Human milk banks, Islamic law and recent controversy in Pakistan

Ata-ul-Haye Nasir, Al Hakam

With the passage of time, the idea of human milk banks is spreading all around the world. These banks collect, screen, process, pasteurise, and dispense prescription human milk donated by nursing mothers who are not biologically related to the recipient infant.

However, since milk bank donors are typically anonymous and the donations are often combined, the practice is rejected in most of the Muslim world. Iran is currently believed to be the only country in the Muslim world with a network of such milk banks. (“Pakistan’s Sindh province suspends human milk bank, refers initiative to Islamic Ideology Council”, www.arabnews.com)

Global history of human milk banks

The first-ever human milk bank was established in Vienna, Austria, in 1909. The most critical demand for human donor breast milk is for the most vulnerable neonates who are either preterm or require gastrointestinal surgery as newborns. Donor breast milk is increasingly becoming available throughout the world including in the United States, Europe, South America and Australia. (“Human milk banking”, www.ncbi.nlm.nih.gov)

The World Health Organization (WHO) recommends donor human milk for low- and very-low-birthweight infants, as well as small and sick newborns who cannot be fed their mother’s own milk. In 2020, it was estimated that there were 756 milk banks in 66 countries, with an increasing number of milk banks being established in low- and middle-income countries.

However, there is no global coordinating body issuing minimum quality, safety and ethical standards to inform national policies on donor human milk. It is believed that despite the growth in human milk banking, the majority of human milk banks are not routinely being regulated at the national level and that global regulation is lacking altogether. (“Developing global guidance on human milk banking”, www.ncbi.nlm.nih.gov)

First-ever milk bank in Pakistan

Just recently, Pakistan’s first Human Milk Bank was established by The Sindh Institute of Child Health and Neonatology (SICHN), however, it has now been suspended pending further guidance from the Council of Islamic Ideology, according to a statement from the SICHN, dated 21 June 2024. (“Pakistan’s Sindh province suspends human milk bank, refers initiative to Islamic Ideology Council”, www.arabnews.com)

Mentioning the purpose behind such an initiative, the statement by SICHN stated, “Our commitment to improving child health and neonatal care has been a driving force behind our initiatives, including the establishment of the Human Milk Bank.” Highlighting the need for the milk bank, the statement noted that babies born prematurely, particularly those below 34 weeks of gestation or less than 2 kg in weight, often do not have sufficient breast milk to support their nutrition.” (“Pakistan’s first Human Milk Bank ‘suspended’ over religious concerns”, www.thenews.com.pk)

According to a recent study, Pakistan has one of the largest birth cohorts globally, with over five million children born each year. Currently, infant and under-five child mortality rates are 62 and 74 deaths per 1000 live births, respectively. Malnutrition is considered one of the most important underlying causes of child mortality, with almost 50% of all under-five deaths attributable to undernutrition. The situation is even worse in Sindh province, where 41.3% of children are underweight, 45.5% stunted, and 23.3% wasted, with rural areas worse than urban areas. (“Barriers and facilitators to exclusive breastfeeding in rural Pakistan: a qualitative exploratory study”, www.ncbi.nlm.nih.gov)

Islamic point of view

In Islam, emphasis has been given to breastfeeding, with passages from the Holy Quran and Hadith shedding light on various aspects. It is considered a child’s right to be breastfed. In the Holy Quran, we read that Allah the Almighty explicitly mentions the period of breastfeeding:

وَالۡوَالِدٰتُ یُرۡضِعۡنَ اَوۡلَادَہُنَّ حَوۡلَیۡنِ کَامِلَیۡنِ لِمَنۡ اَرَادَ اَنۡ یُّتِمَّ الرَّضَاعَۃَ

“And mothers shall give suck to their children for two whole years; [this is] for those who desire to complete the suckling.” (Surah al-Baqarah, Ch. 2: V. 234)

This clearly highlights the significance of breastfeeding.

Further, we must note that breastfeeding establishes a specific type of kinship called rada‘ah. Those children who are breastfed by the same woman are considered siblings and are forbidden to marry each other, even if they are not biologically related.

Hazrat Ibn Abbas^ra narrates that it was proposed that the Holy Prophet^sa be married to the daughter of Hazrat Hamza^ra, whereupon he said:

إِنَّهَا لَا تَحِلُّ لِی إِنَّهَا ابْنَةُ أَخِی مِنَ الرَّضَاعَةِ وَيَحْرُمُ مِنَ الرَّضَاعَةِ مَا يَحْرُمُ مِنَ الرَّحِمِ

“She is not lawful for me for she is the daughter of my foster-brother, and what is unlawful by reason of genealogy is unlawful by reason of fosterage.” (Sahih Muslim, Kitab ar-radaa‘, Hadith 1447a)

Recent guidance from Hazrat Khalifatul Masih V^aa

In 2021, a question was asked to Hazrat Mirza Masroor Ahmad, Khalifatul Masih V^aa, about milk banks where human milk, donated by mothers, is provided for orphans. It was written that such an arrangement would lead to the children, who use the facility, becoming foster siblings, without knowing exactly who among them was whose foster sibling. The individual asked whether, in view of this predicament, it was permissible to establish milk banks according to Islam.

On this, Huzoor^aa gave the following guidance in his letter dated 12 October 2021:

“According to Islamic teachings, children who are suckled by the same mother, establish a mutual foster relationship, due to which such boys and girls cannot marry each other when they grow up. Therefore, an organisation or a government that provides the facility of breastmilk somewhere in response to a need, will have to exercise great care; they will have to keep a record of which child received the breastmilk by which woman, which would seem impossible.

“Therefore, in my view, the establishment of such milk banks is not appropriate as per the Islamic sharia because it can potentially create many types of ambiguities and other issues. Anyway, what is the need for these types of milk banks in this era when scores of different types of formula milk are available on the market? If any institution or government is concerned about the upbringing of orphaned children, they can provide the facility of formula milk for such children.

“Anyway, I am having more research conducted on this issue, but for now, I am of the view that establishing milk banks in this way, as stated in your letter, is not appropriate according to Islamic teachings.”

Later, Huzoor^aa had research conducted on this issue by Dar-ul-Ifta Rabwah. Then, in his subsequent letter, dated 17 August 2022, Huzoor^aa gave further guidance to the questioner as follows:

“I have had further research conducted on this issue by Dar-ul-Ifta Rabwah.

“According to the findings of their research, establishing human milk banks and providing milk to children through them is not appropriate as per Islamic teachings. This is so because Islam has established the sanctity of relationships that have been forged on the basis of nursing to such an extent that it has prohibited the intermarriage of these relationships in the same way that it has prohibited the intermarriage of mahram relationships due to descent.

“On the other hand, one cannot know at all about the milk received from these types of milk banks, as to how many women’s and which women’s milk is in a packet of milk. And even if the details of these women were recorded on these packets, the children who drank such milk would become foster siblings of innumerable other children, and it would be seemingly impossible to keep track of them and take precautions with regard to marriages.

“Therefore, if a child needs breast milk, then for this, the method of the foster mother stipulated by Islam should be adopted. However, if this facility is not available somewhere, then instead of making relationships doubtful by taking the trouble to use milk from milk banks, milk from ordinary cows, buffaloes or formula milk should be used, so that the sanctity of relationships established by Islam can be fully respected.” (“Answers to Everyday Issues – Part 45: Adoption, milk banks, witr prayer, kitchen utensils of non-Muslims, marriage, working in the banking sector”, alhakam.org, 9 December 2022)