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Breast Milk Donation After Perinatal Loss: A Qualitative Exploration of Maternal Grief and Healing Among Israeli Arab Women and the Islamic Legal-Ethical Perspectives: A Qualitative Research Study

PMCID: PMC12733250

PMID:

Abstract

Highlights What are the main findings? Breast milk donation after perinatal loss served as a meaningful coping mechanism for bereaved Muslim mothers, helping them manage grief and maintain a symbolic bond with their lost child. Interviews with participating religious scholars indicated a consensus on the permissibility of milk donation when rida’a regulations are followed, suggesting that Islamic jurisprudence can provide supportive guidance for bereaved mothers in healthcare settings. What is the implication of the main finding? Healthcare providers should integrate structured counseling that includes milk donation options to support grieving mothers emotionally and psychologically, while being sensitive to cultural and religious considerations. Milk banks and medical institutions must implement practices aligned with Islamic ethical guidelines to respect religious concerns and provide compassionate, dignified care. Abstract Background/Objectives : After perinatal loss, namely stillbirth and neonatal death, many bereaved mothers continue to produce breast milk, facing the decision as to whether to suppress lactation or donate their milk. Our aims were to explore the experiences and views of Muslim mothers who had donated their breast milk following perinatal loss and examine the Islamic legal-ethical perspectives relating to milk donation. This research explores how milk donation serves as a coping mechanism and how Islamic teachings frame its permissibility and ethical considerations. Methods : A qualitative research methodology was employed, using a Interpretative Phenomenological Analysis (IPA). Nine bereaved Muslim mothers who had donated their breast milk and three Islamic religious scholars (an Imam, a Mufti, and a Muslim jurist) participated in in-depth interviews. Thematic analysis identified recurring patterns and insights. Results : Our findings revealed that mothers experienced milk donation as a coping mechanism, allowing them to maintain a symbolic connection with their lost child while contributing to other infants’ survival. Religious scholars who we interviewed agreed that milk donation is permissible in Islam, provided that milk kinship ( rida’a ) regulations are observed. Mothers reported a strong need for structured support from healthcare providers and religious leaders in order to assist in the informed decision-making process. Conclusions : Breast milk donation after perinatal loss aids in grief management for bereaved mothers while benefiting vulnerable infants. Healthcare providers should offer comprehensive lactation counseling for bereaved mothers, including milk donation options. Milk banks should implement processes in alignment with rida’a guidelines. Improving support systems for bereaved mothers can alleviate their grieving process while ensuring alignment with cultural and religious norms.

Full Text

Perinatal loss encompasses a profoundly intricate grieving process related to miscarriage (pregnancy termination before 20 weeks), stillbirth (fetal death after 20 weeks), and neonatal death (death within 28 days) [1]. In addition to severe emotional and psychological distress, mothers may experience painful lactation. They must then decide whether to suppress lactation or donate milk. Donation has been recognized as therapeutic, helping bereaved mothers navigate grief and reconstruct maternal identity [2,3,4,5,6], yet it remains underexplored and inconsistently implemented across healthcare and cultural settings [7].
Stillbirth and neonatal death produce unique grief, as mothers mourn both their infant and the loss of their anticipated maternal role [8]. Emotions such as anger, guilt, anxiety, and depression are common [9], and the mother may develop PTSD, a low mood, or sleep disturbances [10]. Notably, prolonged complex grief occurs in ~20–30% of mothers. Broader social responses, such as silence, poor communication, or awkwardness can intensify the sense of loss [11]. Engagement with one’s emotions aids recovery, while meaning making predicts capacity to manage grief and achieve healing [12]. Some mothers even report post-traumatic growth, experiencing personal transformation after their loss [13,14].
Breastfeeding provides numerous advantages, including optimal nutrition, gastrointestinal and psychological benefits, and bolstered immune protection [15]. Human milk contains antioxidative and immune-supportive properties [16], thus, lowering the risk of infectious diseases [17]. The World Health Organization (2015) [18] endorsed breastfeeding as the optimal nutrition for infants, and accordingly, NICUs increasingly rely on donor milk when mothers’ milk is unavailable [19]. Prescription of donor milk has steadily grown [11], with evidence linking it to improved neurodevelopmental outcomes in vulnerable, ill and preterm infants [20].
After loss, lactation continues, requiring management. Options include suppression, gradual reduction, self-expression, or donation [21]. It is known that breast milk holds deep emotional significance for mothers, particularly after perinatal death [2]. In a study conducted in Australia, Welborn [3] found that expressing and donating milk helped bereaved mothers fulfill maternal instincts and process grief. For some, lactation affirms motherhood and memorializes the infant [22,23]. Milk can symbolize hope for mothers who nursed a sick infant or may become a poignant reminder of their loss. For infants who were stillborn, expressing milk may provide a way to navigate grief and maintain a connection with the deceased child [3].
Milk donation involves religious-ethical concerns, particularly, the doctrine of milk kinship (rida’a), which creates familial bonds through breastfeeding [24,25]. This may subsequently complicate future marital prospects among individuals nursed by the same woman. Thus, the use of milk banks, where pooling obscures donor identity, presents difficulties in tracing kinship ties. Some scholars, i.e., Shaykh Ibn Saalih al-‘Uthaymeen, prohibited milk banks for this reason [24,25], while others, i.e., Yūsuf al-Qaradāwī, allowed them, citing that no religious objections exist [24]. Moreover, recent Islamic religious rulings show increasing support for milk donation within Islamic frameworks.
In 2023, the Minnesota Islamic Council issued a fatwa endorsing pasteurized donor milk, noting health benefits and minimal kinship risk [26,27]. In the UK, the United Kingdom Association for Milk Banking and the Muslim Council of Britain likewise supported donor milk, recommending robust systems to ensure traceability in order to mitigate rida’a concerns [27,28]. Though explicit rulings on post-loss milk donation specifically after fetal loss are rare, Islamic principles emphasizing the importance of preserving life and altruism support its permissibility [29].
Maternal grief spans a range of challenging emotions [30]. Our aims were to examine mothers’ experiences of expressing and donating breast milk during bereavement and examine the permissibility of this practice within Islamic teachings. Although, perinatal loss and breast milk donation have been examined in several cultural contexts, a clear gap remains in the literature. Firstly, very few studies have specifically focused on bereaved Muslim mothers, despite the unique religious, social, and ethical factors shaping their experiences. Secondly, no existing research has combined an Interpretative Phenomenological Analysis (IPA) with an Islamic legal-ethical analysis, leaving unexplored how religious jurisprudence interacts with mothers’ lived experiences. Thirdly, milk donation after perinatal loss remains clinically unsupported and ethically under-addressed in Muslim-majority contexts, where rida’a-related concerns and limited institutional guidance create significant ambiguity.
The Interpretative Phenomenological Analysis (IPA) was chosen as the research methodology allowing for a structured and in-depth analysis of lived experiences, emphasizing both phenomenological meaning-making and interpretative contextualization within health-related frameworks. Creswell [31] contends that IPA emphasizes deep exploration of “lived experiences” over broad participant samples, making it ideal for studying breast milk donation after pregnancy loss—a complex and sensitive topic best understood through rich qualitative data [32]. IPA employs “double hermeneutics,” combining interpretative analysis—where researchers contextualize participant data within psychological frameworks—and phenomenological analysis [33], rooted in Heidegger and Gadamer’s philosophies [34], to explore and give voice to participants’ lived experiences and personal meanings. This idiographic focus allows for a systematic, in-depth understanding of individual experiences.
The sample size was guided by the principle of data saturation [35]; thereby, data collection continued until recurring insights and a stable representation of the shared reality emerged. Data adequacy was achieved when no new experiential meanings were emerging, consistent with IPA’s emphasis on depth rather than breadth. Following multiple iterative readings of the transcripts and the development of emergent and superordinate themes, the research team determined that additional interviews were no longer generating novel experiential insights. This point was, therefore, considered sufficient to establish analytic adequacy within the IPA framework
Ethical approval for this study was obtained from the Ethics Committee of the academic institution affiliated with the second author, approval number 2023-1010-MTA. Participants were required to sign an informed consent form detailing the terms of their participation and the conditions of publication of the study’s findings. To maintain confidentiality and privacy, demographic data were aggregated and presented exclusively at the group level, following the recommendations of Morse [36]. The informed consent document stated that participation was both anonymous and confidential and assured participants of their right to withdraw from the interview at any time. Furthermore, the document informed participants that selected excerpts from their interviews might be included in future publications, thereby ensuring transparency in the research process.
Following the methodological framework proposed by Josselson [37], the interview was structured around a single, comprehensive question, allowing participants the flexibility to respond as they saw fit. The session began with an informal dialogue to establish rapport and set the participant at ease. The duration of the interview was generally between 60 and 70 min, following the guidelines suggested by Roberts [38]. The primary question posed during the interview was: “Please articulate your views and the Islamic perspective regarding milk donation.”
The interviews covered various aspects, including milk production, motivations for milk donation, Islamic perspectives, religious leaders’ opinions, the husband’s perspective on milk donation, the role of the milk bank, staff support, and the connection to maternal milk, and decision-making processes. Participants were encouraged to provide detailed accounts of their experiences and share how they found meaning in their journey. As each discovery during the interview was a product of the relationship between the participants and the researcher, the emphasis on demonstrating empathy and sincerity remained a central methodological component [39].
Women who experienced perinatal loss frequently described breast milk donation as a deeply meaningful act aligning with their moral and spiritual values. Rather than abruptly suppressing lactation—a physically and emotionally painful process—donation offered a purposeful alternative [40,41,42]. Providing milk for vulnerable infants imbued their loss with significance, helping them navigate the overwhelming sense of emptiness that followed the death of their baby, restoring their sense of agency and transforming their pain into an act of altruistic giving and healing [43].
Testimonies from donating mothers illustrate the emotional experience associated with this act. Hanan, who experienced a stillbirth: “Knowing that my breast milk could save lives provided me with a purpose during a time when I felt as if I had lost everything.” Layla, who lost her baby in the 8th month of pregnancy: “Donating was my way of giving life, providing fulfillment and comfort, even after losing my baby.” Khadijah, whose infant died: “The donation allowed me to transform my loss into a positive act, offering another baby what mine never had the chance to receive.” Asmaa, who lost her daughter during child-birth: “Knowing that my breast milk was helping other babies was a ray of light in the darkest period of my life.” Fatima, speaking as a physician and as a mother who experienced pregnancy loss, shared: “In medicine, we talk about evidence-based healing, however, grief does not work that way. Donating my milk was the only real thing I could hold onto, it helped me heal.” (Appendix A).
“I thought everything had ended when she passed away, but then I realized that my milk is not just a memory of her, but also a gift to other children. Through every donation, she remains part of this world.” (Appendix B).
The process of pumping and donating milk was described as a complex emotional experience in which grief, physical pain, hope, and fulfillment coexisted. For many, the act of breast milk donation provides women with the opportunity to channel their pain into a positive act, thus, transforming raw grief and a sense of helplessness into restorative purpose and creating a meaningful healing process connecting the body, mind, and faith [44,45]. Soraya, a mother whose infant daughter died in the NICU:
Theme 3 demonstrates how breast milk donation becomes a vital pathway of emotional restoration for bereaved mothers. The women felt that their pain contributed to something greater and helped them move through grief with intention and dignity and a sense of purpose (Appendix C).
For many women who lose infants, breast milk donation becomes a mission in knowing that they are providing life to sick and premature infants, as well as children who lack access to their own mother’s milk. This strengthened their sense of solidarity, and established a support network founded on compassion, hope, and generosity, and has been demonstrated in studies conducted across regions with a predominately Muslim culture, such as Nigeria [46] and Yemen [47].
Khadijah: “My pain didn’t disappear, but it turned into something meaningful by helping others.” (Appendix D).
Through donating, women transformed their grief into collective care, positioning themselves as part of a wider community committed to nurturing vulnerable children (Appendix D).
Breast milk donation is a highly commendable act in Islam; however, recipient infants must be properly documented in order to prevent future legal complications regarding marriage. Because of the rida’a guidelines, this carries significant implications, particularly, concerning marriage restrictions, and thus, societal repercussions [48]. According to Islamic jurisprudence, if a baby consumes breast milk at least five full times from a woman who is not their biological mother, they are considered milk siblings (rida’a), making them legally related to the donor mother’s biological children. Therefore, careful documentation of milk donations and recipient identities are essential, especially when donations are facilitated through milk banks. Documentation practices were valued for clarity in managing milk-kinship implications, though women emphasized that support, empathy, and respectful treatment mattered even more.
For many professional mothers, despite their structured careers and personal achievements, the death of a child often disrupts their sense of identity. The bereaved mothers who were interviewed frequently described donating milk as a meaningful and purposeful response to grief, one that restores a sense of agency and allows continued contribution, both medically and emotionally [49]. Milk donation provides a way for such women, especially those who are used to control and structure in their professional lives, to reclaim a sense of purpose after the abrupt loss of agency caused by stillbirth or neonatal death. Many professional mothers viewed milk donation as an extension of their core identity—the desire to contribute meaningfully to society. The feeling of maintaining a bond with their lost child by helping to nourish other infants offered not only solace but a renewed sense of identity.
The experiences of Muslim mothers who donated breast milk after perinatal loss align with cross-cultural research on parental bereavement. Across Western, African, and Asian contexts, mothers commonly seek to maintain an emotional bond with the deceased child through symbolic or altruistic acts [50,51]. In our study, breast milk donation functioned as such an act. The Muslim mothers’ narratives echo findings from Nigeria, Australia, India, and Europe, where parents oscillate between pain and fulfillment as they affirm relational continuity while dealing with post-loss emotional instability [52,53].
Within this broader cross-cultural landscape, Islamic perspectives provided a distinctive interpretative framework that mediated mothers’ decision-making and shaped emotional meaning. Concepts such as ‘qadar’ (divine decree), ‘ajr’ (spiritual reward), and ‘sadaqah jariyah’ (continuous charity) enabled many mothers to reinterpret perinatal loss as a morally valuable opportunity to help other infants. This theological reframing reduced decisional conflict and supported agency, particularly when religious scholars affirmed the permissibility of donation under regulated rida’a conditions. Mothers described how such guidance alleviated fear, guilt, or confusion, consistent with literature showing that Islamic jurisprudential reassurance plays a key role in reproductive ethics and coping [54,55].
The findings carry significant implications for healthcare practice. First, culturally competent lactation counselling is essential. This means counselling that explicitly integrates religious values, acknowledges rida’a concerns, and affirms the legitimacy of ambivalent emotions. Evidence from culturally attuned maternal-health models shows that such alignment strengthens trust and improves psychological outcomes [56,57].
Second, milk banks serving Muslim populations require structured, transparent, and ethically grounded protocols that address documentation, traceability, and informed consent in ways that respect Islamic jurisprudential sensitivities. Emerging international models demonstrate that when milk-bank processes incorporate religious guidelines, community acceptance increases and conflict diminishes [58,59].
Third, coordinated training between religious leaders and healthcare teams is needed to ensure consistency in counselling. Mismatched messages where clinicians advocate donation but local imams express caution can destabilize mothers emotionally and impede coping. Joint educational initiatives have been shown to reduce conflict and support family well-being [60,61].
Incorporating a quantitative component, such as standardized grief and psychological well-being assessments would allow for statistical comparisons between mothers who choose to donate milk and those who do not, offering a deeper insight into the psychological benefits of milk donation. For policy-making purposes, more in-depth discussion of the legal and ethical implications of breast milk donation in Islamic contexts, particularly regarding the documentation of rida’a would help policymakers craft appropriate guidelines. In particular, providing specific guidelines on how milk banks can operate within Islamic ethical frameworks (e.g., clear donor-recipient documentation to mitigate rida’a concerns), would render the research more practical for healthcare institutions [61,62].

Sections

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Donation has been recognized as therapeutic, helping bereaved mothers navigate grief and reconstruct maternal identity [2,3,4,5,6], yet it remains underexplored and inconsistently implemented across healthcare and cultural settings [7].\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"B8-healthcare-13-03309\", \"B9-healthcare-13-03309\", \"B10-healthcare-13-03309\", \"B11-healthcare-13-03309\", \"B12-healthcare-13-03309\", \"B13-healthcare-13-03309\", \"B14-healthcare-13-03309\"], \"section\": \"1.1. Perinatal Mortality\", \"text\": \"Stillbirth and neonatal death produce unique grief, as mothers mourn both their infant and the loss of their anticipated maternal role [8]. Emotions such as anger, guilt, anxiety, and depression are common [9], and the mother may develop PTSD, a low mood, or sleep disturbances [10]. Notably, prolonged complex grief occurs in ~20\\u201330% of mothers. Broader social responses, such as silence, poor communication, or awkwardness can intensify the sense of loss [11]. Engagement with one\\u2019s emotions aids recovery, while meaning making predicts capacity to manage grief and achieve healing [12]. Some mothers even report post-traumatic growth, experiencing personal transformation after their loss [13,14].\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"B15-healthcare-13-03309\", \"B16-healthcare-13-03309\", \"B17-healthcare-13-03309\", \"B18-healthcare-13-03309\", \"B19-healthcare-13-03309\", \"B11-healthcare-13-03309\", \"B20-healthcare-13-03309\"], \"section\": \"1.2. The Benefits of Breast Milk\", \"text\": \"Breastfeeding provides numerous advantages, including optimal nutrition, gastrointestinal and psychological benefits, and bolstered immune protection [15]. Human milk contains antioxidative and immune-supportive properties [16], thus, lowering the risk of infectious diseases [17]. The World Health Organization (2015) [18] endorsed breastfeeding as the optimal nutrition for infants, and accordingly, NICUs increasingly rely on donor milk when mothers\\u2019 milk is unavailable [19]. Prescription of donor milk has steadily grown [11], with evidence linking it to improved neurodevelopmental outcomes in vulnerable, ill and preterm infants [20].\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"B21-healthcare-13-03309\", \"B2-healthcare-13-03309\", \"B3-healthcare-13-03309\", \"B22-healthcare-13-03309\", \"B23-healthcare-13-03309\", \"B3-healthcare-13-03309\"], \"section\": \"1.3. Bereaved Mothers and Their Breast Milk\", \"text\": \"After loss, lactation continues, requiring management. Options include suppression, gradual reduction, self-expression, or donation [21]. It is known that breast milk holds deep emotional significance for mothers, particularly after perinatal death [2]. In a study conducted in Australia, Welborn [3] found that expressing and donating milk helped bereaved mothers fulfill maternal instincts and process grief. For some, lactation affirms motherhood and memorializes the infant [22,23]. Milk can symbolize hope for mothers who nursed a sick infant or may become a poignant reminder of their loss. For infants who were stillborn, expressing milk may provide a way to navigate grief and maintain a connection with the deceased child [3].\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"B24-healthcare-13-03309\", \"B25-healthcare-13-03309\", \"B24-healthcare-13-03309\", \"B25-healthcare-13-03309\", \"B24-healthcare-13-03309\"], \"section\": \"1.4. Islamic Perspectives on Milk Donation\", \"text\": \"Milk donation involves religious-ethical concerns, particularly, the doctrine of milk kinship (rida\\u2019a), which creates familial bonds through breastfeeding [24,25]. This may subsequently complicate future marital prospects among individuals nursed by the same woman. Thus, the use of milk banks, where pooling obscures donor identity, presents difficulties in tracing kinship ties. Some scholars, i.e., Shaykh Ibn Saalih al-\\u2018Uthaymeen, prohibited milk banks for this reason [24,25], while others, i.e., Y\\u016bsuf al-Qarad\\u0101w\\u012b, allowed them, citing that no religious objections exist [24]. Moreover, recent Islamic religious rulings show increasing support for milk donation within Islamic frameworks.\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"B26-healthcare-13-03309\", \"B27-healthcare-13-03309\", \"B27-healthcare-13-03309\", \"B28-healthcare-13-03309\", \"B29-healthcare-13-03309\"], \"section\": \"1.4. Islamic Perspectives on Milk Donation\", \"text\": \"In 2023, the Minnesota Islamic Council issued a fatwa endorsing pasteurized donor milk, noting health benefits and minimal kinship risk [26,27]. In the UK, the United Kingdom Association for Milk Banking and the Muslim Council of Britain likewise supported donor milk, recommending robust systems to ensure traceability in order to mitigate rida\\u2019a concerns [27,28]. Though explicit rulings on post-loss milk donation specifically after fetal loss are rare, Islamic principles emphasizing the importance of preserving life and altruism support its permissibility [29].\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"B30-healthcare-13-03309\"], \"section\": \"1.5. Rationale for Study\", \"text\": \"Maternal grief spans a range of challenging emotions [30]. Our aims were to examine mothers\\u2019 experiences of expressing and donating breast milk during bereavement and examine the permissibility of this practice within Islamic teachings. Although, perinatal loss and breast milk donation have been examined in several cultural contexts, a clear gap remains in the literature. Firstly, very few studies have specifically focused on bereaved Muslim mothers, despite the unique religious, social, and ethical factors shaping their experiences. Secondly, no existing research has combined an Interpretative Phenomenological Analysis (IPA) with an Islamic legal-ethical analysis, leaving unexplored how religious jurisprudence interacts with mothers\\u2019 lived experiences. Thirdly, milk donation after perinatal loss remains clinically unsupported and ethically under-addressed in Muslim-majority contexts, where rida\\u2019a-related concerns and limited institutional guidance create significant ambiguity.\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"B31-healthcare-13-03309\", \"B32-healthcare-13-03309\", \"B33-healthcare-13-03309\", \"B34-healthcare-13-03309\"], \"section\": \"2.4. Research Design\", \"text\": \"The Interpretative Phenomenological Analysis (IPA) was chosen as the research methodology allowing for a structured and in-depth analysis of lived experiences, emphasizing both phenomenological meaning-making and interpretative contextualization within health-related frameworks. Creswell [31] contends that IPA emphasizes deep exploration of \\u201clived experiences\\u201d over broad participant samples, making it ideal for studying breast milk donation after pregnancy loss\\u2014a complex and sensitive topic best understood through rich qualitative data [32]. IPA employs \\u201cdouble hermeneutics,\\u201d combining interpretative analysis\\u2014where researchers contextualize participant data within psychological frameworks\\u2014and phenomenological analysis [33], rooted in Heidegger and Gadamer\\u2019s philosophies [34], to explore and give voice to participants\\u2019 lived experiences and personal meanings. This idiographic focus allows for a systematic, in-depth understanding of individual experiences.\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"B35-healthcare-13-03309\"], \"section\": \"2.5. Sample Size and Data Saturation\", \"text\": \"The sample size was guided by the principle of data saturation [35]; thereby, data collection continued until recurring insights and a stable representation of the shared reality emerged. Data adequacy was achieved when no new experiential meanings were emerging, consistent with IPA\\u2019s emphasis on depth rather than breadth. Following multiple iterative readings of the transcripts and the development of emergent and superordinate themes, the research team determined that additional interviews were no longer generating novel experiential insights. This point was, therefore, considered sufficient to establish analytic adequacy within the IPA framework\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"B36-healthcare-13-03309\"], \"section\": \"2.7. Ethical Considerations\", \"text\": \"Ethical approval for this study was obtained from the Ethics Committee of the academic institution affiliated with the second author, approval number 2023-1010-MTA. Participants were required to sign an informed consent form detailing the terms of their participation and the conditions of publication of the study\\u2019s findings. To maintain confidentiality and privacy, demographic data were aggregated and presented exclusively at the group level, following the recommendations of Morse [36]. The informed consent document stated that participation was both anonymous and confidential and assured participants of their right to withdraw from the interview at any time. Furthermore, the document informed participants that selected excerpts from their interviews might be included in future publications, thereby ensuring transparency in the research process.\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"B37-healthcare-13-03309\", \"B38-healthcare-13-03309\"], \"section\": \"2.8. Interview Protocol\", \"text\": \"Following the methodological framework proposed by Josselson [37], the interview was structured around a single, comprehensive question, allowing participants the flexibility to respond as they saw fit. The session began with an informal dialogue to establish rapport and set the participant at ease. The duration of the interview was generally between 60 and 70 min, following the guidelines suggested by Roberts [38]. The primary question posed during the interview was: \\u201cPlease articulate your views and the Islamic perspective regarding milk donation.\\u201d\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"B39-healthcare-13-03309\"], \"section\": \"2.9.2. Interview Topics and Key Findings\", \"text\": \"The interviews covered various aspects, including milk production, motivations for milk donation, Islamic perspectives, religious leaders\\u2019 opinions, the husband\\u2019s perspective on milk donation, the role of the milk bank, staff support, and the connection to maternal milk, and decision-making processes. Participants were encouraged to provide detailed accounts of their experiences and share how they found meaning in their journey. As each discovery during the interview was a product of the relationship between the participants and the researcher, the emphasis on demonstrating empathy and sincerity remained a central methodological component [39].\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"B40-healthcare-13-03309\", \"B41-healthcare-13-03309\", \"B42-healthcare-13-03309\", \"B43-healthcare-13-03309\"], \"section\": \"3.1. Theme 1. Breast Milk Donation After Pregnancy Loss as a Meaningful and Value-Congruent Practice\", \"text\": \"Women who experienced perinatal loss frequently described breast milk donation as a deeply meaningful act aligning with their moral and spiritual values. Rather than abruptly suppressing lactation\\u2014a physically and emotionally painful process\\u2014donation offered a purposeful alternative [40,41,42]. Providing milk for vulnerable infants imbued their loss with significance, helping them navigate the overwhelming sense of emptiness that followed the death of their baby, restoring their sense of agency and transforming their pain into an act of altruistic giving and healing [43].\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"app1-healthcare-13-03309\"], \"section\": \"3.1. Theme 1. Breast Milk Donation After Pregnancy Loss as a Meaningful and Value-Congruent Practice\", \"text\": \"Testimonies from donating mothers illustrate the emotional experience associated with this act. Hanan, who experienced a stillbirth: \\u201cKnowing that my breast milk could save lives provided me with a purpose during a time when I felt as if I had lost everything.\\u201d Layla, who lost her baby in the 8th month of pregnancy: \\u201cDonating was my way of giving life, providing fulfillment and comfort, even after losing my baby.\\u201d Khadijah, whose infant died: \\u201cThe donation allowed me to transform my loss into a positive act, offering another baby what mine never had the chance to receive.\\u201d Asmaa, who lost her daughter during child-birth: \\u201cKnowing that my breast milk was helping other babies was a ray of light in the darkest period of my life.\\u201d Fatima, speaking as a physician and as a mother who experienced pregnancy loss, shared: \\u201cIn medicine, we talk about evidence-based healing, however, grief does not work that way. Donating my milk was the only real thing I could hold onto, it helped me heal.\\u201d (Appendix A).\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"app2-healthcare-13-03309\"], \"section\": \"\", \"text\": \"\\u201cI thought everything had ended when she passed away, but then I realized that my milk is not just a memory of her, but also a gift to other children. Through every donation, she remains part of this world.\\u201d (Appendix B).\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"B44-healthcare-13-03309\", \"B45-healthcare-13-03309\"], \"section\": \"3.3. Theme 3. Healing Through Donation: Navigating Pain, Coping, and Emotional Restoration\", \"text\": \"The process of pumping and donating milk was described as a complex emotional experience in which grief, physical pain, hope, and fulfillment coexisted. For many, the act of breast milk donation provides women with the opportunity to channel their pain into a positive act, thus, transforming raw grief and a sense of helplessness into restorative purpose and creating a meaningful healing process connecting the body, mind, and faith [44,45]. Soraya, a mother whose infant daughter died in the NICU:\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"app3-healthcare-13-03309\"], \"section\": \"3.3. Theme 3. Healing Through Donation: Navigating Pain, Coping, and Emotional Restoration\", \"text\": \"Theme 3 demonstrates how breast milk donation becomes a vital pathway of emotional restoration for bereaved mothers. The women felt that their pain contributed to something greater and helped them move through grief with intention and dignity and a sense of purpose (Appendix C).\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"B46-healthcare-13-03309\", \"B47-healthcare-13-03309\"], \"section\": \"3.4. Theme 4. Mission and Solidarity: Contributing to Infant Survival and the Wider Community\", \"text\": \"For many women who lose infants, breast milk donation becomes a mission in knowing that they are providing life to sick and premature infants, as well as children who lack access to their own mother\\u2019s milk. This strengthened their sense of solidarity, and established a support network founded on compassion, hope, and generosity, and has been demonstrated in studies conducted across regions with a predominately Muslim culture, such as Nigeria [46] and Yemen [47].\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"app4-healthcare-13-03309\"], \"section\": \"\", \"text\": \"Khadijah: \\u201cMy pain didn\\u2019t disappear, but it turned into something meaningful by helping others.\\u201d (Appendix D).\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"app4-healthcare-13-03309\"], \"section\": \"3.4. Theme 4. Mission and Solidarity: Contributing to Infant Survival and the Wider Community\", \"text\": \"Through donating, women transformed their grief into collective care, positioning themselves as part of a wider community committed to nurturing vulnerable children (Appendix D).\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"B48-healthcare-13-03309\"], \"section\": \"3.6. Practical Considerations\", \"text\": \"Breast milk donation is a highly commendable act in Islam; however, recipient infants must be properly documented in order to prevent future legal complications regarding marriage. Because of the rida\\u2019a guidelines, this carries significant implications, particularly, concerning marriage restrictions, and thus, societal repercussions [48]. According to Islamic jurisprudence, if a baby consumes breast milk at least five full times from a woman who is not their biological mother, they are considered milk siblings (rida\\u2019a), making them legally related to the donor mother\\u2019s biological children. Therefore, careful documentation of milk donations and recipient identities are essential, especially when donations are facilitated through milk banks. Documentation practices were valued for clarity in managing milk-kinship implications, though women emphasized that support, empathy, and respectful treatment mattered even more.\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"B49-healthcare-13-03309\"], \"section\": \"4. Discussion\", \"text\": \"For many professional mothers, despite their structured careers and personal achievements, the death of a child often disrupts their sense of identity. The bereaved mothers who were interviewed frequently described donating milk as a meaningful and purposeful response to grief, one that restores a sense of agency and allows continued contribution, both medically and emotionally [49]. Milk donation provides a way for such women, especially those who are used to control and structure in their professional lives, to reclaim a sense of purpose after the abrupt loss of agency caused by stillbirth or neonatal death. Many professional mothers viewed milk donation as an extension of their core identity\\u2014the desire to contribute meaningfully to society. The feeling of maintaining a bond with their lost child by helping to nourish other infants offered not only solace but a renewed sense of identity.\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"B50-healthcare-13-03309\", \"B51-healthcare-13-03309\", \"B52-healthcare-13-03309\", \"B53-healthcare-13-03309\"], \"section\": \"4. Discussion\", \"text\": \"The experiences of Muslim mothers who donated breast milk after perinatal loss align with cross-cultural research on parental bereavement. Across Western, African, and Asian contexts, mothers commonly seek to maintain an emotional bond with the deceased child through symbolic or altruistic acts [50,51]. In our study, breast milk donation functioned as such an act. The Muslim mothers\\u2019 narratives echo findings from Nigeria, Australia, India, and Europe, where parents oscillate between pain and fulfillment as they affirm relational continuity while dealing with post-loss emotional instability [52,53].\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"B54-healthcare-13-03309\", \"B55-healthcare-13-03309\"], \"section\": \"4. Discussion\", \"text\": \"Within this broader cross-cultural landscape, Islamic perspectives provided a distinctive interpretative framework that mediated mothers\\u2019 decision-making and shaped emotional meaning. Concepts such as \\u2018qadar\\u2019 (divine decree), \\u2018ajr\\u2019 (spiritual reward), and \\u2018sadaqah jariyah\\u2019 (continuous charity) enabled many mothers to reinterpret perinatal loss as a morally valuable opportunity to help other infants. This theological reframing reduced decisional conflict and supported agency, particularly when religious scholars affirmed the permissibility of donation under regulated rida\\u2019a conditions. Mothers described how such guidance alleviated fear, guilt, or confusion, consistent with literature showing that Islamic jurisprudential reassurance plays a key role in reproductive ethics and coping [54,55].\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"B56-healthcare-13-03309\", \"B57-healthcare-13-03309\"], \"section\": \"4.1. Clinical Implications\", \"text\": \"The findings carry significant implications for healthcare practice. First, culturally competent lactation counselling is essential. This means counselling that explicitly integrates religious values, acknowledges rida\\u2019a concerns, and affirms the legitimacy of ambivalent emotions. Evidence from culturally attuned maternal-health models shows that such alignment strengthens trust and improves psychological outcomes [56,57].\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"B58-healthcare-13-03309\", \"B59-healthcare-13-03309\"], \"section\": \"4.1. Clinical Implications\", \"text\": \"Second, milk banks serving Muslim populations require structured, transparent, and ethically grounded protocols that address documentation, traceability, and informed consent in ways that respect Islamic jurisprudential sensitivities. Emerging international models demonstrate that when milk-bank processes incorporate religious guidelines, community acceptance increases and conflict diminishes [58,59].\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"B60-healthcare-13-03309\", \"B61-healthcare-13-03309\"], \"section\": \"4.1. Clinical Implications\", \"text\": \"Third, coordinated training between religious leaders and healthcare teams is needed to ensure consistency in counselling. Mismatched messages where clinicians advocate donation but local imams express caution can destabilize mothers emotionally and impede coping. Joint educational initiatives have been shown to reduce conflict and support family well-being [60,61].\"}, {\"pmc\": \"PMC12733250\", \"pmid\": \"\", \"reference_ids\": [\"B61-healthcare-13-03309\", \"B62-healthcare-13-03309\"], \"section\": \"4.2. Recommendations for Further Study\", \"text\": \"Incorporating a quantitative component, such as standardized grief and psychological well-being assessments would allow for statistical comparisons between mothers who choose to donate milk and those who do not, offering a deeper insight into the psychological benefits of milk donation. For policy-making purposes, more in-depth discussion of the legal and ethical implications of breast milk donation in Islamic contexts, particularly regarding the documentation of rida\\u2019a would help policymakers craft appropriate guidelines. In particular, providing specific guidelines on how milk banks can operate within Islamic ethical frameworks (e.g., clear donor-recipient documentation to mitigate rida\\u2019a concerns), would render the research more practical for healthcare institutions [61,62].\"}]"

Metadata

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