Table 2 Characteristics of the two main HMB pathways providing safety in accordance with religious concerns
Pathway 1: avoiding the creation of milk kinship | |
Pooling of donor human milk from several to many women | Infants are fed only a small amount of milk from several mothers which means that the criteria for milk kinship requiring that the infant be fed to satiety by milk from one woman is not met [48, 50] |
Donor human milk is not pooled but is shared between many infants | Infants are fed only a small number of feeds from any one mother meaning that the criteria for milk kinship requiring a certain number of full feeds is not met [46] |
Infants receive breastmilk from many women | Infants are fed only a small amount of milk from several to many women which means that the requirement for satiety and/or number of feeds is not met by any single woman [46, 48] |
Feeding of breastmilk by means other than direct breastfeeding such as nasogastric tube, bottle or cup | Where the infant does not suckle at the breast, the emotional bonding that occurs during breastfeeding does not occur and bonding criteria for milk kinship is not met [2, 46, 47] |
Anonymity of women who have donated to the milk bank | Milk kinship cannot be created if the provider of the breastmilk is unknown [46, 48] |
Pathway 2: recording milk kinship and avoiding consanguineous relationships | |
 Breastmilk from multiple donors is not pooled, and infants receive milk from one or few donor mothers who are known | Single or few known donors enables records to be kept of who has donated milk to each infant so that the milk kinship relationships created are few and known and consanguineous relationships can be avoided [49, 51] |
 System of registration and records kept of the identity of breastmilk donors and breastmilk recipients | Documentation of milk donors and recipiences enables the kinship relationship created by the consumption of breastmilk to be recognised and consanguineous relationships avoided [2, 47, 51] |
 Introducing milk donor mothers and milk recipient mothers to one another | Where milk donor and milk recipient family know each other, they can ensure that consanguineous relationships are avoided [49, 51, 52] in a similar way to the wet nursing tradition |