Factors Influencing Muslim Women’s Decisions about Induced Lactation: A Qualitative Study

Abstract

The induction of lactation occurs when breast milk is produced in a woman, without going through the process of pregnancy and delivery. Induced lactation is a method of strengthening the bond between the adopted child and the adoptive mother. This study aimed to explore the factors influencing Muslim women’s decisions about induced lactation in Malaysia. This qualitative study used in-depth interviews with women who had induced lactation in five states based on five regions in Malaysia (Central Region (Selangor), Northern Region (Penang), Southern Region (Johor), East Coast Region (Kelantan), and Malaysia Borneo (Sabah)). All interviews were consented, audio-recorded, and transcribed verbatim, followed by identification of emerging themes. After interviewing 23 induced lactation women, data saturation was achieved. Data synthesized using thematic analysis revealed three themes describing the main factors in determining women’s decisions on induced lactation: (1) mahram relationship, (2) experiencing motherhood, and (3) the perceived superiority of breastfeeding. It is hoped that by identifying the various factors that influence the decision to induce lactation, health care professionals and the community will be empowered to support breastfeeding in terms of facilitating motherhood, providing breastfeeding aid equipment, and assisting with daily necessities. By expanding efforts and programs, the government and other stakeholders can assist adoptive mothers in breastfeeding their children and feeling more accomplished as women and mothers.

1. Introduction

Induced lactation is a method of stimulating the production of breast milk in women who have not gone through the pregnancy process (Cheales-Siebenaler 1999). Past research in Western countries explored the breastfeeding of adopted children, as well as the perceptions, achievements, and challenges of this process (Bryant 2006; Wittig and Spatz 2008; Szucs et al. 2010). Many women claimed that the choice to breastfeed their adopted child makes them feel more accomplished as women and mothers. Thus, the adopted child and parent can form stronger maternal–infant bonds (Flores-Antón et al. 2017).

The existing literature on breastfeeding of adopted children, which includes the experiences, successes, and challenges of this process, is dominated by Western countries. Despite the wealth of literature available in the field, there is a lack of clarity due to limited studies on induced lactation practice in Malaysia. Only a few researchers have looked into the factors that influence women’s decisions to undergo induced lactation (Saari and Yusof 2015). According to Saari et al. (2017), awareness among adoptive mothers and their determination to breastfeed are important. However, there are many factors to be considered in induced lactation programs, due to adoptive mothers’ diverse religious and ethnic backgrounds, health status, and financial and environmental challenges.

In Malaysia, only 47.2% (n = 17) of women who sought help at a Breastfeeding Support Centre (Susuibu.com accessed on 22 February 2019) reported success in the induced lactation process (Monoto et al. 2015). Others, meanwhile, have not been able to give their adopted children breast milk. This private facility focuses on providing high-quality breastfeeding consultation services, as well as teaching and training to healthcare providers and the general public. According to a survey conducted by the Malaysia National Lactation Centre (NLC), 85.0% of women who had never been pregnant or breastfed were able to breastfeed during the program after service consultation (National Lactation Centre 2019). However, only 30.0% of breastfeeding mothers achieved mahram status throughout the national breastfeeding program. The term mahram is used to denote a level of relationship between close family members, i.e., those with whom the hijab does not have to be observed (Islamic Religious Affairs Malaysia 2014). When the non-biological children are breastfed for five times or more within the first 2 years, they indirectly established a milk kinship between them, and the baby then becomes her milk son or milk daughter. Therefore, the mother becomes mahram or haram (illegal) to be married to the child she nursed. In Islam, children that consume milk from the same women are haram to wed each other. This situation indicates that the process requires effort and patience to overcome the challenge involved in the process. Mental strength and physical and spiritual readiness are also important to overcome many challenges prior to the successful implementation of the induced lactation process.

The process of induced lactation in Malaysia can be further explored by identifying and comprehending the factors that influence women’s induced lactation decisions. The findings of this study could also apprehend the maternal perspectives on the mothers’ needs and motivations for the induced lactation process. The government and other stakeholders should make more efforts and implement more programs to assist these mothers in breastfeeding their adopted child and make them feel more accomplished as women and mothers. Intense passion, deep desire, patience, and, most importantly, sincere intentions are the root of success in the process of raising an adoptive child (Lommen et al. 2015). Therefore, this study aimed to explore the factors influencing women’s decisions about induced lactation in Malaysia.

2. Materials and Methods

2.1. Study Design and Setting

The case study design was the most suited approach for this study. The nature of this case study was sufficient to explain and discuss “what” induced lactation practices used in Malaysia and “how” induced lactation is interpreted and practiced in the country as knowledge of nursing and adopted children increases gradually with adoption practice. This exploratory qualitative study utilized a purposive sampling method and was conducted from June 2017 to November 2017 and involved five Malaysian regions representing the East Region, North Region, South Region, Central Region, and Borneo. The chosen states from each named region were Kelantan, Penang, Johore, Selangor, and Sabah. This study has been done on Muslim women in Malaysia. This enabled the recruitment of respondents with a wide range of sociodemographic characteristics, as well as the induced lactation experiences. The qualitative approach helped to establish a comprehensive insight into the women’s experiences throughout the journey of induced lactation. The design allowed for the exploration of respondents’ feelings, behavior, thoughts, insights, and actions (Mayan 2009). The detailed methodology of this study was described and published by Rahim et al. (2020).

2.2. Sampling

Information on the women who induced lactation was obtained through lactation centers, hospitals, and health clinics that provide consultations on breastfeeding of adopted children in Malaysia. The sample size was estimated based on the saturation concept for qualitative research (Ritchie and Lewis 2003). Data saturation was achieved after interviewing a total of 23 induced lactation women. The saturation occurs when new data collection no longer contributes to new information on the issues under investigation. The respondent’s selection procedure was based on the following criteria: Muslims, has never been pregnant, does not have a biological child, the adopted child must not be more than two years old according to the lunar month calculation during data collection, no previous breastfeeding experience, and undergoing an induced lactation procedure (completed or still under treatment). The selection of women who were undergoing an induced lactation procedure (completed or still under treatment) was obtained from the practitioners who agreed to participate in this study. The practitioners provided one to 10 names of women who were their clients based on the inclusion and exclusion criteria.

2.3. Data Collection

In-depth interviews (IDIs) were conducted using a topic-based protocol to explore respondents’ experiences and their perspectives on the induced lactation process. The interviews were conducted in home settings, with some conducted in other locations at the requests of the respondent. Interviews were conducted in the Malay language, because the majority of the respondents were Malays who understood and preferred the language. The respondents provided written consent and brief socio-demographic information prior to the interview sessions. The confidentiality and anonymity of respondents were maintained. All interviews were conducted for approximately 45 to 90 min per session.

2.4. Ethical Approval and Consent to Participate

This study was authorized by the Human Research Ethics Committee University Sains Malaysia, with the code project USM/JEPeM/14044139, and the Medical Research Ethics Committee (MREC), Ministry of Health of Malaysia (MOH), and it was registered under NMRR-15-1600-26147 (IIR). Written informed consent was secured from study respondents after explaining the study’s objective and purpose to each study respondents. The respondents were also assured about the confidentiality of the data.

2.5. Data Analysis

The interviews were audio recorded with some notes taken by the researcher. The Malay language audio files were transcribed verbatim. These interview transcripts were then coded and managed using ATLAS.ti version 8 software. Thematic analysis was chosen as the method to analyze the data from the interviews. The analysis represents a systematic framework to code qualitative data in order to identify patterns across the data (Braun and Clarke 2014). Six discrete steps are involved in thematic analysis: (1) become familiar with the data, (2) generate initial codes, (3) search for themes, (4) review themes, (5) define themes, and (6) write-up (Braun and Clarke 2006). In order to enhance the credibility of the study, triangulation from different sources was applied by researchers. To ensure the validity of the information, the interview was supplemented with secondary data from home and hospital-based information sheets. Any discrepancies between the data reported in the information sheet and the data collected during the interview were investigated. Next, the member checking process was carried out via phone calls to the respondents, and the polished content of the transcripts and the quotations cited were read to the respondents. Rich, thick description was used to provide many perspectives on a theme, making the results more realistic and richer. The study procedures were clearly documented in order to ensure reproducibility (Creswell and Creswell 2018). The transcription notes were cross-checked with the audio files several times to minimize obvious errors. Furthermore, triangulation of data included conducting a pilot interview, multiple case studies, triangulation between case study interview data, and respondent’s verification of interview data.

2.6. Availability of Data and Materials

The datasets generated and/or analyzed during the current study are not publicly available due to the sensitive nature of the information of the respondents provided. Still, they are available from the corresponding author on reasonable request. This is to protect and maintain respondents’ anonymity and confidentiality. The data are kept saved in order not to expose the feelings of the respondents to the public.

3. Results

Table 1. Descriptive characteristics of respondents.

Respondents	Age (Year)	Occupation	Duration of Marriage (Year)	Adopted Child
				Sex	Age of Child during Interview (month)
A1	37	Housewife	8	Girl	5
A2	32	Housewife	11	Girl	8
A3	38	Teacher	12	Boy	12
A4	38	Lecturer	NA	Girl	12
A5	38	Liaison officer	9	Girl	19
A6	33	Lecturer	8	Boy	24
A7	27	Housewife	4	Boy & Girl	19
A8	34	Housewife	5	Boy	2
A9	36	Teacher	12	Boy	3
A10	34	Teacher	10	Boy	12
A11	40	Librarian	13	Girl	24
A12	38	Nurse	12	Girl	8
A13	34	Industry officer	9	Boy	4
A14	31	Housewife	7	Girl	4
A15	29	Lecturer	4	Girl	4
A16	40	Administrative assistant	13	Girl	24
A17	30	Accountant	9	Girl	20 days
A18	34	Safety guard	7	Boy	20 days
A19	26	Assistant pharmacist	5	Boy	1
A20	36	Medical laboratory technologist	9	Boy	20
A21	35	Nurse	10	Girl	2
A22	37	Teacher	10	Boy	1
A23	36	Housewife	15	Boy (Twin)	12

shows the characteristics of the respondents. Out of 23 women undergoing induced lactation procedures, six respondents were housewives (26.0%), and 17 respondents worked in the government or private multi-sectors (74.0%). The respondents ranged in age from 26 to 40 years. Three respondents had two adopted children (one respondent had twins as adopted children). The others had only adopted one child. In total, 25 children were adopted from 23 women; 13 were boys (52%), and 12 were girls (48%). The adopted children’s ages ranged from 20 days to 24 months when the interview was conducted. In this study, respondents barely were ethnic Malay Muslims.

The mean duration of marriage before treatment among the adoptive couples was nine years (with marriage duration ranging from four to 15 years). Seven women were married for more than 10 years, 15 women were married for less than 10 years, and one woman was single and not married. Those married for more than 10 years were between the ages of 32 and 40. Three of the 15 women married for less than 10 years were between the ages of 26 and 38. They were all of reproductive age, which ranged from 26 to 40 years old.

Table 2. Summary data for the respondents.

Variables	Frequency (n)	Prevalence (%)	Mean ± SD
Mother
Age (year)			34.47 ± 3.87
21–30	4	17.4
31–40	19	82.6
Occupation
Housewife	6	24.0
Working mother	17	68.0
Duration of marriage (year)			9.18 ± 3.03
0–5 years	5	21.7
6–10 years	11	47.8
11–15 years	7	30.4
Adopted Child
Age			10.09 ± 3.02
Below 1 month	2	8.0
1–12 months	16	64.0
11–24 months	7	28.0
Sex
Male	13	52.0
Female	12	48.0

summarizes the data.

Based on the findings of 23 interviews, various factors influence women’s decisions on induced lactation. There were three main themes (refer

Table 3. Themes and sub-themes of the factors influencing women’s decisions about induced lactation.

Main Theme	Sub Theme
(1) Mahram relationship.	Awrah Touch. Marriage. Fulfilment of religious duty.
(2) Experiencing motherhood.	Genuine satisfaction. Mother’s instinct. Mother–infant bonding. Pleasure of breastfeeding. Increased self-esteem.
(3) The perceived superiority of breastfeeding.	Natural antibodies. The primary source of nutrition for new-borns. Breast milk for growth. Help protect babies from many infectious illnesses.

) that described the main factors influencing women’s decisions on induced lactation, which were (1) mahram relationship, (2) experiencing motherhood, and (3) the perceived superiority of breastfeeding.

3.1. Main Theme 1: Mahram Relationship

The main factor that drives the mother to be a wet nurse is driven by Islamic law, and it is a part of the fulfillment of religious duty. As a Muslim, this is a matter of responsibility and obligation. This is part of Sharia law (religious law forming part of the Islamic tradition and derived from the religious precepts of Islam, particularly the Quran and the hadith) and is intended to build a mahram relationship. Mahram is an Arabic word that means unmarriageable kin (man or woman) because of the bloodline (biological family); mahram status can be obtained by breastfeeding an adopted child or other non-biological child.

During the interviews, women repeatedly mentioned the following phrases and terms: “cover your awrah”, “be a mahram”, “to have a halal relationship”, “touching”, “hugging”, “keep wudu’”, “cannot get married”, “to get rewards from Allah (Almighty God)”, and “know the rewards and sins”. In the context of this study, the main motivation for a mother to become a wet nurse was to establish a mahram relationship between the baby and herself and her family. They described it as:

“I wanted to adopt a child because I know that the child is male. So, my concern was to get the mahram status.”

(Woman A4)

“Yes, I would like to have a child, so I need to breastfeed them to achieve mahram status. Either a boy or a girl, both need to be breastfed.”

(Woman A1)

One of the women also mentioned that giving breast milk can help build a halal relationship (relationship allowed or permitted by Islamic Law):

“That means, breastfeeding is the first thing, other than bonding, to build a halal relationship.”

(Woman A11)

This study found that majority of the women were concerned about their awrah (body parts which must be covered from others) with the (adopted child) non-mahram. They were aware that adopted children were not mahram, which would cause significant problems when the adopted children reached puberty. Therefore, the women decided to undergo induced lactation to get the privilege of not covering themselves. Some women realized the importance of breastfeeding an adopted child when they heard about other women’s experiences. They expressed their feelings as:

“I know the awrah of my husband, which is why I need to breastfeed the baby.”

(Woman A16)

Most of the women agreed that even though the parent may have given all their love and affection to the adopted child, as the child grows older, their physical interaction and the awrah may limit their relationship. One woman stated:

“It is important to achieve mahram status while it is still possible because after they grow up, they might not understand the awrah restrictions that they have with the family if they are not mahram. It includes activities like hugging and touching, and it is not possible for a girl to wear hijab (scarf) all the time. They do not understand that aspect.”

(Woman A11)

They also knew that the physical interaction between the adopted child and the parent is permitted and does not break their wudu’ (a cleansing ritual or ablution that is an important part of purity and cleanliness in Islam before performing worship):

“Because there might be a problem like cancelled wudu’ if we are non-mahram, I choose to breastfeed to prevent that from happening.”

(Woman A18)

One woman explained that her family members would not be able to marry her adopted child if she breastfeeds the child, making the infant mahram to the family. The child also cannot marry the foster siblings because the child is also mahram to the family. She said:

“The baby girl will become mahram of my husband, and the boy will be my mahram. Even if I have or will have my own children, he/she will be unable to marry them.”

(Woman A7)

Women wanted to breastfeed an adopted child in order to improve their family relationship with their adopted child. In addition, being a wet nurse is one of the obligations to maintain the importance of Sharia law and the fulfilment of religious duty. It is believed that it is a significant sacrifice to take good care of an adopted child, least of all because the mother willingly goes through a very complicated process to induce lactation. Adoptive mothers are also believed to be greatly rewarded and blessed by Allah (Almighty God) for undertaking this task. The women’s feelings are reflected in the quotations below:

“I feel relieved because we had fulfilled one big responsibility in religion thus do not feel guilty living in a house together.”

(Woman A11)

3.2. Main Theme 2: Experiencing Motherhood

The second factor that motivated women to breastfeed was the experience of motherhood; this strong mother instinct comes from within the women. Even though the women were unable to experience pregnancy and labor, they still desired to experience motherhood through the breastfeeding process.

All of the women stressed that they wanted to breastfeed their adopted child in order to build a better maternal–infant relationship with the infant. One of the women said that it was a success for the mother to be able to breastfeed the adopted child until he/she was full:

“In my opinion, being successful in breastfeeding means that the baby can suck until they are full. It is my intention since earlier to breastfeed the baby. Please, pray for me.”

(Woman A9)

One of the women’s desires when becoming an adoptive mother was to experience the moment of breastfeeding:

“I wanted to breastfeed the baby because I wanted to experience the moment of feeding because I do not have my own child.”

(Woman A5)

The nature of the women and their strong desire to become mothers encouraged them to adopt and subsequently breastfeed their adopted children. Most women who have had experience in induced lactation programs agree that breastfeeding is a rewarding journey. It has taught them how to be a birth mother and the joy of breastfeeding too.

One woman described how she was impressed with the breastfeeding journey:

“I feel happy that I can breastfeed because I do not have my own children. I am happy that I can still produce milk, although not much, but enough to breastfeed the child that I adopted. Alhamdulillah, I get to experience it.”

(Woman A15)

Some of them also stated their desire to breastfeed for as long as their breasts could produce milk. This is one of the quotes about their feelings on this matter:

“I have already exceeded the five-time full-fed but will continue breastfeeding my child if the child still wants it.”

(Woman A8)

The true definition of success was the good feelings or the satisfaction gained when the women successfully breastfed their adopted babies. Most of the women said that this feeling was subjective and unique to each of them. One of them described her situation as follows:

“My motherly instinct is stronger within me. If it is possible, I would like to breastfeed all the children in this welfare house, not just my adopted child. When I knew that I could breastfeed, I felt passionate to breastfeed the child and the feeling came naturally.”

(Woman A10)

They also felt joy and satisfaction, as well as relief and relaxation, whenever they breastfed their babies. They expressed this feeling as:

“I feel very happy with what I have been through. I feel grateful and relieved at the same time that my husband and I have achieved what we have been longing for.”

(Woman A1)

Most of the women who attempted to induce lactation wanted to improve the mother–infant relationship. For them, it was sufficient that their baby was breastfed. The decision to nurse their adopted baby often hinged on the mother–infant relationship and emotional benefits to the baby. The women stated that breastfeeding fosters love between two people who were total strangers previously. A respondent expressed it in this way:

“We want to adopt a child and bond with him or her. Breastfeeding is the best way to create the bond.”

(Woman A13)

3.3. Main Theme 3: The Perceived Superiority of Breastfeeding

All of the women who practiced adoptive breastfeeding appreciated the benefits that their infants gained from breastfeeding. They believed that formula milk would not provide them with the same benefits. This motivated them to continue providing the best nutrition for their infants. All of them noticed that their infants’ resistance against infection was higher than it was before the infant started receiving breast milk. The majority of women believed that breast milk contained an antibody that protected children from a variety of diseases. One of them said:

“The benefits of breast milk are different from the formula milk. It helps to make the baby’s antibodies stronger to prevent diseases.”

(Woman A8)

All the women were aware that breast milk provides all the nutrition that babies need and that it could be the primary source of nutrition for the first six months of a baby’s life. Breastfeeding is the healthiest option, and the milk on its own is the best, without adding formula milk, as this woman said:

“If possible, I want to breastfeed my baby until the baby is full and avoid formula milk because breast milk is the best for the baby.”

(Woman A15)

A woman said that breast milk contains better nutrients for the growth and development of the baby than formula milk:

“I breastfeed because of its benefits. Old folks also said that breast milk is beneficial for growth in comparison to formula milk that came from cows.”

(Woman A15)

Breast milk contains antibodies that fight bacteria, viruses, funguses, and parasites, helping to protect the baby from infection by bacteria and other diseases. One woman expressed her gratitude for the benefits of this:

“Alhamdulillah (Praise be to Allah) that I breastfed, and my baby did not suffer from fever even during teething like the other babies do.”

(Woman A15)

4. Discussion

The results showed that three main themes influence women’s decisions about induced lactation in Malaysia. However, this study found that the recruitment of respondents with a broad range of sociodemographic characteristics, as well as the induced lactation experiences, did not influence induced lactation decisions. Our study respondents described the main factors in determining their decisions on induced lactation: (1) mahram relationship, (2) experiencing motherhood, and (3) the perceived superiority of breastfeeding.

All of the women who underwent induced lactation procedures in this study were Malay Muslim; thus, being a mahram was the main factor in their desire to breastfeed their adopted child. Efforts to establish a relationship between an adoptive mother and her adopted child, despite a different viewpoint, are equivalent to the attempts to establish a mahram relationship in Muslim culture. This study proved that most of the respondents were concerned about their awrah with the (adopted child) non-mahram. They knew that adopted children were not their mahram, which would cause considerable problems when the children reach puberty. This finding aligns with findings of a study conducted by Saari and Yusof (2015), which found that Muslim respondents interviewed stated that their main goal was to obtain mahram status.

Therefore, the respondents decided to undergo induced lactation to attain the privilege of awrah (nakedness; the intimate parts of a person’s body that must be covered). Not all the women were concerned about awrah, despite having heard about the importance of breastfeeding an adopted child. They consented that even though the parent had given all their love and affection towards the adopted child, as they grew older, their physical interaction and the awrah limitation had limited their relationship. When the breastfeeding process occurs, they cannot marry each other because they were already mahram. The child also cannot marry their foster family because they are also mahram to the family (Zanariah et al. 2018). The respondents in this study decided to breastfeed an adopted child in order to develop a better family relationship with their adopted child.

Moreover, being a wet nurse is one of the obligations to maintain the importance of Sharia law and the benefit of the ummah (the whole community of Muslims bound together by ties of religion) (Mohd 2011; Saari and Yusof 2015; Zanariah et al. 2018). They also believe that it is a significant sacrifice to take good care of an adopted child. In addition, the women willingly go through a very complicated process to induce lactation. Those who sincerely engage in this process will be rewarded and blessed greatly by Allah (Almighty God). However, the process of induced lactation is not without challenges. Not all women who initiate the lactation process are successful in producing breast milk and achieving their ultimate goal of mahram with their adopted child. This type of research has not been commonly undertaken in non-Western countries, and the outcome of the study may apply to Muslim communities in both non-Western and Western countries.

Analysis of the data showed that all of the respondents who sought to induce lactation had a strong desire to breastfeed their adopted child. Even though they could not experience pregnancy or be in labor, they still wanted to feel motherhood through the breastfeeding process. All of the respondents stressed that they wanted to breastfeed their adopted child in order to improve the maternal–infant relationship. The primary purpose is to get mothers bonding only to establish a relationship of love and as a motivator for a woman to breastfeed their adopted child (Auerbach and Avery 1981; Goldfarb 2009).

The respondents from these interviews said the true definition of success was the good feelings or the satisfaction gained when she breastfeeds the adopted baby. Most of them said that this feeling was subjective. They also experienced a sense of joy and satisfaction, as well as felt relieved and relaxed, whenever they breastfed their babies. As stated in the study by Flores-Antón et al. (2017) mothers often decide to undergo induced lactation to strengthen the mother–child bond. It is common for a woman to have a strong desire to be a mother, which motivates them to have children and, in this context, to adopt a baby and then breastfeed a baby. Most of them who participated in programs to induce lactation agreed that this journey was fun-filled and taught them how to be a good mother, and they were finally able to feel joy in breastfeeding. There was also a woman who stated that after breastfeeding the adopted child, she felt that her self-esteem and affection as a woman had increased. Self-esteem is a confidence and satisfaction in oneself or self-respect. Some of the respondents said that breastfeeding had increased the love and affection between the mother and child.

All respondents who induced lactation and practiced adoptive breastfeeding appreciated the benefits that their infants gained from breastfeeding. They believed that they would not get a similar experience from giving formula milk. This motivated them to continue providing the best to their infants. They noticed that their adopted children have a higher resistance against infection. Breastfeeding was accepted as a natural form of nutrition for babies, and it was considered the best food for them. Breast milk is not only the ideal food for babies, but it is also the only food a baby needs from the time he or she is born until the age of six months (Victora et al. 2016). Breast milk contains an antibody that helps to protect babies from many diseases. Breastfeeding offers immunological, metabolic, and psychosocial benefits for both the mother and infant (Berlanga-Macías et al. 2020). Breast milk contains secretory Immunoglobulin A (IgA), anti-inflammatory agents, and other immunomodulators that provide infants with immunological advantages over formula-fed infants (Ballard and Morrow 2013). Breast milk contains anti-infectives (which fight infection) that help protect a baby from infections caused by various bacteria and other diseases. Breastfeeding is the healthiest option, and the milk on its own is the best, without adding formula milk. Breast milk provides and contains the best and enough nutrients for babies.

Strengths and Limitations

This study was conducted nationwide and used a primary data source. The study was conducted across Malaysia, which represents the five regions. Women in the current sample reported having no children of their own; however, as questions primarily focused on societal attitudes towards adoptive breastfeeding, the nulliparous sample offered unique perspectives related to perceived social norms of breastfeeding. However, there was a possibility of recall bias among the respondents, since the information was collected retrospectively, one to two years after the induced lactation practice was completed. As a result, we cannot rule out recall bias in the responses given in the interviews. The fact that in this study, all of the women who underwent induced lactation were Muslims presents a limitation in that the findings cannot be extrapolated to other religious groups. In this study, the women who underwent induced lactation were ethnic Malay Muslims. Thus, comparisons to other ethnic groups were not possible. This was due to the difficulty of getting women from different ethnic groups who had undergone induced lactation to participate in the study. Because the data was obtained in 2017, induced lactation may be more common in Malaysia now, and attitudes may have changed in the last five years.

5. Conclusions

In conclusion, the mahram relationship, experiencing motherhood, and the perceived superiority of breastmilk were the factors influencing women’s decisions on induced lactation in this study. All of the women who underwent induced lactation procedures in this study were Malay Muslims, and their desire to breastfeed their adopted child was primarily motivated by their mahram status. Breastfeeding an adopted child, starting nursing, and continuing breastfeeding until at least five full feedings are completed are all influenced by a variety of circumstances (to reach the mahram status for Muslim parents). The above is intended to provide insight into the challenges faced by mothers who wish to induce lactation and breastfeed their adopted children. Many of these women seek out a means to induce lactation and breastfeed in the hope that their bodies will function as they should, thereby providing them with a means of healing the psychological impact of infertility. Furthermore, it is the researcher’s aspiration that adoptive mothers will discover protocols or procedures to bring in their breastmilk and feed their infants at their breast, as nature intended. Researchers equate the lactation process to everyday life, where positive attitudes are followed by a strong desire to succeed. We hope our study will help other researchers and practitioners better understand the women’s lived experiences during induced lactation. Moreover, we hope that health professionals and lactation support providers consider it when providing care during these processes. Through identification of the various factors that influence the decision to induce lactation, it is hoped that this paper will motivate health care professionals and the community to provide breastfeeding support in terms of facilitating motherhood, assisting in the provision of breastfeeding aid equipment, and assisting in the provision of daily necessities to help women achieve their set breastfeeding goals.