf al-Qaraḍāwī and Dr. Muḥammad ʿAlī al-Bar on the occasion of the IIFC discussion of milk banks, as well as the resolution that resulted from it.
  • Naqeeb, Niran A. al-, et al. “The Introduction of Breast Milk Donation in a Muslim Country.” Journal of Human Lactation 16, no. 4 (2000): 346–350. The paper describes the Adan Hospital, Kuwait trial.
  • Wazārat al-Awqāf wa-al-Shuʾūn al-Islāmiyah [Ministry of Awqaf and Religious Affairs]. “Al-Raḍāʿ” [Breastfeeding]. In Al-Mawsūʿah al-Fiqhiyah [The fiqh encyclopedia], vol. 22, pp. 238–256. Kuwait, 1992. Sound information on the most important Islamic legal rulings concerning breastfeeding, with relevant background information on the establishment of foster relations through breastfeeding.
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