Breast Milk Science and Religion

1. بسم الله الرحمن الرحيم Breast Milk Science and Religion Dr. Mohammed Albar FRCP Medical Ethics Center International Medical Center , Jeddah

2. Mothers shall suckle their children for two whole years; that is for those who wish to complete the suckling. Sura2:233 • وَالْوَالِدَاتُ يُرْضِعْنَ أَوْلَادَهُنَّ حَوْلَيْنِ كَامِلَيْنِ ۖ لِمَنْ أَرَادَ أَنْ يُتِمَّ الرَّضَاعَةَ ۚ سورة البقرة : 233

3. Breastfeeding Benefits • Breastfeeding is the best way of infant feeding. WHO recommended exclusive breastfeeding for 6 months, to be continued for two years.

4. Breastfeeding Benefits • Prolonged breast feeding has many advantages, including protection against breast cancer and leukemia of children.

5. Phenyl ketonuria

7. Cystic Fibrosis Autosomal recessive Reduced by Breast feeding

8. Pediatric Acrodermatitis Enteropathica (zinc deficiency) Autosomal recessiveAcrodermatitisn.s diseasebreast feedingReduces the disease

9. اللبا colostrum Secretary Immunoglobulin IgA against bacterial and viral Invasion + Interferon prevents viral diseases

10. Diabetes+ Obesity +Atherosclerosis? Reduced in breast feeding

11. Vit D+ Lactoverine Breast milk prevents Rickets & Anemia

12. Breast Milk Rich in Mono and Poly unsaturated fatty acids Important in N.S. development

13. Psychology Breast feeding prevent many psychologycal problems in the mother and her child

14. Oxytocine .Breast feeding pancreases production of oxytocine from pituitary gland restores uterus its size prevents hemorrhage and puerperal fever

15. Bottle feeding cause diarrhea and death of millions of babes Breast Milk Sterile+ No Preperation Lactobacillus bifidus) ). Breast Feeding saves million of dollars for poor countries

16. Breast milk Has No Equal • Stem cells • More than 150 oligosaccharides not found in other mammals milk. • Protective effect against diseases of the gut + It has an antimicrobial effect.

17. Breast milk Has No Equal • oligosaccharides support neuronal functions and help the developing brain • human milk oligosaccharides were discovered recently.

18. Factors influencing Breastfeeding in Saudi Arabia, 1988: Al Sukait M ( National working women are less likely to breastfeed.

19. Breast feeding Eastern Mediterranean (WHO) • The search revealed 17 studies from 1987 to 2012 . The duration of breast feeding showed a decline over time. Older, less educated and multiparous mothers living in rural areas and of low socioeconomic class were more breastfeeding and prolonged duration compared with other groups.

20. BREASTFEEDING IN SAUDI ARABIA Most mothers breastfeed after birth, but soon introduce bottle feeding. supposedly because of breast milk insufficiency.(Mixed feeding) There is a need for media campaign for promoting breastfeeding Nutrition and Health, 2003, Vol. 17, pp. 123-130 M AL-JASSIR et al

22. USA Trends in Breastfeeding

24. ‘The Nursing of the Child’: • قال تعالى :{وَالْوَالِدَاتُ يُرْضِعْنَ أَوْلَادَهُنَّ حَوْلَيْنِ كَامِلَيْنِ ۖ لِمَنْ أَرَادَ أَنْ يُتِمَّ الرَّضَاعَةَ ۚ} البقرة :233 . Mothers shall suckle their children for two whole years; that is for those who wish to complete the suckling. Sura2:233

25. ‘The Nursing of the Child’: • 1. The mothers are encouraged to nurse [breast feed] their babies for two years. • 2. If the mother is divorced, she retains the right to nurse her child. The father should pay for her cost of living as she will be fully occupied by nursing his offspring.

26. The Nursing of the Child • 3. If the father dies, his heir should support both the nursing mother and her baby for the whole period of breast- feeding. The custody of the baby remains in the hands of the mother.

27. The Nursing of the Child • If the pregnant lady commits a crime which is punishable by death sentence, punishment should be suspended until she deliver the baby and nurse her/him for two complete years. This was stressed by Prophet Mohammed(SW) who suspended the death punishment of Alghamedia.

28. Colostrum (Shaafi and Hambali) • All the jurist agree to this policy. • The Shaafi and Hambali stress the importants of Colostrum (Allaba) for the life and health of the new born • Prevoius doctors denied the benefits of colostrum (Allaba) • Ibn Qodama (602 H/ 1223 Gr)(Al Mognae) stressed the importance of (Allaba) Colostrum as life saving

29. Adoption is not allowed • {وَمَا جَعَلَ أَدْعِيَاءَكُمْ أَبْنَاءَكُمْ ۚ ذَٰلِكُمْ قَوْلُكُمْ بِأَفْوَاهِكُمْ ۖ وَاللَّهُ يَقُولُ الْحَقَّ وَهُوَ يَهْدِي السَّبِيلَ (4) ادْعُوهُمْ لِآبَائِهِمْ هُوَ أَقْسَطُ عِنْدَ اللَّهِ ۚ فَإِنْ لَمْ تَعْلَمُوا آبَاءَهُمْ فَإِخْوَانُكُمْ فِي الدِّينِ وَمَوَالِيكُمْ} [الاحزاب: 3-4] Neither has He made your fostered sons as your own sons. These are your own sayings, words which you utter with your mouths; but Allah speaks the truth and guides to the Path.

30. The Kinship of Rhida’a • Forbidden unto you are your mothers, and your daughters, and your sisters ….and your milk mothers, and your milk siblings. Sura4:23 • حُرِّمَتْ عَلَيْكُمْ أُمَّهَاتُكُمْ وَبَنَاتُكُمْ وَأَخَوَاتُكُمْ ... وَأُمَّهَاتُكُمُ اللَّاتِي أَرْضَعْنَكُمْ وَأَخَوَاتُكُمْ مِنَ الرَّضَاعَةِ • سورة النساء :23 • حديث شريف : ”ما أنشز العظم وأنبت اللحم ”

31. The Kinship of Rhida’a(breast feeding) • If a lady breast feed or donate her milk to an under two years child for 5 times then she becomes milk mother for the baby, and her daughters and sons will be his/her milk sisters and brothers. The Kinship will extend to her whole family . • The Hanafi school considers single feed as enough for the lady to become his/her suckling mother.

32. Human breast milk stem cells • Breast milk stem cells were found in the blood and the brain, thymus, pancreas, liver, spleen and kidneys, in experimental mice, and developed into mature functioning cells, and play role normal growth and development. • No allergy between breast milk the suckling baby. Neurology Research InternationalVolume 2014 (2014),

33. Breast milk stem cellsincorporate into neonatal organs • The stem cells and multitude of cells in breast milk (especially in colostrums ) signify the importance of biological relationship between the wet nurse ( foster mother ) and the baby she suckled.

34. Breast milk stem cellsincorporate into neonatal organs • Breast milk contains stem cells that express genes which incorporate in germ layers(ectoderm,mesoderm,entoderm). • These studies provide the evidence of migration and integration of breast milk stem cells to organs of the neonate. Neurology Research International Volume 2014 (2014) F. Hassiotou, B. Heath, O. Ocal, et. al

35. Human breast milk stem cells • Stem cells from breast milk do not induce tumors when injected into patients, and can be used in cell therapies and tissue replacement. • Breast milk contains bioactive molecules that provide a multitude of immunologic, developmental and nutritional benefits to the infant. Neurology Research InternationalVolume 2014 (2014),

36. Human breast milk stem cells • Breast milk, contains millions of maternal cells in every milliliter that the infant ingests. • Discovery of stem cells in breast milk with multilineage potential that are transferred to the offspring during breastfeeding. • This has generated numerous implications for both infant and maternal health and regenerative medicine. Neurology Research InternationalVolume 2014 (2014),

37. Differentiation of Human Breast-Milk Stem Cells to Neural Stem Cells and Neurons • Breast milk contains special pluripotent stem cells, which can be utilized as a valuable and a new easily available source for regenerative medicine. • Both mammary gland and nervous system have the same origin. with common regulators i.e. breast milk-derived cells are good source for neural cell lineages differentiation. Neurology Research InternationalVolume 2014 (2014),

38. Differentiation of Human Breast-Milk Stem Cells to Neural Stem Cells and Neurons • The breast milk stem cells have the ability to be differentiated into 3 neural cell lineages: neurons, astrocytes, and oligodendrocytes. • Using breast milk-derived cells as a source of cell therapy is preferable for the patients in child-bearing ages. It avoids isolation of neural stem cells which needs invasive procedure. Neurology Research International Volume 2014 (2014),

39. Human breast milk stem cells • Unlike adult stem cells, these ‘human breast milk stem cells’ demonstrate the self-renewal and tissue differentiation properties found in embryonic stem cells – the ability to regenerate cells in many different parts of the body including in particular neural (brain) cells. • The discovery of breast milk stem cells provides further evidence of the value of breastfeeding. • The presence of stem cells is a quality of breast milk that infant formula will never be able to replicate.

40. Human milk bank Human milk bank collects, milk from nursing ladies , process, and dispense human milk to needy babies. The International Milk Banking (IMBI), was founded in 2005. It lists 33 countries with milk bank programs.

41. Human milk bank • Brazil: 210 milk banks. In 2011, 165,000 liters of breast milk were donated by some 166,000 mothers, and provided to nearly 170,000 babies. It reduced infant mortality by 73% since the 1990s. • North America: 16 milk banks as of 2014. They collect about 3,000,000 oz per year as of 2013. • Europe : 203 human milk banks with as of 2014,

42. How long does frozen breast milk retain its value and nutrition?  Fresh breast milk : 4 hrs (room temperature) refrigerated: 24-48 hrs immediately. frozen : 3 months. It loses important nutrients

43. The Fatwa of the International Jurisprudence council (OIC) Jeddah 1985 on milk banks (decision) : 1- Islam considers Rhida’a (Breastfeeding) as important as lineage, and the suckled baby becomes a member of the family. 2- The social fabric in many Muslim societies is still strong and can afford milk mothers for premature babies.

44. The Fatwa : • If the milk donated by each lady is identified, (name and address) and the baby using her milk is known, and both the donor lady and the family of the baby know these facts, then it is allowed to use milk banks.

45. Allaith ibn Saad(الليث ابن سعد) and Ibn Hazm insisted that suckling from the breast of the woman by the baby is prerequisite for becoming milk mother. If she gives the milk through a bottle or spoon it is not considered as Rhida’a.

46. Saudi Arabic • In Saudi Arabic babies neglected by their unknown mothers, are taken by the government in orphanages who encourage Saudi ladies to breast milk a certain baby who becomes her child. • The baby becomes a member of her family.

47. Thank you 