Minnesota doctors seek religious nod for donor breastmilk to feed Muslim newborns

Minnesota doctors are seeking what they believe will be the first Islamic ruling, or fatwa, in the U.S. that would OK donor breast milk for fragile newborns.

Uncertainty over Islamic beliefs has led some parents to refuse donor breast milk, even when doctors recommend it for newborns clinging to life in neonatal intensive care. Leaders of Children's Minnesota and M Health Fairview are scheduled to meet Thursday with scholars and imams from five mosques to formally clarify the issue.

The need to supplement breast milk is common when infants are born prematurely, often before mothers can produce enough of their own, said Dr. Leah Jordan, a Children's Minnesota Hospital neonatologist. The use of breast milk instead of formula can prevent a dangerous infection called necrotizing enterocolitis, she added, but the risks often don't persuade Muslim parents.

"It is a very resolute: 'We cannot even consider this,'" she said.

Parent concerns are influenced by Islamic teachings that a woman providing breast milk develops kinship with the baby who receives it. According to those teachings, the children of the anonymous donor could then be considered related to the baby creating, among other things, the possibility of accidental incestuous marriages later in life.

Donor breast milk is permitted in emergencies, and some Islamic nations such as Iran have more broadly sanctioned its use. But local religious interpretations can have a strong influence, resulting in a diversity of views in Minnesota — which has a growing Somali population, but also Afghani refugees and immigrants from other predominantly Muslim nations.

"All the more reason for us to have a region-specific resource" for Minnesota, Jordan said.

The religious question stems from a good problem: A donor supply has grown since the 2020 opening of the Minnesota Milk Bank for Babies. Hospitals previously bought breast milk from out-of-state banks, even if it had been donated by Minnesota women.

More than 1,100 mothers have donated 738,000 fluid ounces of pasteurized milk to the Golden Valley bank — enough to provide more than 2 million meals for premature infants. The donations are fueling more donations, because mothers who benefit from the resource want to give back, said Linda Dech, the bank's executive director.

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

Donor programs in countries such as Kuwait tried to address Islamic concerns by eliminating anonymity so that recipients can know the identities of donors with whom they have kinship. That would present complications in the U.S., where the recommended practice is to blend three to five donations because that increases the diversity of protective antibodies and nutrients that infants receive.

Many Muslim scholars already sanction donor milk, because it doesn't involve breastfeeding and because the blended milk from multiple, anonymous donors eliminates kinship concerns, said Munira Maalimisaq, a HealthPartners nurse practitioner who is Muslim and helped arrange Thursday's meeting. The sale of donor milk for personal profit is prohibited.

Maalimisaq also is chief executive of Brighter Health MN, a nonprofit health literacy organization that surveyed pregnant Muslim women. The majority indicated that a fatwa would resolve their objections, she said.

"It takes the burden off of the families and it puts it almost on the mosques and on the scholars to say, 'I am putting my knowledge on the line,'" Maalimisaq said.

A fatwa in this circumstance would be non-binding but influential, Maalimisaq said. The ruling or clarification must be issued by a mufti, a scholar with advanced knowledge of Islamic texts and beliefs.

Donor breast milk has an additional benefit beyond preventing infection, because women who use it tend to continue breastfeeding when they are able, said Dr. Nancy Fahim, an Egyptian-born neonatologist at M Health Fairview's Masonic Children's Hospital. While formula is a viable option for infants, breastfeeding is preferred, she added.

Insurance coverage for donor breast milk is spotty, which is a problem considering that the milk costs about $4.50 per ounce, Fahim said. Advocates are lobbying Minnesota to become the 15th state to cover donor milk through its Medicaid health plans for low-income residents.