Introduction:

Breast milk is universally recognised as the best source of nourishment for babies. It provides essential nutrients, growth factors, and hormones, in addition to aiding brain development and boosting the immune system. Although formula milk is available, it is not as beneficial and cannot be digested as easily as breast milk.¹

Whilst research shows that a mother’s own milk is the most valuable for a baby due to its unique composition and special anti-infective properties, at times it is not possible for a mother to establish her milk supply. Human milk banks have been developed to collect donated breast milk, process it safely, and distribute it to babies, especially preterm infants, who have a medical need for human breast milk. Often, donor milk is offered to support mothers while they are establishing their own milk supply, or if they are unable to provide their own milk due to geographical separation or maternal illness. Neonatal babies born prematurely, or those who have undergone surgery or have congenital abnormalities affecting the gut, have a higher chance of survival and improvement when they receive human breastmilk instead of formula milk.²

Clinical guidelines governing human milk banks vary in different countries. Typically, women with babies under six months old can become donors after screening. The milk is frozen within 24 hours, labelled, tested, pasteurised, and retested before being given to babies in neonatal intensive care units via a feeding tube or bottle. In some countries, donor milk is pooled from more than one woman before it is given to a baby, whereas in others, milk is not pooled and is administered to a baby over a period of time. Donor anonymity is generally maintained; however, some countries require that all records are maintained for traceability.³ In this case, it is possible for individuals to determine whether they have received milk from the same donor if necessary. Access to milk banks can also vary from country to country. In the UK, it is prioritised for premature babies or sick and hospitalised newborns, as well as babies in the community, but all under medical guidance.

Despite these benefits, medical practitioners in neonatal units report reluctance among Muslim families to allow their babies to receive donor milk.⁴ This is often due to concerns regarding forming milk kinship (raḍā’a ) with a woman who donates milk and her family or any other children who have also received her milk. In Islamic law, kinship can be established through being a blood relation as well as through breastfeeding by someone who is not a blood relation. If a woman breastfeeds a baby under certain conditions (such as a specified number of sucklings and the age of the baby), that baby is considered her “milk child”, and it creates a relationship similar to blood kinship. Such kinship has significant implications around marriage, for instance, a person cannot marry someone who is their milk sibling (another child breastfed by the same woman) or even their milk mother.

The Quran states explicitly regarding this matter that

Therefore, part of the reluctance exhibited by Muslim families in using donor milk stems from the fear of unknowingly marrying a milk sibling. On the other hand, aside from the reluctance to receive donated breastmilk, Muslim women are also hesitant to donate their own breast milk.⁶ A systematic review conducted by Nor Azman et al. (2024), reported religious reasons, poor understanding of the operational aspects around donation, lack of awareness of Muslim-friendly milk banks, as well as the risk of transmission of diseases as some of the reasons why Muslim women chose not to donate their breastmilk.⁷ This is despite the long-established practice of wet nursing, a common practice in Arab culture even prior to Islam. Inhabitants of cities like Mecca, Yathrib, and Taif would send their infants to be nursed in the desert with the aim of strengthening their physical constitution. Prophet Muḥammad (pbuh) himself was suckled by two wet nurses: Thuwāyba al-Aslamiyya and Ḥalīma bint Abī Dhu’ayb as-Sa’diyya, as a baby, demonstrating the acceptability of the practice at that time.⁸ There is a reluctance, however, to extend wet nursing to modern practices of donating and indeed receiving expressed breastmilk.

Contemporary Shia jurists such as Sayed Sistani and Sayed Khamenei, allow for donating breastmilk, provided traceability is upheld so that both the donor and recipient are identified and issues around ‘milk kinship’ can be resolved at a later stage. Receiving donor milk is also deemed permissible, provided it is done to preserve life and is necessary for the health and survival of the baby, even if it is from an anonymous source.

In addition, they do not believe that ‘milk kinship’ is established through receiving pooled or unpooled donated milk, as it is not directly suckled from the mother, but rather is expressed and fed through a tube or other device and may not be from one source only. Traditionally, for ‘milk kinship’ to be established, certain conditions are stipulated, namely, the child must be under 2 years of age, the milk must be suckled directly from the woman, be pure and not mixed with anything and the baby must suckle so that his/her bones grow firm – generally designated at 15 consecutive sucklings or a period of a full day and night. In addition, breastfeeding ought not to be interrupted with breastmilk from another woman or even food, both of which would nullify the establishment of milk kinship.⁹

Bearing all this in mind, two separate issues arise: Firstly, does Sharia permit the donation and receiving of human breastmilk? Secondly, does ingesting donor milk give rise to ‘milk kinship’ and what are the consequences of this kinship?

The ICCI opinion is divided into two parts to reflect these separate issues. The justifications for each part will follow sequentially.

ICCI Opinion:

PART I: DONATING & RECEIVING BREASTMILK

Muslim women are permitted to donate their breastmilk. Babies and children are permitted to receive donated breastmilk, regardless of whether the milk comes from one or multiple women, whether the donor is married or unmarried, Muslim or non-Muslim, or whether the child has a medical need or not.

Justifications for Part I:

1. Historical records show that wet nursing was a common practice for pre-Islamic Arabs, to the extent that the Prophet Muḥammad (pbuh) himself was also breastfed by two wet nurses. A lack of opposition to this practice, or rather tacit approval (taqrīr) on the part of the Prophet in his adult years and especially after his declaration of prophethood, can serve as the first justification for the practice of wet nursing.

2. The Quran does not negate the culture of breastfeeding by non-biological mothers. Several verses, from the Medinan period, refer to wet nursing and provide regulations for the practice. For example,

By not negating the existing culture of wet nursing, the Sharia inevitably gives tacit approval to forms of wet nursing concurrent with the era of revelation. Such verses also place the onus of the expenditure of wet nursing upon the biological father.

3. Given that the Quran endorses wet nursing, the donation of breast milk to human milk banks can be seen as a modern extension of this practice. The essential principle remains the same: providing nourishment to infants, which is a highly regarded act in Islam.

If one were to argue that human milk banks are a new concept not directly addressed in the Quran or Hadith, the principle of permissibility (aṣālat al- ibāḥa) may be applied. This applies in the absence of any general or specific reason for prohibition and is known as the juristic maxim of the primacy of permissibility. It is derived from the Quran and traditions of the Prophet and the Imams, and in accordance with this maxim, everything is deemed as being permissible unless proven otherwise.

4. The recommendation, or even the obligation, of donating breast milk to a milk bank and/or baby can be derived from the overarching principles and ethos of the Quran. Verses that commend saving lives and practising altruism and generosity support giving in the service of humanity.¹¹ In situations where a baby has a medical need for breast milk, the verses commanding the saving of a human life may be interpreted as obliging parents to allow their child to receive donated milk.¹² The preservation of life and ensuring the well-being of the child take precedence, emphasising the responsibility of providing necessary nourishment.

5. The source of the breastmilk is not important; in other words, whether the milk comes from one or multiple women, whether the donor is married or unmarried and whether they are Muslim or non-Muslim. The Quran explicitly permits wet nursing and endorses the pre-Islamic Arabian practice of wet nursing. It was common for a child to be given to different wet nurses in both pre-Islamic and post-Islamic cultures. The Sharia did not set any obligatory conditions with regard to the religious affiliation of the wet nurse.

ICCI Opinion:

PART II: ESTABLISHING MILK KINSHIP IN MILK BANKS

ICCI Majority opinion: Milk kinship is established if the baby is directly breastfed.

ICCI Minority opinion: Milk kinship is established regardless of whether the baby is directly breastfed or given expressed milk through any other means. Thereafter, other conditions become necessary: the baby must be under 2 years of age and is fed from the milk of one woman to the extent that it causes the flesh to grow and the bones to strengthen.

If kinship is established, it creates a consanguineous relationship, prohibiting marriage between the child and the milk mother, her husband, their children, and any other individuals who received her milk (milk siblings).

The responsibility of determining whether a person is a milk sibling hinges on the likelihood of two children having received milk from the same donor. If the probability of such consanguineous relationships is very low, detailed scrutiny is not required by Sharia.

Justifications for Part II:

1. The Quran clarifies that ‘milk kinship’, or consanguinity, is established between a wet nurse and the baby she suckles, as well as between any children who have been suckled by the same woman or who are her biological children, making marriage between them impermissible. The Quran states:

Similarly, a ‘milk father’ (the husband of the milk mother)¹⁴ is also considered maḥram to the nursed child, establishing a familial bond that prohibits marriage.

2. Justification for majority ICCI Opinion (only direct suckling establishes milk kinship):

Historically, infant feeding occurred through two primary methods: direct breastfeeding by the mother or nursing from another woman's breast. The narrations that form the primary basis for the rulings on milk kinship consistently employ the term riḍāʿa, which refers to suckling or breastfeeding. Linguistically and contextually, riḍāʿa appears to indicate direct suckling at the breast. Therefore, extending its application to include the feeding of expressed milk is not a straightforward extrapolation and lacks clear textual support.

In the context of contemporary practices such as milk banks, adhering to the majority opinion (which limits milk kinship to direct suckling) renders the other conditions traditionally required for the establishment of milk kinship (such as the number of suckling sessions and the child's age) inapplicable. The majority view, therefore, holds that direct physical nursing is essential for the legal and moral implications of riḍāʿa to take effect.

3. Justification for minority ICCI Opinion (that expressed milk also establishes milk kinship):

Religious texts utilise the term ridāʿa for suckling or breastfeeding, and on the face of it, it indicates direct breastfeeding. However, when the narratives are looked at in their totality, they indicate that mere consumption from the breast is not enough to establish the legal effect of milk kinship. The milk must instead be consumed to the extent that there is physical growth in the baby. Accordingly, the determining factor is bodily development through milk consumption. While it remains possible that direct suckling itself has a unique legal significance, common linguistic usage does not necessarily recognise such a distinction when interpreting the texts. It can be argued then, that religious texts appear to use the term ridāʿa to describe the conventional method of transferring milk to a child, rather than establishing a legal requirement for direct suckling from the breast. Therefore, consumption of expressed milk would also establish milk kinship.

If adhering to the minority opinion, then other conditions that are mentioned in narrations must also be considered:

I. The baby must suckle to the extent that there is growth of the flesh and the strengthening of the bones. This can be deduced to be between ten or fifteen times (according to different narrations)¹⁵ and the feeds must be consecutive without suckling from another woman. These criteria are gleaned from the following narration:

Ziyād ibn Suqa said:

II. The baby must be under the age of 2 years. This is indicated by the following narration:

Manṣūr ibn Hazim narrates from Abu ʿAbd Allah (peace be upon him), who said:

III. The milk must originate from a legitimate sexual relationship. The principle ‘every community has its marriage’ (li-kulli qawmin nikāḥ) can be used to recognize the legitimacy of relationships based on social legal agreements and marital contracts, as accepted within different communities.

4. The obligation to trace milk relations depends on the certainty that another person has taken milk from the same woman during that period in an amount that leads to the occurrence of kinship. This is in addition to us having knowledge that this other person is on a list of possible persons close to the first suckled child, and is limited in number.

The result of this is that if we do not know of the existence of another person who has suckled from the milk of the same woman, or we know, but the suckling does not meet the conditions for establishing kinship, but the person who has suckled is one in a hundred thousand people who we cannot usually identify, then in such cases the milk should not be traced nor should caution be exercised.

5. Best practice indicates that, when couples intend to marry, they should verify that they do not share consanguinity if they have received donor milk. This practice is particularly feasible in countries with milk bank traceability requirements, such as England, or those developing 'halal milk banks', like Malaysia. Traceability ensures each milk donation can be linked to its donor, allowing individuals to determine if they share a milk donor. This verification can prevent accidental marriages between milk siblings.

References:

1. World Health Organisation, ‘Breastfeeding’ https://www.who.int/health-topics/breastfeeding
2. UKAMB, ‘Receiving Donor Milk’ https://ukamb.org/receiving-donor-milk/
3. PATH, ‘Strengthening Human Milk Banking: A Global Implementation Framework https://media.path.org/documents/MCHN_strengthen_hmb_frame_Jan2016.pdf
4. Subudhi S, Sriraman N. Islamic Beliefs About Milk Kinship and Donor Human Milk in the United States. Pediatrics. 2021 Feb;147(2):e20200441. doi: 10.1542/peds.2020-0441. PMID: 33483451.
5. Quran, Nisa:23
6. Ghaly M. ‘Milk banks through the lens of Muslim scholars: one text in two contexts.’ Bioethics. 2012;26(3):117–127.
7. Nor Azman, N. A., Muda, S. M., Jamani, N. A., Mustapha Kamal Basha, M. A., & Hakimi, S. (2024). A Systematic Review of Muslim Women’s Knowledge, Perception and View Toward Breast Milk Donation and Milk Bank. INTERNATIONAL JOURNAL OF CARE SCHOLARS, 7(2), 69–85. https://doi.org/10.31436/ijcs.v7i2.354.
8. Harun, H. M. F., Rejab, S. N. M., & Samori, Z. (2017). Breastfeeding Practices: A Cross-Believed Perspective. Advances in Social Sciences Research Journal, 4(3) 228-245.
9. al-Khūʾī, Minhāj al-Ṣāliḥīn, vol. 2, p. 267; al-Sīstānī, Minhāj al-Ṣāliḥīn, vol. 3, p. 46; wa Muḥammad Saʿīd al-Ḥakīm, Minhāj al-Ṣāliḥīn, vol. 3, p. 128.
10. Quran 2:233, 4:23, 65:6
11. Quran 5:32, 2:261
12. Quran 17:33, 5:32
13. Quran 4:23
14. The husband referred to here is the man because of whom the milk mother became pregnant, referred to as ‘the owner of milk’ (Ṣāḥib al-laban).
15. ʿAlī ibn Riʾāb narrated from Abū ʿAbdullāh (peace be upon him): "I asked, 'What makes breastfeeding prohibited?' He replied, 'What causes the flesh to grow and the bones to strengthen.' I asked, 'Does ten feedings make it prohibited?' He said, 'No, because ten feedings do not cause the flesh to grow or the bones to strengthen.'" Tafṣīl Wasāʾil al-Shīʿa, vol. 20, p. 374
16. Tafṣīl Wasāʾil al-Shīʿa, vol. 20, p. 374
17. Ḥurr al-ʿĀmilī, Tafsīl Wasā’il al-Shīʿa, vol. 20, p. 384, Book of What Becomes Prohibited Through Breastfeeding, Chapter 5, ḥadīth 1