Understanding the Islamic principles of milk kinship to enable equitable access for vulnerable infants to donor human milk: Protocol for a qualitative study (Preprint)

BACKGROUND Since 1979, the World Health Organization (WHO) and UNICEF have recommended the use of pasteurized human milk from a human milk bank (HMB) to feed low birthweight and preterm infants as the first alternative when mothers are unable to provide their own milk. Globally, there are about 700 HMBs, and the number is increasing. Concerns relating to milk kinship, insufficient guidance, and inconsistent application of available guidance around HMB might alter the scale up of HMB network in Islamic countries and among children born by Islamic parents in other countries. OBJECTIVE This research protocol describes a study that aims to examine Islamic religious concerns relating to milk kinship and HMB in three Southeast Asian countries with a majority or significant Muslim population. Specific objectives are: 1) to examine perceptions of key stakeholders relating to the Islamic principle of milk kinship and their proposed solutions to address potential barriers thereby enabling equitable access of vulnerable babies' to safe donor human milk and 2) to examine current technical guidelines and religious decrees from the perspective of the Islamic principle of milk kinship and HMB services. METHODS This proposed study will include desk reviews and in-depth interviews (IDIs). Desk reviews will examine and compare the contents of fatwa, regional or national technical guidelines and standards. Qualitative data collection and analysis will be conducted to examine relevant stakeholders' perceptions about the Islamic principle of milk kinship, and proposed solutions to address barriers to equitable access for vulnerable infants to safe donor human milk. A total of 12-18 key stakeholders, including representatives of Muslim Councils, experts on Islamic studies, decision makers from Government Offices, or members of HMB Networks, across Southeast Asia with focus on Indonesia, Malaysia, and Singapore. RESULTS This study, funded in June 2020, was approved by the Institutional Review Board (FHI 360) on September 14, 2020. Date(s) of data collection will be September 23 to January 15, 2020. As of December 12, 2020, nine IDIs have been completed. Results are expected to be published in June 2021. We will present a comparison of Fatwa across countries and compared with other major Muslim countries in the world. Findings from in-dept interviews will highlight relevant stakeholders' perceptions grouped by relevant theme such as the principle of milk-kinship and barriers, solutions and recommendations, actors and process, and timelines of establishing HMB services. CONCLUSIONS Findings from this study will help to increase the understanding of the evidence-informed process leading to the issuance of a fatwa and development of national technical and operational guidelines. CLINICALTRIAL NA