“Allah u Akbar,” the adhan resonated from the immaculate minarets of the mosques in Morocco. It’s one of the most profound, sensorial memories I have from my studies abroad; the deep, ethereal song dancing through the bustling streets of the medina inviting believers to prayer.
Islam’s holy month of Ramadan, a time for introspection, purification of the body and strengthening of spiritual bonds marked by the sighting of the new moon, is now well underway.
During the celebration of Ramadan, from sunup to sundown, Muslims worldwide take part in:
daily readings of the Quran,
avoidance of smoking and sexual intercourse and
fasting with no food or water.
Fasting requires a great deal of self-control and offers Muslims an opportunity “to diminish…dependence on material goods, purify their hearts and establish solidarity with the poor to encourage charitable works during the year.” [Retrieved from: http://www.time.com/time/world/article/0,8599,1919257,00.html#ixzz2YlNq3Hlt]
But as much as fasting during Ramadan is about self-discipline, it also presents communities with a unique chance to come together in support of one another.
“A community that fasts together supports each other,” as Rabbi Robert W. Haas puts it in the film American Ramadan.
Perhaps it is this sense of community, where Muslims fast and partake in iftar together, that grants participants the strength for this religious undertaking.
While there are several interpretations of fasting for pregnant and lactating women amongst Muslim communities, Union Institute and University Maternal Infant Health student and Babies Express founder Alice Byrd RN, IBCLC, ANLC, CBE tells me that the choice to fast during Ramadan is typically up to the mother’s discretion.
Mothers sometimes express concern about fasting while lactating: does fasting during Ramadan affect the quality and quantity of breastmilk?
Bener’s research, Fasting during the holy month of Ramadan does not change the composition of breast milk, concludes that breast milk quality and composition in nursing mothers is unaffected by Ramadan fasting.
Kelly Bonyata, IBCLC of KellyMom also offers research that supports these findings in Religious Fasting and Breastfeeding. She provides information about maternal diet and breastfeeding in How does a mother’s diet affect her milk?
Although studies show that breastfeeding mothers need not worry about milk composition during Ramadan fasting, Byrd recommends lactating mothers reevaluate their choice to fast day by day.
“[Mothers] definitely have to get up to eat in the morning so that their energy level is up, especially early on when the baby is eating about every two hours,” she says.
When and if a breastfeeding mother finds that she is unable to participate in fasting due to the risk of her or her child’s health being harmed, she has other options to take part in the holy celebration.
She may make up the fast at any other point in the year.
She may offer food to the less fortunate, feeding one person for each missed day of fasting.
“For those who cannot do this except with hardship is a ransom: the feeding of one that is indigent…. Allah intends every ease for you; He does not want to put you to difficulties….” (Quran 2:184-1)
Interestingly, according to Lactation in Islam., “…the moral importance of breastfeeding is stressed. The mother receives the reward of a good deed for every single drop she gives her child.”
Byrd cautions that when fasting during Ramadan becomes too trying for a mother, she may resort to bottle feeding, spurring a potentially vicious downfall of her breastfeeding relationship.
However, stressing the religious importance for a Muslim woman to breastfeed her child may preserve and promote breastfeeding, as suggested by Lactation in Islam. Ensuring that she is aware of her religious rights as well as ensuring proper breastfeeding education and support offers mother the confidence to feed her baby and fully participate in her religion.
For example, the Quaranic verse 2:233 recommends breastfeeding for two years which is (potentially) significantly longer than the American Academy of Pediatrics’ breastfeeding recommendations.
Even more, “according to Islam a nursing mother is entitled to receive compensation from the father for nursing the child.” This idea stresses the value of breastmilk and may even serve as a source of empowerment.
Milk kinship, where non-biological mother breastfeeds a non-biological baby also implies the importance of breastmilk in Islam. Historically, milk kinship was practiced to forge loyalty amongst community members, but the custom persists in modern time.
Natural term breastfeeding isn’t always easy to achieve especially when a mother must return to work, Byrd reminds us.
“Becoming educated about pumping [in the workplace] and their right to breastfeed is hard for some women,” she explains.
Muslim families might also face the challenges associated with English as a second language. This is a particularly important barrier to recognize during prenatal care and labor and delivery as it is documented that birth experience affects breastfeeding outcomes.
Because there are an estimated 50 different dialects of Arabic, language can pose a special challenge when it comes to communicating with Muslim families.
Byrd says she often finds that families don’t quite understand the translated phone lines that she uses with non-native English speaking clients.
If language doesn’t present a barrier to breastfeeding, sometimes cultural misunderstandings do.
Byrd mentions traditional male and female roles within Islam for instance.
She also says that lactation professionals might misinterpret Muslim signs of respect for discourteous behavior.
“If a female [professional] is speaking to a male, he might be turned away from her or he might lower his gaze,” she explains.
Further, it is the mother’s postnatal right to be at a state of rest for 40 days after childbirth.
Byrd explains that family, friends and neighbors cook meals, clean the home and sometimes even feed the mother during this postpartum period. She says that medical professionals often deem Muslim mothers “princesses” or “needy women” instead of accepting this as a part of their upbringing.
How upsetting that we don’t better embrace this practice in America!
The notion of modesty within the Muslim religion may present cultural barriers when not fully understood as well. Female modesty is associated with endless interpretations.
For example, Muslim women may choose to wear no traditional covering, a full body covering called the burqa or any variation in between. (Explore more Middle Eastern veil styles here: http://www.huffingtonpost.com/anne-peterson/know-your-veils_b_812944.html#slide=228734)
No matter her image, all women’s humility must be respected. A woman in a low cut tank top may never nurse her baby in public whereas a woman dressed in hijab may. Medical and lactation professionals should exercise special cultural sensitivity around nursing Muslim women and remember that things like region and adherence to traditional Islamic beliefs will influence her comfortability to expose any part of her body.
Byrd explains that there are special clothing for nursing Muslim mothers who wish to remain completely covered. I found this website which offers breastfeeding abaya: http://www.modestclothes.com/islamic/dept/muslim-nursing-clothing.html.
The Boston University School of Medicine has compiled a list of general guidelines to respectful interaction with Muslim patients that may be helpful for the lactation professional. This resource can be found here: http://www.bu.edu/bhlp/Resources/Islam/health/guidelines.html.
Lactation professionals working with Muslim families should also consider that culture and medical practice often muddle.
As I explored the Quran’s statements on breastfeeding, I found this narration from ImÄm as-SÄdiq (as): “Oh Mother of IshÄq, don’t feed the child from just one breast, but feed from both, as one is the substitute for food, and the other is a substitute for water.”
The Quran also directs women to eat only pure food because all she ingests affects her nursing child.
With these examples in mind, we’re presented with the dangers of culture dictating improper breastfeeding practice.
It is imperative that lactation professionals practice cultural sensitivity and receptiveness to better influence the success of Muslim families’ breastfeeding relationships.
Especially during the intense celebration of Ramadan, breastfeeding advocates and professionals can preserve a nursing dyad’s breastfeeding relationship through careful consideration of cultural and medical practice.