Breast Feeding and Islamic Teaching

Mohammad Ali Al-Bar, MB, ChB, MRCP
Dr AI-Bar is a Consultant of Islamic Medicine
at the King Fahd Medical Research Centre,
King Abdul Aziz University, Jeddah, Saudi Arabia

(Note from Islamic Garden Editors: The following are verses from theQur'an, the Holy Book of Muslims.)

"The mothers (including those divorced) shall nurse their children for two whole years if they wish to complete the period of nursing. The father shall bear the cost of their feeding and clothing on equitable terms. No soul has a burden laid on it greater than it can bear. No mother shall suffer because of her child. Similarly the father should not suffer. The same duties rest upon the heir (that is, if the father dies). If they (that is, the parents) both decide on weaning (the child) by mutual consent and after due consultation they are not to blame. Also they are not to blame if they decide on a foster mother, provided they insure, in a fair manner the safety of the child."

"Remain conscious of God, and know that God sees all that you do." (Qur'an 2:233)

"His mother bore him by strain after strain. His nursing (suckling) period lasts two years. Be grateful to Me and to your parents." (Qur'an 31:14)

"In pain did his mother bear him, and in pain did she give him birth, and her bearing and his suckling period took thirty months." (Qur'an 46:15)

"Let the women divorced (in the waiting period) live in the same house you live in and in the same manner, in accordance with your means. Do not harass them, and if they are pregnant spend freely on them until they deliver their burden. If they nurse your offspring, give them their due recompense. Counsel each other in a fair manner about the child's future. If you get in discord, let another woman nurse him; and the father should pay for the nurse."

"The wealthy should spend in accordance to his wealth, and the poor should spend in accordance to his income. God does not burden any soul more than it can bear."

"God will grant after hardship ease." (Qur'an 5,6:7)

From these verses we can understand the following points regarding the "nursing of the child."

• Mothers are encouraged to nurse their babies for a period varying from 16 to 24 months.

• Even if the mother is divorced, she should be supported in her nursing of her child for that period. The father should pay her cost of living as she will be fully occupied by nursing his offspring.

• If the parents are separated or divorced they should frequently counsel each other for the sake of the child's future.

• If it is decided that the mother cannot nurse the baby (for example, if she lacks milk in her breasts), then a wet nurse must be asked to help. The wet nurse in Islam is a foster mother; she is also considered as the child's mother. Her children become the baby's brothers and sisters, and her husband becomes another father for the baby. No marriage, however, is allowed between the baby and its foster mother's children, brothers, sisters and husband. The true father should pay the foster mother recompense.

• If the mother dies, the baby's heir should support both the nursing mother and her baby for the period of breast-feeding. The custody of the baby remains in the hands of the nursing mother.

During the reign of Khalifa Omer Ibn AI-Khatab, every Muslim in the community, except for new born babies up to and including the weaning stage, received social security benefits from Baitulmal, the Government treasury. When Omar noticed that mothers tended to wean their babies too early to get the benefit of social security he cried, "How many young Muslim souls you have deprived from their food O, Omar!" So he ordered that every new-born should get the subsidy from birth.

From Surah 2:233 and from Surah Al Hakaf 46:15 (Chapters from the Qur'an -ed.), Ali lbn Abi Talib deduced that the shortest period of pregnancy for a child to survive was six months.

It was not recognised until recently that a six-month-old baby can survive (outside the womb-ed.). Until the sixties it was taught in medical schools that viability is not possible before 28 weeks: that is, seven months.

The Islamic communities paid great attention to breast-feeding and wet nurses were very common until recently. Even if the mother nurses her baby it is not uncommon for a neighbor, relative or friend to breastfed the newcomer. Extended families also have the advantage of relieving the burden from young mothers.

If we remember that many girls marry at 15 or less, and boys under 18 too, then we are aware of their need for help and guidance from older generations.

I personally saw a lady in my clinic in Jeddah who became a grandmother at the age of 27. Al Imam AI Shafi saw a girl of 21 who had become a grandmother.

However, the tide of western civilisation is quickly changing the pattern of social and cultural attitudes in all Muslim countries. This is more pronounced in the urban areas. Breast-feeding is rapidly declining not only in urban areas but also in rural areas. There are many reasons such as the influence of the western and industrial culture, the dramatic changes in the structure of Islamic and Third World societies, and promotion of bottle feeding by multi-nationals. The baby food companies are the vital cause of the decline of breastfeeding in developing countries. The companies saw the potential of increasing their sales and profits to the large and rising infant population of the developing world. The sales of these companies to the Third World alone have already exceeded $8,000m annually.

The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) consider these companies as the number one killer of babies in the Third World and have strongly advised Third World governments to ban the advertising of manufactured baby foods.

Bottle-fed infants in the Third World often receive dilute and contaminated feeds containing little nutrients and massive doses of micro-organisms. It is estimated that 9.4 million cases of severe malnutrition occur in the Third World annually, of which at least half are due to bottle feeding.Similarly, there are annually about 10 million infant deaths due to GE in the Third World. At least half of them are due to bottle feeding.

Thus, we find 10 million babies die annually due to the widespread use of bottle feeding in the Third World. They can be saved by the simple measure of breast feeding.

All the bodies concerned with infant health, including WHO and UNICEF, stress the importance of breast-feeding, especially in the Third World. Breast feeding in these poor countries will not only save 2,000 million dollars annually that is badly needed for health and education, but also has many other advantages:

• Human milk contains the nutrition which a child needs, including the proportion and suitability for its body and digestion and absorption. The various nutritional elements are not static. They change daily, according to the infant's needs. A premature baby has a special formula prepared in his mother's breast to make it a suitable diet. Gracious and bountiful God provides the mammary glands with the know-how to adjust its secretions according to the variable and changing needs of the growing infant.

• Human milk is naturally stored at the right temperature making it completely aseptic and automatically adjusted to infant needs. It is always available on demand.

• It involves less work, as there are no teats or bottles to be cleansed or feeds to be prepared.

• It has definite psychological benefits, both to the nursing mother and suckling baby.

• Breast-feeding helps the mother to return to her pre-pregnant size and weight. It helps the uterus to involute under the effect of oxytocin secreted by the pituitary gland and released by reflexes through suckling.

• Breast-feeding protects the baby from many diseases and problems such as diarrhea and chest infections. Recent studies have proved that infants who are breast-fed are less liable to suffer from respiratory and gastrointestinal diseases. Those who do catch the diseases are less morbid and have a much lower mortality rate than those who are bottle fed.

• Human milk contains IgA specific antibodies in the mammary glands manufactured by lymphocytes that have migrated from the gut of the mother.

• The clostrum, which is the pre-milk secretion from the breast at parturition, contains a huge amount of antibodies. The IgA forms 97 percent of the cholesterol protein on the first day which falls to 25 per cent on the fourth day of lactation.

• Furthermore, breast milk supplies the infant with viable immunological cells and non-specific humoral factors. These provide both cellular and humoral immunity against a variety of organisms, especially E Coli, Staph areus, Coxackie B5 virus, Herpes Simples virus, polio virus and Pneumococcus.

• The lacteal antibodies against entero bacteria are largely of IgA class. They are synthesised in the mammary gland by the B-Lymphocyte migrating from the mother's gut.

• Further studies have shown that antitoxins against Vibreo cholera and E Coli are secreted in the colostrum and are not absorbed by the intestine of the baby, remaining as protective barriers in the infant's gut.

• Similarly, cholesterol cells secreting anti E Coli antibodies have been detected in mothers who ingested the antigen. Antibodies to other bacteria or antigens have been detected. Recently, tuberculin sensitive mothers were found to pass a long lasting immunity to their infants by breast feeding.

• Breast feeding is crucial in providing humoral and cellular immunity, especially in the infant's first weeks, as the infant is less susceptible to gastro-intestinal and respiratory infections.

• Cow's milk and other types of non-human milk are more liable to cause sensitivity and allergy in the bottle-fed infant. The infant is more liable to get eczema, bronchial asthma and gastro-intestinal upsets caused by sensitivity to the proteins of the non-human milk.

• The colostum not only contains high amounts of cellular and humoral-immune bodies, but also has a laxative effect which helps discharge the muconium of the new born baby.

• It is no wonder, therefore, to find breast-fed infants thriving better and less liable to infections and immunological diseases.

• It has the advantage of being a contraceptive measure in itself. It has been found that if the lactating mother is somewhat debilitated the contraceptive effect of breast feeding is enhanced.

• It is also suggested that breast-feeding may decrease the incidence of breast cancer.

• The Holy Qur'an has stressed the importance of prolonged breast feeding. The advantages of prolonged breast-feeding are starting to be known. Recent studies have shown that breast fed infants may not need complementary or supplementary feeding during the first nine to 12 months.

• The psychological benefits for both the nursing mother and the baby are well established.

• Human milk contains PGE2 which acts as a zinc ligand while cow's milk contains none. Zinc deficiency is, therefore, more liable to occur in bottle-fed infants or after premature weaning of breast-fed infants. Zinc deficiency causes acute or chronic dermatological manifestations. The acute ones are characterised by vesiculo pustular eruptions with marked erythema that turns into haemorrhagic erosive lesions with crusts, mainly around the body orifices (mouth and perianal region), and extremities.

• Verrucous patches on the extremities are chronic manifestations, with eczema, alopecia, nail dystrophy, paronychia and angular stomatisis being common.

• A rare hereditary autosomal recessive disorder "Acrodermatitis Enteropathica" is associated with zinc deficiency. Manifestations of the disease only occur if the baby is bottle-fed or weaned prematurely. Acrodermatitis Enteropathica is a persistent dermatitis manifested by a vesicular rash around the mouth and extremities. The vesicles soon crust and thicken and become secondarily infected with bacteria or candida. It is also associated with diaorrhea, T. cell mediated immunity deficiency, absent thymus, lack of germinal centres and plasmocytosis of lymph glands and spleen. Plasma zinc is also low. The management of this type of case depends on both prolonged breast feeding and zinc supplements.

Islamic teaching encourages mothers to nurse their children. The renowned Ibn Hazim said, "A mother should nurse her baby even if she was the daughter of the king. She is not exempted from that duty, unless she is incapable of nursing."

The nursing mother should be financially supported by the husband, even if she is divorced. If the father dies, his heirs should support her fully during lactation. If there is no heir, the government takes responsibility.

If Islamic teachings are adhered to many evils that befall children and their mothers could be avoided.

Islamic World Medical Journal
July/August 1986/D.Qudah 1406
Pages 55, 56 and 57