Breastfeeding an Adopted Baby According to Islamic Law

Written by: dr Reica Aprilyana

RS Permata Depok – RS Ali Sibroh Malisi Jagakarsa

Case 1

Mrs. N and Mr. had been married for 14 years and did not have any biological children. Mrs. N had a history of hysterectomy in 2021 due to infection during myoma surgery. This couple initially consulted at a lactation clinic in one of the clinics in Jakarta in purpose to be able breastfeed their adopted baby. The lactation doctor referred them to a hospital in West Java which could provide lactation induction treatment.

The adoptive parents do not only want to take care for this baby, but also want to be able to breastfeed for up to 2 years. The reason adopted mothers want to breastfeed their adopted babies is to create a strong emotional bond between the mother and her adopted baby and hopes to establish mahram with the mother with the terms and conditions that apply in accordance with Islamic law.

In October 2021, the adoptive mother and father went for consultation. At that time the baby had not yet been born. The biological father is the adoptive mother’s cousin and the baby is his 3rd child. The letter of reason for handing over the baby from the biological parents to the adoptive parents had been received, at that time the baby was estimated to be born in November 2021. The lactation doctor explained the lactation induction program starting from collecting the adoptive parents’ files and adopted baby’s files. Then, the mother was referred to consult an OBGYN doctor for further examination for the provision of contraceptive pills that the mother will consume in preparation for breastfeeding. The parent was advised that supplementation was given using formula milk or donor breast milk, babies should not be given pacifiers during lactation induction, and baby should be brought for control regularly until they are 2 years old.

The baby (Baby A) was male, born spontaneously male with a birth weight of 3800 grams. Baby A was breastfed by the biological mother 4 times, then in the afternoon the baby was taken to the house of the adoptive mother. During the first 6 days the baby was breastfed directly by the adoptive mother with a supplementary device containing formula milk. There was an occasion when the mother left the baby at home, then the baby was given formula milk by the grandmother using a teat-bottle. Since then the baby often refused to breastfeed directly from the mother’s breast using a supplementary device.

In December 2021, the adoptive parents came back to the lactation clinic for inpatient lactation induction with Baby A. Baby A was 26 days old when they came to the lactation clinic and weighed 4285 grams, an increase of 18.6 grams/day from birth weight. Based on physical examination, it was observed that the general condition was good. The adoptive mother’s breast milk had started to come in, although not much. The process of breastfeeding with a Supplementary Nursing System (SNS) was observed. The SNS was filled with formula milk and the baby showed an intention to latch onto the mother’s left breast. Baby A was fussy at the start of breastfeeding but finally able to suck continuously until the formula milk runs out in the SNS.

During inpatient lactation induction, mother and baby have continuous skin to skin contact using Praborini method. Babies was not be given pacifiers; they can only breastfeed directly at the mother’s breast using SNS containing formula milk with frequency as often as the baby’s desire (no prescribed schedule). The mother’s contraceptive pills are continued for 1 cycle and the lactogog is continued. It is recommended to play Al-Quran recitation so that the mother and baby are calmer during the treatment.

The mother and the baby were hospitalized for 3 days. The baby can breastfeed smoothly from both mother’s breasts using SNS. They were advised to come for control within 1 week after returning home.

At the first control after hospitalization, the baby was 1 month 6 days old, the baby’s weight was 4540 grams, an increase of 25.5 grams/day, and his nutritional status was good. The mother was still taking birth control pills and lactogogue. The baby was still breastfed directly using SNS. The baby was given BCG immunization.

During the 2nd control, the baby was 1 month and 19 days old, weighed 4815 grams, an increase of 21.1 grams/day and considered within good nutritional status. The baby was still breastfed with SNS and can consume 90 cc of formula milk each feed. The mother’s breast milk has started to increase, the contraceptive pill had been stopped and the lactogogue dose had been increased.

During the 3rd control, the baby was 2 months and 18 days old, weighed 5460 gr, an increase of 16.5 gr/day and considered within good nutritional status. The baby was still breastfeeding with SNS. The baby was given Hep B-DPT-Polio-HIB immunization.

During the 4th control, the baby was 4 months old, weighed 6210 grams, an increase of 17.8 grams/day, and considered within good nutritional status. The baby was still breastfed with SNS, but sometimes at night the mother breastfed directly without SNS. The baby was given Hep B-DPT-Polio-HIB immunization. The lactogogue dose was reduced slowly, because the mother’s breast milk had started to increase.

During the 5th control, the baby was 5 months and 2 days old, weighed 6715 gr, increased by 15.7 gr/day. The baby was still breastfed directly with SNS. Babies were given Hep B- DPT-Polio-HIB immunization. There were no breastfeeding complaints.

During the 6th control, the baby was 6 months and 3 days old, weighed 7085 gr, increased by 11.9 gr/day. The baby was still breastfed with SNS and had been given early complementary feeding but it was not in accordance with WHO standards. The mother consulted to a lactation clinic for early complementary feeding counseling.

During the 7th control, the baby was 7 months and 29 days old, weighed 7810 gr, increased by 12.9 gr/day. The baby was still breastfed with SNS and had been given early complementary feeding. The mother had plenty of breast milk. The baby was given PCV 2 immunization, Vitamin D, Iron and the mother’s lactogogue dose was reduced slowly.

During the 8th control, the baby was 9 months and 4 days old, weighed 8125 grams, increased by 9 grams/day. The baby was still breastfed but if the baby had been sleepy, SNS would have not been used. Babies were given MR immunization.

During the 9th control, the baby was 1 year old and the baby’s weight was 8775 grams, an increase of 6 grams/day. The baby was still breastfeeding directly from the mother. However, he had bloody diarrhea. The baby received diarrhea therapy and vitamin D.

By the end of treatment, the baby was 23 months old, still breastfeeding directly at the breast with and without SNS. The baby’s growth and development were also good; the baby had been given complementary feeding with an adult texture and a family menu.

Case 2

Mrs D and Mr A have a child who is 14 years old and has been successfully breastfed for up to 1.5 years. In the last 13 years, Mrs. D had never been pregnant again. She had tried to get pregnant several times but failed. Mrs D was diagnosed by the doctor having blocked right and left tubes. In addition, her husband’s was diagnosed having abnormal sperm. The doctor offered IVF but the family did not agree.

In October 2021, Mrs. D came for a consultation, that she would adopt a baby girl who was the child of Mrs. D’ sister. At that time, Baby A was 5 months and 15 days old. The adopted mother wanted to breastfeed the adopted baby for the reason that it has a strong emotional and mahram bond with the father.

In April a baby girl was born spontaneously, with a birth weight of 3200 gr. The baby was taken care by the adoptive parents 1 month prior to the first consultation. The baby handover letter has also been agreed upon by both parties. The birth mother handed over the baby to the adoptive parents citing economic difficulties. The birth mother breastfed the baby for the first 2 weeks, then stopped breastfeeding directly and the baby was given formula milk with a teat-bottle.

From the physical examination, it was found that the baby’s weight was 7295 grams, and her general condition was good. However, she had not been able to breastfeed to the adoptive mother yet. The adopted mother’s breast milk had not come in at this time.

Inpatient lactation induction treatment was carried out using the Praborini method. Praborini method involves continuous skin to skin contact between the baby and mother, direct breastfeeding, and use of SNS filled with formula milk that the baby usually drinks. If the baby does not want to breastfeed, the baby is given a drink from a glass by the nurse. The mother was given small doses of birth control pills and lactogogue. During treatment, it is recommended to turn on murotal (Quran recitation) so that the mother and baby are calm.

The inpatient lactation induction treatment was conducted for 1 day 1 night. Mother and baby were allowed to go home and continue the treatment at home. They were scheduled for control at the pediatrician’s clinic 1 week later.

The first control was at the pediatric clinic. The baby was 5 months and 21 days old.  The baby’s weight was 7620 grams and the nutritional status was good. The mother said the baby was easily distracted when breastfeeding, the mother felt her breasts were full but the milk was still not coming out. Mother still took birth control pills and lactogogue.

During the 2nd control, the baby was 6 months and 6 days old. The baby’s weight was 7880 gr and the nutritional status was good. The mother says the milk had come out and the baby was breastfeeding well at the breast with SNS. Birth control pills were stopped, the mother was advised to have acupuncture and the lactogogue dose was increased.

During the 3rd control, the baby was 7 months and 4 days old. The baby’s weight was 8365 grams and the nutritional status was good. The mother had the baby receive regular immunizations at the midwife. The baby had started early complementary feeding (MPASI) with good progress. The mother’s breast milk had increased. Galactogogue and acupuncture were continued.

During the 4th control, the baby was 8 months and 9 days old. The baby’s weight was 8800 g and the nutritional status was good. The mother’s breast milk was starting to get a lot. Therefore, the lactogogue was continued with the dose was reduced gradually.

During the 5th control, the baby was 9 months and 21 days old. The baby’s weight was 9290 gr and the nutritional status was good. The mother had no complaints about the breastfeeding process. The baby was still breastfeeding with SNS. Galactogogue was continued with the dose reduced gradually.

During 6th control, the baby was 10 months and 21 days old. The baby’s weight was 9610 gr and the nutritional status was good. The baby was growing and developing well. The baby was still breastfeeding directly at the breast, sometimes breastfeeding with SNS, sometimes without SNS. Galactogogue was continued with the dose reduced gradually.

During the 7th control, the baby was 1 year and 24 days old. The baby’s weight was 9900 gr and the nutritional status was good. The baby was still breastfeeding and the mother’s galactogogue dose was reduced.

The baby stopped breastfeeding from the mother at the age of 1.5 years. By that age, the baby had complementary feeding with family food menu and texture suitable for adults.

Discussion

Breastfeeding is the most optimal process for feeding babies 0-6 months. WHO recommends that babies should breastfeed exclusively for 6 months and receive complementary foods starting from the age of 6 months and continue breastfeeding until the age of 2 years or more.

The majority of the population in Indonesia is Muslim. In Islamic religious teachings there is the term mahram regarding kinship relationships where marriage is not permitted between men and women. Becoming a mahram in the context of breastfeeding an adopted baby facilitates contact between mother and adopted child or father and adopted child. Babies who are breastfed by adoptive mothers through hormonal therapy will be considered their breastfed children. (Praborini, Febriyanti, & Subekti, 2019)

Lactation induction is the process of breastfeeding in women who are not pregnant or have not breastfed for a long period of time. In this case, the husband and wife had been preparing themselves before the baby was born. Lactation induction is beneficial for both the adoptive mother and the adopted baby. The risk of breast and ovarian cancer will decrease in adoptive mothers who breastfeed. Adoptive mothers also benefit from skin-to-skin contact which encourages the release of oxytocin hormone. This will increase the mother’s self-confidence, providing better outcomes for the emotional well-being of the baby. (Al Mohsen & Jamal, 2021)

The lactation induction protocol according to the Praborini Method is:

1.     Skin to skin 

The Praborini method emphasizes skin to skin to rebuild the bond between mother and baby so that they can attach and breastfeed. Inpatient lactation induction aims to focus on psychological bonding.

2.     Lactation induction

Starting with using birth control pills containing estrogen and progesterone for 3 weeks, we used brand Yasmin® because it contains high levels of progesterone and it is available in Indonesia (drospirenone 3 mg and ethynylestradiol 0.03mg). The mother was consulted with Obgyn doctor before consuming Yasmin® to ensure there were no contra indications. Ideally, when the biological mother is 5-6 months pregnant, the adoptive mother should start taking Yasmin®.

3.     Increase breast milk production

The mother consumes galactogogue according to the dosage given by the lactation doctor. Apart from pharmacological therapy, acupuncture is also carried out to increase breast milk production. According to Traditional Chinese Medicine (TCM), insufficient breast milk production can be explained by 2 mechanisms: as a deficiency of Qi (vital energy) and blood and stagnation of liver Qi. Acupuncture is performed 6-8 times, carried out by experienced and qualified acupuncture doctors. 

4.     Supplementation for the baby

Stimulation of the baby’s sucking is to increase breast milk production, increase bonding between mother and baby and provide adequate food for the baby. We do not ask mothers to express regularly to increase milk production as practiced in the US. We prefer to maximize direct stimulation from the baby. In this way, mothers can optimize their time to care for their adopted baby while also resting and relaxing through breastfeeding sessions rather than spending time pumping their breasts. The adoptive mother breastfeeds the baby using SNS and the parents can choose whether to use formula milk or donor breast milk. (Praborini, Febriyanti, & Subekti, 2019)

In Islam, adopted babies remain to have nasab (family lineage) according to their biological father. As mentioned in Surah Al Ahzab verses 4 and 5.

“Allah does not place two hearts in any person’s chest. Nor does He regard your wives as ˹unlawful for you like˺ your real mothers, ˹even˺ if you say they are.1 Nor does He regard your adopted children as your real children.2 These are only your baseless assertions. But Allah declares the truth, and He ˹alone˺ guides to the ˹Right˺ Way.” (33:4)

“Let your adopted children keep their family names. That is more just in the sight of Allah. But if you do not know their fathers, then they are ˹simply˺ your fellow believers and close associates. There is no blame on you for what you do by mistake, but ˹only˺ for what you do intentionally. And Allah is All-Forgiving, Most Merciful.” (33:5)

Ibn Umar once explained this verse,

We used not to call Zaid bin Haritha the freed slave of Allah’s Messenger (ﷺ) except Zaid bin Muhammad till the Qu’anic Verse was revealed: “Call them (adopted sons) by (the names of) their fathers. That is more than just in the Sight of Allah.” (HR Bukhori 4782 and Muslim 2425)

Solutions for adopted children to become mahram (Tuasikal, 2020)

1.     Adopt child from someone who is still related to the wife or husband.

For example, if you want to adopt a girl, you can look for a daughter from your husband’s relative (husband’s niece), because it is a niece, so she is a mahram.

If you want to adopt a boy, you can take the son of your wife’s sibling. So the status of the wife is mahram for the boy because the wife is his aunt.

It’s just important to note that the status of an adopted child is not like that of a blood-born child, so there are no inheritance rights.

2.     Became a mahram relationship because of breast milk

Hadith 44 from Jamiul Ulum Wal Hikam Ibnu Rajab

Aishah (may Allah be pleased with her) reported that the Prophet (peace

be upon him) said, “Suckling relations make all things unlawful which

are unlawful through corresponding birth (blood) relations”

(Recorded by AI-Bukhary no 2646, 5099  and Imam Muslim no 1444)

In the Al-Quran, Surah An-Nisa verses 22-24 explain in great detail about mahram

(4:22) Do not marry former wives of your fathers—except what was done previously. It was indeed a shameful, despicable, and evil practice.

(4:23) ˹Also˺ forbidden to you for marriage are your mothers, your daughters, your sisters, your paternal and maternal aunts, your brother’s daughters, your sister’s daughters, your foster-mothers, your foster-sisters, your mothers-in-law, your stepdaughters under your guardianship if you have consummated marriage with their mothers—but if you have not, then you can marry them—nor the wives of your own sons, nor two sisters together at the same time—except what was done previously. Surely Allah is All-Forgiving, Most Merciful.

(4:24) Also ˹forbidden are˺ married women—except ˹female˺ captives in your possession.1 This is Allah’s commandment to you. Lawful to you are all beyond these—as long as you seek them with your wealth in a legal marriage, not in fornication. Give those you have consummated marriage with their due dowries. It is permissible to be mutually gracious regarding the set dowry. Surely Allah is All-Knowing, All-Wise

There are two conditions to become a mahram through breastfeeding: (Tuasikal, 2020) (Setiawan, 2017)

1.     Baby’s age is less than 2 years

(2:233) “mothers will breastfeed their offspring for two whole years, for those who wish to complete the nursing ˹of their child˺”

From Ibn ‘Abbas radhiyallahu ‘anhuma, he said,

“There is no breast milk (which makes a mahram) except at the age of two years” (HR. Baihaqi in As-Sunan Al-Kubra, 7:462)

2.     At least five times breastfeeding

One feeding is defined when the baby breastfeeds until he is full or releases his own suction.

‘A’isha (Allah be pleased with, her) reported that it had been revealed in the Holy Qur’an that ten clear sucklings make the marriage unlawful, then it was abrogated (and substituted) by five sucklings and Allah’s Apostle (ﷺ) died and it was before that time (found) in the Holy Qur’an (and recited by the Muslims). (HR. Muslim, no. 1452)

In the second case, baby A is the mother’s nephew, so he has become a mahram for the adopted mother and father. Mothers want babies to have a strong inner bond, babies to be healthier and have a strong immune system. So mothers want to breastfeed their babies for up to 2 years. However, the lineage of an adopted baby is still linked to the biological parents.

Induced lactation in adopted babies can become a mahram because the Ar-Radhaa’ process occurs. However, in this case we don’t know when exactly they will become a mahram because the baby is still using SNS in the breastfeeding process. If the baby is 5 times full then he can become a mahram, Wallahua’lam. The growth and development of both babies is also good. Both babies are still breastfeeding from their adopted mother. Adopted children may not use the names of their adoptive parents directly, except as a form of identification. Adoptive parents do not have the right to be guardians/custodian in the marriage of an adopted child. Adopted children may be given a gift from their adoptive parents as provisions for their future life. However, the provision is that no more than 1/3 of the adoptive parents’ assets will be passed on to their rightful heirs. 

The requirements and procedures for adopting a child based on the Directorate General of Population and Civil Registry (DUKCAPIL) of the Ministry of Home Affairs are as follows:

Based on Presidential Decree no. 96 of 2018, a child can be registered as a member of his adoptive parents’ family with the relationship status with the head of the family as “child”. Furthermore, the name of the biological father/mother remains listed in the father and mother name column. This means that the data on the child’s birth certificate must be correct, there must be no manipulation or lies.

If the child has been registered in the Family Card and has a Residency Identification Number (NIK), a birth certificate can then be made with the names of the biological parents still listed on the certificate.

If a court decision with permanent legal force regarding the adoption of the child has been issued, it must be reported to the local Dukcapil Service. Based on this report, the civil registration official then makes notes on the birth certificate. The note is a statement that the child whose name is listed on the birth certificate has been adopted by his adoptive parents.

Completing the aforementioned process, the adoption process through this registration, as regulated in Article 47 of Presidential Decree no. 96 year 2018 concerning Requirements and Procedures for Population Registration and Civil Registration, has been completed administratively. Therefore, the relationship between the Head of the Family and the adopted child is as “child” in the Family Card. The names of the biological parents still listed in the parent’s name column.

Furthermore, Article 6 PP no. 54 year 2007 explains that adoptive parents are obliged to inform adopted children about their origins and biological parents. This is also in accordance with Law no. 35 of 2014 concerning amendments to Law No. 23 of 2022 concerning Child Protection, in Article 27 that children have the right to know their origins from the moment they are born.

Sanctions for Illegal Child Adoption

Registering an adopted child as a biological child is against the law. If that happens, it is certain that there was manipulation of data during recording so that it could have criminal indications.

Article 94 of Law no. 24 year 2013 concerning Amendments to the Law. No. 23 year 2006 concerning Population Administration states that anyone who manipulates elements of population data is threatened with imprisonment for a maximum of 6 years and/or a fine of a maximum of IDR 75 million. Dukcapil**

Conclusion

Islamic law has regulated in great detail regarding adoption and mahram. This is to avoid marriages between blood brothers which lead to incest. Apart from that, it is also to maintain the lineage (blood relationship) between the child and the biological parents. Therefore, adoption or breastfeeding must be done clearly and carefully in accordance with Islamic law and Indonesian state law.

Referensi

Al Mohsen , Z. A., & Jamal, H. F. (2021). Induction of Lactation After Adoption in a Muslim Mother With History of Breast Cancer: A Case Study. Journal of Human Lactation, 173-178.

Praborini, A., Febriyanti, D., & Subekti, R. (2019). Induced Lactation for Adoptive Breastfeeding Dyads. Clinical Lactation .

Setiawan, T. (2017). Persusuan (Ar-Radhaa’) menjadikan Kemahraman dalam Perkawinan (Kajian Tafsir Maudu’i Al Quran Surat An Nisa Ayat 23). Jurnal Ilmiah Syariah, 19-30.

Sukardi. (2018). Adopsi Anak Dalam Hukum Islam . Raheema, Jurnal Studi Gender Anak , 173-194.

Tuasikal, M. A. (2020, Juli 1). Karena Persusuan Menjadi Mahram dan Solusi Anak Angkat (Hadits Jamiul Ulum wal Hikam #44). Retrieved from rumaysho.com: https://rumaysho.com/25147-karena-persusuan-menjadi-mahram-dan-solusi-anak-angkat-hadits-jamiul-ulum-wal-hikam-44.html

https://dukcapil.kemendagri.go.id/berita/baca/1046/mau-angkat-anak-simak-syarat-dan-prosedur       hukumnya