6/07/2017

Breastfeeding and fasting during Ramadan

Breastfeeding and fasting during Ramadan


“Fast for a specified number of days [during the month of Ramadan]. Whoever of you is sick or travelling and does not fast, let him fast the same number of days later”
The Koran. Surah 2, Ayah, 184

AUTHORS:
Yasmin Paricio Burtin, journalist, communication and sponsorship officer in APILAM
Dr. José María Paricio Talayero, pediatrician, President of APILAM

Ramadan, the holy month of Islam, coincides with the ninth month of the Islamic lunar calendar. During this period Muslim adults fast: from dawn to sunset they do not eat or drink, take medication orally, or smoke and abstain from sexual intercourse. Everyone should fast except those who are ill or travelling (Bajaj 2012, Rashid, 2007).

Based on the lunar calendar, each year Ramadan falls eleven days earlier, and depending on the season, the duration of daily fasting varies annually: fasting in summer is longer, while in winter it is shorter (Rashid 2007 ). The duration of fasting also varies according to the geographical position of the country, ranging from 10 to 19 hours a day (Bajaj 2012) and even longer in Scandinavian countries such as Sweden (Al Jazeera 2014).

But what do breastfeeding Muslim women do during this holy month? Should they fast? Do they fast? Is fasting safe for the baby and / or breastfeeding mothers? Does fasting affect the composition of breast milk? Does milk production decrease?

In this article we will address these issues drawing on published scientific studies on breastfeeding and fasting during Ramadan.

1.8 billion Muslim people in the world, half of whom are women
Fasting during Ramadan is one of the five pillars of Islam (Bajaj 2012), a religion professed by 24% of the world's population: about 1.8 billion people, according to estimates by the Pew Research Center (PRC 2017/05/26) and of which approximately half are women (Bajaj 2012).

It is the second largest religion in the world, after Christianity, and the fastest growing religion (PRC, 2017/05/26).  In the period between 2010 and 2015, births among the Muslim population accounted for 31% of the world's population, with a fertility rate of 2.9 children per woman (PRC 2017/04/05).

The majority of Muslims, 62%, live in Asia-Pacific, 19.8% in the Middle East and North Africa, 15.5% in sub-Saharan Africa, 2.7% in Europe, 0.2% in North America and almost 0.1% in Latin America and the Caribbean (PRC, 2015/04/02-a).

It is estimated that by 2020 there will be some 54.4 million Muslims in Europe, of whom, excluding Russia, most will live in Germany (5.5 million), France (5.4 million), United Kingdom (3.9 million), Italy (2.9 million), Albania (2.6 million), Kosovo (1.7 million), Bosnia-Herzegovina (1.6 million), Spain (1.6 million) and the Netherlands (1.2 million) (PRC, 2015/04/02-b).

Should breastfeeding Muslim women fast during Ramadan?
Breastfeeding has a religious basis in Islam (Shaikh 2006), which recommends breastfeeding for two years. Weaning before two years of age must be decided by the father and mother, and wet nurses are allowed as long as they are paid as agreed (The Koran, Surah 2, Ayah 233).

Although people who are ill or are travelling are exempt from fasting, there is controversy over whether breastfeeding mothers should or should not fast. For some authors they would be exempt in any situation (Khalife 2015, Mubeen 2012, Shaikh 2006, Andrews 1997), others are only excused if there is good reason to believe that fasting can cause them or their babies some harm (Rashid 2007, Shaikh 2006). In any case, fasting is postponed to a later date (Shaikh 2006, Andrews 1997).

Do breastfeeding Muslim women fast during Ramadan?
Most breastfeeding mothers fast during Ramadan (Khalife 2015, Kridli 2011). In Canada, most prefer to fast during Ramadan with their community rather than to do it alone later (Jessri 2013, Andrews 1997). In Turkey, 69% of breastfeeding mothers fast regardless of level of education (Rashid 2007). 

In Pakistan, up to 88% of pregnant women practice religious fasting (Mubeen 2012) and in some areas of rural Africa 100% of breastfeeding mothers fast during Ramadan (Prentice 1983).

Are there changes in breast milk due to fasting during Ramadan?
There is a lack of knowledge and research on possible changes in breast milk and on the safety and impact of breastfeeding due to Ramadan fasting (Bajaj 2012, Kridli 2011).

In conditions of extreme heat (Gambia), significant changes in milk composition (increase of sodium and osmolarity and decrease of lactose) have been found during fasting hours (Prentice 1984).

A decrease in some micronutrients such as zinc and magnesium has been observed (Rakicioğlu 2006), but in general, although breastfeeding mothers experience a mild degree of dehydration during fasting hours and in extreme heat conditions, -4.9% on average, slightly higher than that of non-breastfeeding women in the same period, -3.8% (Prentice 1984), they do not undergo any clinically significant metabolic or physiological disorder (Rakicioğlu 2006, Andrews 1997, Prentice 1984).

Does milk production fall during fasting? Does it affect the growth of infants? Does it affect the mother?
It has been reported that one in five women report decreased milk production during Ramadan fasting and there may be an increase in milk supplements given to infants younger than six months old (Bajaj 2012, Ertem 2001).

Since changes in the macronutrient composition of breast milk are not of major clinical significance, the growth of infants is not affected (Rakicioğlu 2006, Andrews 1997).

Nor do the levels of prolactin or other hormones involved or not in the reproduction process change  in the mother (Cağlayan 2014, Prentice 1984, Prentice 1983). Moreover, breastfeeding mothers gain on average 1 kg following Ramadan without significant changes in body mass index (Rakicioğlu 2006).

Recommendations
Breastfeeding mothers who choose to fast should be advised to drink plenty of fluids and eat nutritious foods between dinner and dawn in order to compensate for daytime losses, and should avoid excessive daytime activity and know the warning signs that would justify breaking the fast, such as extreme fatigue, dizziness, nausea or vomiting (Khalife 2015), whilst monitoring milk production (Bajaj 2012).

Some authors, doctors and pediatricians, advise breastfeeding mothers against fasting (Rakicioğlu 2006) especially when exclusively breastfeeding infants under 6 months (Bajaj 2012).


Maternal and child health care providers should be well informed about the religious and cultural phenomena of Islam and understand the effects of fasting during Ramadan in order to use appropriate methods to prevent possible adverse effects (Ertem 2001).




Bibliography:
  1. Agnew T, Gilmore J, Sullivan P.  A multicultural perspective on breastfeeding in Canada. Health Canada. Minister of Public Works and Government Services Canada, 1997. FrEn.
  2. Al Jazeera. 2014.  Ramadan in Sweden with no dusk, no dawn. (Accessed  25.05.2017)
  3. Bajaj S, Khan A, Fathima FN, Jaleel MA, Sheikh A, Azad K, Fatima J, Mohsin F. South Asian consensus statement on women's health and Ramadan. Indian J Endocrinol Metab. 2012 Jul;16(4):508-11. doi: 10.4103/2230-8210.97995. PubMed PMID: 22837905; PubMed Central PMCID: PMC3401745.
  4. Cağlayan EK, Göçmen AY, Delibas N. Effects of long-term fasting on female hormone levels: Ramadan model. Clin Exp Obstet Gynecol. 2014;41(1):17-9. PubMed PMID: 24707675.
  5. Ertem IO, Kaynak G, Kaynak C, Ulukol B, Gulnar SB. Attitudes and practices of breastfeeding mothers regarding fasting in Ramadan. Child Care Health Dev. 2001 Nov;27(6):545-54. PubMed PMID: 11737021.
  6. Jessri M, Farmer AP, Olson K. Exploring Middle-Eastern mothers' perceptions and experiences of breastfeeding in Canada: an ethnographic study. Matern Child Nutr. 2013 Jan;9(1):41-56. doi: 10.1111/j.1740-8709.2012.00436.x. Epub 2012 Aug 22. PubMed PMID: 22909247.
  7. Khalifs T, Pettit JM, Weiss BD. Caring for Muslim patients who fast during Ramadan. Am Fam Physician. 2015 May 1;91(9):641-2. PubMed PMID: 25955739.
  8. Kridli SA. Health beliefs and practices of Muslim women during Ramadan. MCN Am J Matern Child Nurs. 2011 Jul-Aug;36(4):216-21; quiz 222-3. doi: 10.1097/NMC.0b013e3182177177. PubMed PMID: 21709516.
  9. Mubeen SM, Mansoor S, Hussain A, Qadir S. Perceptions and practices of fasting in Ramadan during pregnancy in Pakistan. Iran J Nurs Midwifery Res. 2012 Nov;17(7):467-71. PubMed PMID: 23922591; PubMed Central PMCID: PMC3730448.
  10. Pew Research Center 2017/05/26. Muslims and Islam: Key findings in the U.S. and around the world. (Accessed 26.05.2017).
  11. Pew Research Center 2017/04/05. The Changing Global Religious Landscape. (Accessed  15.05.2017).
  12. Pew Research Center 2015/04/02-a. The Future of World Religions: Population Growth Projections, 2010-2050. (Accessed 25.05.2017).
  13. Pew Research Center 2015/04/02-b. Religious Composition by Country, 2010-2050. (Accessed 28.05.2017).
  14. Prentice AM, Lamb WH, Prentice A, Coward WA. The effect of water abstention on milk synthesis in lactating women. Clin Sci (Lond). 1984 Mar;66(3):291-8. PubMed PMID: 6692661Full text.
  15. Prentice AM, Prentice A, Lamb WH, Lunn PG, Austin S. Metabolic consequences of fasting during Ramadan in pregnant and lactating women. Hum Nutr Clin Nutr. 1983 Jul;37(4):283-94. PubMed PMID: 6643131.
  16. Rakicioğlu N, Samur G, Topçu A, Topçu AA. The effect of Ramadan on maternal nutrition and composition of breast milk. Pediatr Int. 2006 Jun;48(3):278-83. PubMed PMID: 16732795.
  17. Rashid H. Ramadan fasting and breast milk. Breastfeed Med. 2007 Mar;2(1):59-60. PubMed PMID: 17661623.
  18. Shaikh U, Ahmed O. Islam and infant feeding. Breastfeed Med. 2006 Autumn;1(3):164-7. PubMed PMID: 17661593.

Other links of interest:

We require funding in order to continue our research and dissemination. You can collaborate with the project by donating to e-lactancia.org

1/18/2017

12 million searches on the compatibility of breastfeeding with medications in 2016


In 2016 APILAM´s e-health project e-lactancia.org received more than 12 million searches on the compatibility of breastfeeding with medications, illnesses, plants and medical procedures. 

Three million more searches than in 2015, carried out by more than 2.4 million people from all around the world. 


In this infographic we have prepared you can find the number of searches made by country! 

http://www.e-lactancia.org/donativos

We require funding in order to continue our research and dissemination. You can collaborate with the project by donating to e-lactancia.org

1/12/2017

APILAM sponsors the “Breastfeeding in public" photo prize


Winning photo of the 2016
APILAM "Breastfeeding in public” prize
- The “Breastfeeding in public" prize consists of 600€ and a copy of the book  Tú eres la mejor madre del mundo (You are the best mother in the world), signed by the author, the pediatrician José María Paricio

-The prize sponsored by APILAM is part of the 21st "Marina Alta Breastfeeding" photo competition, with 5,000€ distributed over 17 prizes

Winning photo of the 2014
APILAM "Breastfeeding in public” prize

In APILAM we love breastfeeding, its beauty, its goodness. For the four year running, APILAM is participating in the 21st "Marina Alta Breastfeeding" photo competition organized by Grup Nodrissa, sponsoring the "Breastfeeding in public” prize of 600€ and a copy of the book Tú eres la mejor madre del mundo (You are the best mother in the world), signed by the author, the pediatrician José María Paricio.

Winning photo of the 2015
APILAM "Breastfeeding in public” prize
With the "Breastfeeding in public” prize, the non profit organization APILAM, which runs the e-health project e-lactancia.org, and the breastfeeding museum telasmos.org, seeks to contribute to the normalization and visibility of breastfeeding in public places: in a shop, a bank, a conference, a public swimming pool, a waiting-room, at a circus, in an airport, at a demonstration, in a queue at the market or a polling station, in a television studio, in Parliament

It is little wonder that many women and their babies are discriminated against for exercising a right, to breastfeed in public.

The “Marina Alta Breastfeeding” photo competition has 16 prizes sponsored by associations, city councils, businesses and breastfeeding support groups.  

Photos will be accepted until 31st March and the prizes will be given on June 2017.  The rules of the competition and the participation form can be found here and here.



We require funding in order to continue our research and dissemination. You can collaborate with the project by donating to e-lactancia.org



12/20/2016

Help us to promote breastfeeding



In APILAM we love breastfeeding, its beauty, its goodness.

Today I am asking for your collaboration to help us keep promoting breastfeeding: last year via our online health project e-lactancia.org, we helped answer nine million queries from 1.5 million people from 184 countries.

Your donation is important
We need funding to keep publishing the latest scientific evidence on the compatibility of breastfeeding with medicines, medical tests, illnesses, and make it available to everyone.  


With your support you make it possible for us to promote breastfeeding by answering doubts held by mothers, fathers and health professionals.

Warm regards, happy holidays and congratulations for believing in the goodness and beauty of breastfeeding.

Dr. José María Paricio Talayero
Pediatrician
President of APILAM


2/13/2016

The Zika virus and breastfeeding in nine paragraphs


1. e-lactancia has classified the Zika virus as low risk, compatible with breastfeeding, with no risk for breastfeeding or the infant.

2. The Zika virus is a Flavivirus which is mainly transmitted by the bite of the Aedes mosquitoes from infected carriers (humans and various animals).
                                        
3. Sexual transmission as well as vertical transmission from mother to child (placental and perinatal) has been documented sporadically.

4. The relationship between placental transmission and congenital microcephaly is being researched.

5. Possible transmission via transfusion is also a concern.

6. Although Zika virus RNA has been found in breast milk, transmission of the infection through breastfeeding has not been documented.

7. Viral infection is asymptomatic in 75% of cases. Only one in four people develop symptoms which are generally benign, with few complications in adults and children, including infants, and which rarely require hospitalization.

8. In the case of two infants who had tested positive for the virus, presumably after perinatal transmission, one was asymptomatic and the other had mild symptoms with doubtful links to the virus. Both infants, as well as their mothers, progressed favorably (Besnard, 2014).

9. Given the benefits of breastfeeding, expert committees – the Centers for Disease Control and Prevention (CDC) – recommend breastfeeding even in areas where there the Zika virus is present.


For more detailed information, containing nine bibliographical references, please consult the e-lactancia.org entry on the compatibility of breastfeeding withthe Zika virus prepared by pediatricians from APILAM (Association for the promotion and scientific and cultural research of breastfeeding)

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We require funding in order to continue our research and dissemination. You can collaborate with the project by donating to e-lactancia.org

2/04/2016

APILAM sponsors the “Breastfeeding in public" photo prize

Winning photo of the 2014
APILAM "Breastfeeding in public” prize
- The “Breastfeeding in public" prize consists of 600€ and a copy of the book  Tú eres la mejor madre del mundo (You are the best mother in the world), signed by the author, the pediatrician José María Paricio.

-The prize sponsored by APILAM is part of the 20th "Marina Alta Breastfeeding" photo competition, with more than 6,000€ distributed over 17 prizes.

For the third year running, APILAM is participating in the 20th "Marina Alta Breastfeeding" photo competition organized by Grup Nodrissa, sponsoring the "Breastfeeding in public” prize of 600€ and a copy of the book Tú eres la mejor madre del mundo (You are the best mother in the world), signed by the author, the pediatrician José María Paricio.

With the "Breastfeeding in public” prize, the not-for-profit organization APILAM seeks to contribute to the normalization and visibility of breastfeeding in public places: in a shop, a bank, a conference, a public swimming pool, a waiting-room, at a circus, in an airport, at a demonstration, in a queue at the market or a polling station, in a television studio, in Parliament

It is little wonder that many women and their babies are discriminated against for exercising a right, to breastfeed in public.

The “Marina Alta Breastfeeding” photo competition has 17 prizes sponsored by associations, city councils, businesses, support groups and the Valencian government.

Photos will be accepted until 31st March and the prizes will be given on 18th June 2016.  The rules of the competition and the participation form can be found here and here.


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We require funding in order to continue our research and dissemination. You can collaborate with the project by donating to e-lactancia.org

1/25/2016

Nine million searches in e-lactancia.org in 2015. Discover how many by country

In 2015 APILAM´s e-health project e-lactancia.org received more than nine million searches on the compatibility of breastfeeding with medicines, illnesses, plants and medical procedures. 

 Three million more searches than in 2014, carried out by more than 1.5 million people from 184 countries. 

In this infographic we have prepared you can find the number of searches made by country!


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We require funding in order to continue our research and dissemination. You can collaborate with the project by donating to e-lactancia.org
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