Resolution on the Use of Donor Human Milk for Muslim Infants

Background: The introduction of anonymised donor human milk (DHM) to countries with Muslim populations has been challenged by the Islamic concept of milk kinship. Here the sharing of milk, historically in the form of a wet nurse, creates kinship ties and thus marriage prohibitions between the family of the donor and the recipient. Surveys in the United Kingdom have shown that these beliefs may affect the acceptability of DHM to Muslim parents, and impact on the clinical use of DHM in Neonatal Units in areas with predominantly Muslim populations. Given the many benefits of DHM, especially in the prevention of necrotising enterocolitis in preterm infants, we believed it was necessary to find a resolution to this situation. In order to facilitate this, representatives from the Muslim Council of Britain (MCB), the United Kingdom Association for Milk Banking (UKAMB) , and the British Association of Perinatal Medicine (BAPM) met at a Round Table Discussion on the 26th April 2015 in London.

Aims: To work together in an atmosphere of mutual respect and understanding to give vulnerable infants the best possible start in life, regardless of their religion or ethnicity.

Summary of Round Table Discussion: The National Institute for Health and Care Excellence (NICE) issued guidelines for the use of DHM throughout the United Kingdom in 2010. These state that every aliquot of DHM given must be traceable from donor to recipient. Participants at the Round Table Discussion agreed that this means that, in the future, should there be doubt about whether a potential bride or groom had received DHM from a particular donor, it will be possible to address this.

The process would involve reviewing the recipient’s medical records, in conjunction with records from the relevant Human Milk Bank, to rule out whether they had received milk from the same lactating mother. In the future, electronic barcode tracking is likely to be introduced. This will make the process more straightforward, and also extend the current 30 year limit for the retention of medical records as mandated by NICE.

Resolution: Concerns about milk kinship should not lead to donor human milk being with-held from vulnerable infants, as there are safeguards in place that guarantee the traceability of milk from donor to recipient.

Actions agreed upon:

1. To reinforce, via the inclusion of a statement in the soon to be published BAPM Framework for the use of DHM in the United Kingdom, the need for a robust system to ensure the traceability of donated milk. This would ideally be via an electronic bar code system.

2. To recommend at the next review of the NICE guidelines on the DHM that records for the use of DHM be kept for longer than the current standard of 30 years.

3. To produce a parent information leaflet explaining the rationale for the use of DHM, and steps that can be taken by families who are concerned about the implications of establishment of possible milk kinship.

4. To disseminate throughout the United Kingdom, via local religious communities and clinicians in neonatal units in areas with significant Muslim populations.

 

Signatories:

Dr. Shuja Shafi , Secretary General of the Muslim Council of Britain

Mufti Zubair Butt, Islamic Medical Ethics Advisor to the Muslim Council of Britain

Dr. Syed Mohiuddin, Royal London Hospital

Dr. Morgan Clarke, University of Oxford

Gillian Weaver, UK Association for Milk Banking

Dr. Amanda Ogilvy-Stuart, British Association of Perinatal Medicine

Dr. Thomas Williams, British Association of Perinatal Medicine