Twin Cities Muslim leaders OK donor breast milk for critically ill infants

A decree by Twin Cities Muslim leaders this week in favor of the use of donor breast milk for medically fragile infants has rippled across the globe.

Brighter Health MN received hundreds of emails and calls from people worldwide after Thursday's fatwa, which is a formal explanation of Islamic beliefs. The Bloomington-based health agency was part of a coalition that requested the religious decree to address parent objections that use of the breast milk would create kinship under Islamic law between donor and child.

"We just got another email from somewhere in Australia: 'Hey, I just had twins and I saw this article. Is this real? Can we use this in this country?' " said Munira Maalimisaq, chief executive of Brighter Health and a nurse practitioner.

When mothers can't produce enough breast milk, pediatricians recommend donor milk to prevent a dangerous infection called necrotizing enterocolitis in infants born prematurely or at low weights. Muslim parents understood the risks but often refused, fearing that kinship with an unknown donor would put their children at risk for unwittingly entering into incestuous marriages later in life.

Leaders of seven Twin Cities mosques met after receiving the request in October. Imam Mohamed Mahad of the Nurul-Iman Mosque in Minneapolis said they recognized that their decision could have "lasting impact" in a Muslim community with a large Somali population but also Afghani refugees and others with different perspectives on the issue.

"The benefits of pasteurized donor human breast milk are so significant that all babies, particularly pre-term, low birthweight and ill babies, should be given this milk when their own mother's [milk] is not available," Mahad said Thursday.

The fatwa is believed to be the first of its kind in the United States on an issue with which other nations are grappling. Thursday's announcement was attended by Mohamed Sheikh Issak, Somalia's ambassador to Sudan.

Iran was among the first Islamic nations to broadly approve the use of donor breast milk.

Donor milk supplies have increased locally with the 2020 opening of the Minnesota Milk Bank for Babies, which has collected and processed 738,000 fluid ounces of milk from more than 1,100 mothers. That equates to 2 million feedings for premature infants.

A typical scenario is for an infant born very prematurely to receive donor breast milk until reaching 35 weeks gestation, after which the infection risk goes down. Births are considered full term at 39 to 40 weeks.

The pasteurized milk is combined from multiple donors, a key distinction that influenced the fatwa and eliminated the kinship concern, Maalimisaq said.

Emails came from a mother of twins in Winona who agreed to the donor milk after learning of the announcement. Other people are interested in how the fatwa was achieved and whether it can be applied to other areas of health care that may conflict with religious beliefs, she said.

"I did not expect this," Maalimisaq said. "I thought we were going to have a lot of people saying, 'Why are you doing this?' "

She checked with an imam before replying to the Australian woman with the news that the local action could apply to her.

The fatwa should help close a racial inequity when it comes to Minnesota's growing supply of donor milk and the children who receive it, said Dr. Nancy Fahim, a neonatologist at M Health Fairview.

One of her patients earlier this year couldn't produce enough milk at first for her child but hesitated to accept donor milk because of her beliefs. The woman felt more comfortable when Fahim told her about a fatwa issued in Europe in 2004.

"It became clear we needed something here at home," Fahim said.