Dr. Mujibur Rahman explaining how human milk is stored in the milk bank. Image from an YouTube video by Prothom Alo.

For the first time in Bangladesh, a Human Milk Bank — an initiative of the Bangladesh Institute of Child and Mother Health, a hospital in Matuail, Dhaka — has been set up to save breast milk for newborns who cannot get their mothers’ milk.

Lactating mothers who have lost their infants, or have leftover milk after feeding their babies, can donate breast milk at the bank. The idea is for the bank to operate pro bono: there will be no compensation for the donors, and the receivers will get the milk free of charge. However, the launch of the milk bank has been postponed several times, allegedly because of the religious sentiment of conservative Bangladeshis, mainly staunch Islamists.

Why breastmilk is important for newborns

Although breastfeeding is ideal for newborns, the reality is that some babies cannot have their mother's milk. Some may have lost their mothers during childbirth, others may be adopted, and some mothers are unable to breastfeed their infants for a variety of reasons.

Many babies cannot sufficiently develop their immune system without mother's milk, however. Some newborns, who cannot digest cow's milk or formula, end up in critical care and may die without breastmilk. The milk bank will help these newborns get much-needed mother's milk.

Although the official launch of the Human Milk Bank was scheduled for December 1, 2019, it was postponed after objections from some religious organisations and individuals, who consider the initiative to be anti-Islam.

Why oppose the milk bank?

One organisation, Tafsir Parishod, warned about the implications of unknown “milk siblings” — a situation it says could arise because of the Human Milk Bank.

Islam encourages breastfeeding for up to two years, but once infants are breastfed by a foster mother, she becomes a “milk mother” to the child — a relationship that holds special rights under Islamic law. The suckled child is recognised as a full sibling to the foster mother's other children, and intermarriage between them is forbidden. Conservative Islamists therefore fear that the milk bank will make it difficult to identify who the “milk mothers” and resulting “milk siblings” are. If, in the future, “milk siblings” were to marry, that would be considered haram (sinful).

Quoting Islamic scripts, Saiful Islam tweeted:

✒ রক্তের সম্পর্কের ভিত্তিতে যেসব স্বজনেরা (বিয়ের জন্য) হারাম তদ্রুপ দুধপাণের সম্পর্কের ভিত্তিতে তারা হারাম #বুখারী ও #মুসলীম।
✒ তোমাদের জন্য নিষিদ্ধ (বিয়ের জন্য) তোমাদের দুধমাতা ও দুধবোন – সূরা : নিসা -২৩|
অবিলম্বে হিউম্যান মিল্ক ব্যাংক বন্ধের আহ্বান জানাই ? pic.twitter.com/3gZUSfFyNi

— syful alam001? (@DrSyful) December 23, 2019

Marriage between those are forbidden on the basis of relations include the relations of milk-mother -#Bukhari and #Muslim (Hadiths).
Forbidden for you (for marriage) are your milk mother and milk sister – Surah: Nisa-25 (from the Quran)

I urge to close the Human Milk Bank immediately.

Mamunur Rashid also thought it better not to take the risk:

যাদের মাঝে বিবাহ হারাম তাদের মাঝে অন্যতম দুধ ভাই বোন। আর মিল্ক ব্যাংক থেকে দুধ পান করা হলে আপনি জানবেন না যার সাথে বিবাহ হচ্ছে সেও একই মায়ের দুধ পান করেছেন কিনা। হারামের ঝুকি থেকেই যায়, আর হারামের ঝুকি থাকলে সেইদিকে না যাওয়াই উত্তম

— Mamunur Rashid (@SMM_Rashid) December 25, 2019

Marriage between milk-siblings is forbidden. If breastmilk is fed from the bank, the recipient will not know whether the person whom they are marrying in the future have been fed the same breastmilk. There is a risk of Haram and better to avoid this.

Mohammad Mahmudul Hasan, a legal practitioner of the country's Supreme Court, has already sent a legal notice to the respective authorities against the Human Milk Bank, citing the legal and religious complications in donating milk to others.

However, Associate Professor Dr. Mujibur Rahman, who is leading the human milk donation project, defended the bank in an interview with the Bangla Tribune, explaining that there will be a proper record of both donors and recipients:

প্রত্যেকের জন্য আলাদা ডাটা, আলাদা আইডি কার্ড রাখা হবে। যিনি দান করবেন এবং যিনি গ্রহণ করবেন, তাদের দুজনের কাছেই পরিচয়পত্র থাকবে। এখানে প্রত্যেক মায়ের দুধ আলাদা কৌটায় রাখা হবে, যেসব শিশুকে আরেক মায়ের দুধ খাওয়ানো হবে, তাদের দুই পক্ষকেই আইডি কার্ড দেওয়া হবে। রেফারেন্স নম্বর-রেজিস্ট্রেশন নম্বর, খাতা ও ভলিউম, এন্ট্রি পৃষ্ঠার নম্বর, সবই তাদের দেওয়া হবে।

There will be separate ID cards and data for both the donors and recipients of breastmilk. Donated milk will not be mixed and will be kept in separate containers. The ID records of both of them; reference nos, registrations nos, entry and volume, all will be shared.

Once this is the case, the issue of future marriage between “milk siblings” should not arise. Dr. Rahman further stated that the milk bank is being created for infants in critical care, so its main aim is to save their lives, and Islam has placed the utmost importance on saving human lives.

Sourcing breastmilk

Finding breast milk for newborns in Bangladesh is difficult — an overwhelmingly conservative mindset means that most women do not want to breastfeed other people's children.

On Facebook, Tuli Sangeeta shared an incident from her childhood, in which her neighbour prematurely gave birth to twins. The mother was not yet lactating, one child had already died and the other was in critical care — she therefore needed help from others to breastfeed her child:

আমার মা পুরো হাসপাতালে ঘুরে ঘুরে অন্য মায়েদের সহায়তা চেয়ে বেরিয়েছেন, যদি একটুখানি মায়ের দুধ পান ছোট্ট বাচ্চাটার জন্য। কেউই খুব একটা রাজী ছিলেন না অন্যদের সন্তানকে একটুখানি বুকের দুধ দিতে!!

অবশেষে দুজন মাকে খুঁজে পাওয়া গিয়েছিলো যারা এক কোলে নিজের সন্তান আর আরেক কোলে ওই আন্টির সন্তানকে মাতৃস্নেহের ভাগ দিতে রাজী হয়েছিলেন। সারাজীবন এই দুজনের জন্য মনে মনে আনত শ্রদ্ধা পুষে এসেছি।

My mom roamed around the hospital to find other women who just gave birth. She begged breast milk from them to save our neighbour's remaining newborn.

At last, she found two mothers who, after feeding their own newborns, were willing to share their breast milk with the child in critical care. All my life, I thanked these two mothers with the utmost respect.

Number of deaths of infants under five years per 1,000 live births in Bangladesh for the period 1960–2016. Image from Wikimedia Commons by MagHoxpox. CC BY-SA 4.0.

Bangladesh has made great strides in reducing the infant mortality rate. In spite of this, being a populous country, the number of annual infant deaths is still considerably high compared to developed countries.

Each year in Bangladesh, 62,000 newborns die after birth — half of them on the first day of their lives and most of the rest within the first month. Such deaths occur due to premature birth, infections, and breathing-related complications as a result of delivery. Each year, 5,200 mothers also die during childbirth.

According to researchers, if a newborn is fed with breastmilk within one hour of birth, as many as one-third of these deaths could be prevented.

The Human Milk Bank at the Bangladesh Institute of Child and Mother Health will not be available for all newborns, however, only for those in critical care.

Jainab Tabassum Banu Sonali expressed hope in an op-ed in the Daily Sun that similar milk banks would be set up to help working mothers who have been struggling to breastfeed their babies while working full-time jobs.

Human milk banks or breastfeeding support groups already operate in many Muslim countries, including Iran, UAE, Malaysia, and many have suggested that their methods — which should encounter no objection from a religious perspective — can be researched and adopted in Bangladesh.