During the month of Ramadan, Islamic religion involves fasting from sunrise until sunset. According to Islamic Law however, breastfeeding mothers do not necessarily have to fast. Breastfeeding mothers can make up any missed fasts at a later date.1
The following article from La Leche League International explains:
[…] pregnant and breastfeeding mothers are exempt from fasting according to the Hadith [sayings of the Prophet].
Some cultures interpret the Hadith very generally and will not fast at all if breastfeeding. In other cases and in Arab cultures in particular, mothers will only miss fasts in cases of hardship. They will often continue to fast during breastfeeding unless it has a negative effect on them or their babies. If they do not fast at the appropriate time, they will have to “pay back” the fast when they are able. Some mothers with children spaced very close together will choose to make up the fast after all of their children have weaned. Some scholars say that instead of making up the fasts, these mothers can pay a compensation by feeding poor people a meal for the number of fasts missed [fidyah].
To fast or not to fast?
An article by Dr Naomi Mirza on breastfeeding during Ramadan notes that an important consideration in the decision whether a breastfeeding mother might fast or not is whether her baby is still exclusively breastfeeding:
An important factor to consider when you are thinking of fasting is the age of your baby. If your baby is still very young (less than six months) and is completely dependent on breast milk, then you should not fast. If your baby is more than a year old, already on complementary foods and drinks breast milk only a few times a day, or only during bedtime, then you may be able to fast with little or no discomfort.
In a book about breastfeeding during Ramadan, author Latonia Anthony mentions partial fasting may be a possibility for a breastfeeding mother who really wants to fast, but she cautions against fasting in the following circumstances:
Women who have a baby less than six months old (whom make almost 1 litre of breast milk a day), live in hot climates, are low income, tandem nurse, have multiples e.g. twins and who are older than 35 years are most at risk of severe dehydration and should not fast until weaning has occurred. The same goes for women who have confirmed low milk supply, must supplement, have a child that is underweight (preemies) or ill, take medications or have health conditions that make it difficult to breastfeed. If a mother really wants to fast, she can do partial fasting—committing to two to three days a week.
Making up missed fasts
Missed fasts can be made up at a later date. There are differing opinions on whether giving compensation in the form of meals for the poor in lieu of missed fasts (fidyah) is acceptable23.
How can fasting affect my breast milk?
The intermittent style of fasting during Ramadan can usually provide enough time for a healthy well-nourished mother to eat and drink between dusk and dawn. Intermittent fasting is not thought to be associated with decreasing milk supply 4 or a change in the major nutrient composition (fat, carbohydrate, protein) of breast milk 5. However intermittent fasting may affect the micronutrients (vitamins and minerals) in breast milk. Rakicioğlu et al explain:
Ramadan fasting had no significant effect on the macronutrient composition of the breast milk and consequently the growth of the infants. There were significant differences in some of the micronutrients such as zinc, magnesium and potassium. The nutritional status of lactating women was affected by Ramadan fasting. All of the nutrient intakes (except vitamins A, E and C) decreased during Ramadan. For these reasons, it would seem prudent to excuse lactating women from fasting during Ramadan.
Deciding to fast
Some breastfeeding mothers may prefer to fast with the rest of the family rather than fasting at a later date. If this is the case, and the baby is exclusively breastfed, the Hamad Medical Corporation 6 recommend that the mother discuss fasting with her health professional first to avoid complications. They recommend the mother stays cool, well rested and hydrated and that she watch her baby for any signs he is not getting enough milk.
Keep well hydrated
Mothers fasting while breastfeeding are advised to drink plenty of water to stay well hydrated between sunset and dawn and to try to rest during the day:
If a mother feels that she is able to fast, then it is important to keep herself well hydrated by drinking lots of water between Iftar (breaking the fast at sunset) and Suhoor (starting the fast at dawn). Making sure she eats a nutritious Iftar and Suhoor meal and has plenty of rest during the day will ease the fast.
Dehydration and milk supply
In certain situations and climates, a breastfeeding mother could be at risk of dehydration during fasting in the month of Ramadan. Severe dehydration needs urgent medical treatment and may reduce milk supply. Warning signs for dehydration are listed on the UK’s National Health Service (NHS) website7 and include feeling very thirsty, feeling dizzy, having headaches, fatigue, dark concentrated urine, and dry mouth, lips and eyes. The NHS advise:
If you produce very little or no urine, feel disoriented and confused, or faint as a result of dehydration, you must stop fasting and have a drink of water or other fluid.
Islam doesn’t require you to make yourself ill when you fast. If a fast is broken, it will need to be compensated for by fasting at a later date.
The Hamad Medical Corporation recommend taking sweet fruit juice or a salt-water solution and resting if a mother experiences any signs of dehydration. If she doesn’t feel better after 30 minutes the mother should contact her doctor8.
Watch baby for ill effects
Parents should check with their baby’s health care provider if they have any concerns their baby might not be getting enough milk during fasting:
…if a fasting mother is worried that her baby is not getting enough milk, especially when the baby cries constantly, has fewer wet diapers, passes green-colored stool, or has weight loss, she should stop fasting and immediately contact her doctor or a lactation consultant.
Ramadan and coronavirus
The World Health Organisation has produced a guidance document relating to Ramadan and coronavirus: Safe Ramadan Practices in the Context of the COVID-19 (April 2020). The information is available in English, Russian and Arabic..
Breastfeeding mothers are exempt from fasting during Ramadan. The fast can be made up at a later date. However, if a mother feels fasting would be manageable for her and wouldn’t affect her own or her baby’s health, she may choose to fast or do partial fasting.