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Ramadan is a month of fasting practiced by Muslims across the world. From sunrise to sunset throughout the month, they abstain from all food and drink. Fasting is mandatory for all adult Muslims with a few exceptions, such as those who are menstruating, acutely or chronically ill, and breastfeeding.
Should breastfeeding mothers fast?
Although fasting during Ramadan is likely to negatively impact the health of both breastfeeding mothers and babies, many breastfeeding mothers decide to fast. According to Islamic law, if there is concern that fasting may harm the health of a mother or her child, she is exempt from fasting and can make up for fasting days later on in the year.
Breastfeeding mothers must consider numerous factors that determine the impact of fasting on breastfeeding, such as the child's age, growth rate, mother's nutrition, and the mother's health status. The age of the child is the most important aspect to consider when deciding whether to fast during Ramadan.
The book ‘Breastfeeding in Ramadan’ notes that women who have a baby less than six months old, make almost 1 liter of breast milk a day, live in a hot climate, are low income, tandem nurse, have multiples (twins, triplets, etc), and who are older than 35 years are most at risk of severe dehydration and should not fast until weaning. The same goes for women who have confirmed low milk supply, need to supplement, have a child that is underweight or ill, take medications or have health conditions that make it difficult to breastfeed. If a mother wants to fast, she can partially fast—committing to two to three days a week. (1)
Newborns to six months old
Experts advise breastfeeding mothers of children under six months not to fast, as breastfeeding during this age period is the primary source of nutrition for the child. During the fasting period, breastfeeding women are more likely to feel hungry and thirsty, which also puts them at risk of dehydration; this may lead to decreased milk supply.
Babies over six months old
Some babies start eating complementary foods at six months, making it possible to replace breastfeeding with extra meals. In such cases, breastfeeding mothers may feel that they can fast and continue breastfeeding due to the decrease in the frequency of breastfeeding.
The decision to adhere to fasting while breastfeeding is a personal decision for the mother, but it is also important to be aware of its effects on breastfeeding. Consequently, breastfeeding mothers should be able to identify symptoms that necessitate stopping fasting, also reaching out to a breastfeeding consultant at the appropriate time.
Infants must receive adequate food at the appropriate time for normal, healthy growth. The basic period for children is the first 1000 days of their lives - from the beginning of pregnancy until the age of two years, and mother's milk is the main food during this period, providing all the nutrients they need to grow, including vitamins, minerals, antioxidants, and much more.
How does fasting affect a breastfeeding mother?
If the mother chooses to fast during Ramadan, she must eat and drink well during the period between sunset and dawn to avoid dehydration and preserve the nutritional components in the body. Dehydration can affect the amount of breast milk and reduce it. If a breastfeeding mother experiences signs of dehydration - headaches, dizziness, dry mouth, lips, or eyes, or a change in the color of her urine - she must seek medical assistance immediately.
Fasting may bring about other physiological changes in the mother, such as sleepiness, impaired concentration, nervousness, and fatigue. This affects the child's development, communication, and interaction with the mother.
If a mother feels that she can fast, then it is important to keep herself well hydrated by drinking plenty of water between Iftar (breaking the fast at sunset) and Suhoor (starting the fast at dawn). Making sure she eats nutritious Iftar and Suhoor meals and has plenty of rest during the day will ease the fast. (3)
How does fasting affect breast milk?
The response of each breastfeeding mother's body to fasting differs from the other. Some mothers can fast and maintain proper and balanced nutrition for themselves and their babies, while others may have difficulty implementing this. It is very important to pay attention to the needs of the mother's body and the baby’s.
If a nursing mother stays well hydrated and maintains a balanced diet in the post-fasting hours, her body can adapt to dietary changes, and the amount of milk her body produces won’t be affected. However, some studies indicate a change in the composition of breast milk and the nutritional status of breastfeeding mothers during Ramadan.
A study done about the effect of Ramadan on mother's nutrition and breast milk composition mentioned that fasting had no significant effect on the macronutrient composition of the breast milk and consequently the growth of the infants. Yet, there not only significant differences in some of the micronutrients - such as zinc, magnesium, and potassium - but the nutritional status of lactating women was also affected by fasting. The study noted that almost all of the nutrient intakes (except vitamins A, E, and C) decreased during Ramadan. As such, it may be wise to excuse lactating women from fasting. (2)
How does fasting affect the baby?
In general, fasting should not cause any harm to a nursing infant. Nevertheless, it is imperative to monitor the child's behavior and pay attention to signs that confirm he is getting enough milk.
The indicators of a negative impact on the child:
Decreased number of wet diapers per day (normal: 6-7 per day)
The decrease in the number of times you pass stool per day (normal: 3 diapers per day)
If the child appears uncomfortable and cries more than usual due to hunger
The child's loss of weight and delayed growth and development rate
When one or more of these indications occur, the mother should consult a doctor and breastfeeding consultant.
Nutrition recommendations for nursing mothers while fasting
A nursing mother must adhere to a proper diet not only during Ramadan but throughout the year. An ideal diet would comprise primarily fresh fruits and vegetables, legumes, fish, olive oil, and dairy products. Below are some more nutritional recommendations for a nursing mother to follow during Ramadan:
Drink more water and fluids in general during the eating period.
Limit caffeine and sweetened drinks, to avoid dehydration and thirst.
Limit the use of table salt and salty foods to avoid dehydration and reduce the feeling of thirst.
Have a complete and nutritious Iftar meal.
The Suhoor meal is vital, make sure it contains foods rich in calcium (cheese or yogurt), protein and iron (beans, chickpeas, and eggs) - these are all great sources of energy that keep you energized longer in the daytime.
Eating small and varied meals in between Iftar and Suhoor is essential. Make sure to integrated nutrient-dense foods into those meals, such as Qamar al-Din, nuts, milk with fruits, and more.
Stay away from carbonated and sweetened drinks.
Make sure to commit to breastfeeding frequently and upon request without skipping breastfeeding meals or replacing them with formula, as this reduces the amount of milk produced.
In the end, we are here to help and support you concerning you and your child’s health, whatever your decision, you are a wonderful mother.
From the Mommy Zone team, we are always here for you.
References:
https://www.amazon.co.uk/dp/1530642027/?tag=breastfsuppor-21 Breastfeeding in Ramadan: A Guide for Fasting Mothers Paperback – 19 Latonia Anthony, 2016
Rakicioğlu N, Samur G, Topçu A, Topçu AA.2006 Jun, The effect of Ramadan on maternal nutrition and composition of breast milk. Pediatr Int.
https://www.llli.org/islamic-cultural-practices-breastfeeding-2/