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Abstract There Are Clear Exemptions in Islam from Fasting in Ramadan During Sickness, Pregnancy, and Breastfeeding

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Abstract There Are Clear Exemptions in Islam from Fasting in Ramadan During Sickness, Pregnancy, and Breastfeeding Abstract There are clear exemptions in Islam from fasting in Ramadan during sickness, pregnancy, and breastfeeding. Yet, some Muslim women still elect to fast while sick, pregnant, or breastfeeding because of a confl uence of social, religious, and cultural factors. Little is known about the physiological effects of fasting during Ramadan on the mother or her unborn baby, and thus nurses and other healthcare providers are faced with the diffi cult task of providing appro- priate medical advice to Muslim women regarding the safety and impact of their fasting. This article describes what is known about this topic and suggests that healthcare professionals learn as much as possible about the multicultural best practices and research-driven information about fasting in order to help Muslim women make informed decisions. Keywords: Beliefs; Fasting; Islam; Women. 216 volume 36 | number 4 July/August 2011 Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Suha Al-Oballi Kridli, PhD, RN Health Beliefs and Practices of MuslimRamadan Women During asting the month of Ramadan is one of the five pillars of Islam. The fi ve pillars are an- Fasting the month of Ramadan is one of the nouncement of faith, praying fi ve times a day, Zakat (giving five pillars of Islam: (1) announcement of the poor), fasting during the faith, (2) praying five times a day, (3) Zakat month of Ramadan, and Hajj (pilgrimage Fonce in a lifetime). Ramadan is the ninth (giving to the poor), (4) fasting during the month of the Islamic Lunar calendar and is an important month because it was the month of Ramadan, and (5) Hajj (pilgrimage month in which the Qur’an, the holy book of Islam, was revealed. During this month, once in a lifetime). Muslims abstain from eating and drinking from sunrise to sunset. Since Ramadan is based on a Lunar calendar, it begins 11 or 12 days earlier each year and it lasts 29 to 30 days advising them about the safety of fasting during preg- (Robinson & Raisler, 2005). Ramadan can occur in any nancy and breastfeeding. Providing this advice and counsel of the four seasons; it is considered more diffi cult to fast requires that the nurse understand and respect beliefs and in the summer than the winter due to the heat and longer practices during this time to be able to provide appropri- day hours (Zaidi, 2003). ate and sensitive care. This article discusses health beliefs The purpose of fasting is for Muslims is to learn and practices of Muslim women during the fasting month self-restraint from indulgence in everyday pleasures, for of Ramadan as well as provides recommendations to self-discipline; to develop God-consciousness; to develop nurses and other healthcare providers. The information self-control; to purify the body; and to empathize with is derived from the author’s experience as a researcher, as the poor and hungry (Cross-Sudworth, 2007; Zaidi, a Muslim healthcare provider, and from the literature. 2003). As stated in the Qur’an “O you who have be- The purpose of the discussion is to synthesize a review of lieved, decreed upon you is fasting as it was decreed upon research in context of the reproductive health of Muslim those before you that you may become righteous” (The women and fasting; to explore promising new innovative Qur’an, 2007; S 2, V 183). approaches to serving this population; and to make the Islamic law is very clear about the exemption from fast- case that additional research is necessary to better inform ing for the sick, menstruating, traveling, elderly, the breast- both theory and practice. feeding and pregnant, and those unable to understand the purpose of fasting during Ramadan. Yet, some Muslim Sexual Relations and Menstruation women may still choose to fast while pregnant and breast- Islamic law is also very clear on the two areas of sexual feeding (Ertem, Kaynak, Kaynak, Ulukol, & Baskan relations and menstruation during the month of Rama- Gulnar, 2001; Josooph, Abu, & Yu, 2004; Pearce & dan. Fasting Muslim women must abstain from sexual Mayho, 2004; Robinson & Raisler, 2005; Zaidi, 2003). relationships from dawn to dusk for all the days of the The holy month of Ramadan is an important time for month of Ramadan. As stated in the Qur’an “It has been Muslim women, but nurses and other healthcare provid- made permissible for you the night preceding fasting ers taking care of Muslim women face the diffi cult task of to go to your wives [for sexual relations]. They are July/August 2011 MCN 217 Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. clothing for you and you are clothing for them” (The (2000), an increased risk of hyperemesis gravidarum in Qur’an, 2007; S 2, V 183). fasting women during the fi rst month of pregnancy was Muslim women are exempt from fasting during the found. In another study by Malhotra, Scott, Scott, Gee, period of menstruation and up to 40 days following and Wharton (1989), the maternal cortisol of fasting childbirth as it interferes with cleanliness and ritual pu- women was elevated. Mirghani, Weerasinghe, Ezi- rity (Kridli, 2002). However, they are expected to make mokhani, and Smith (2003) found a reduction in fetal up the missed fasting days before the following Rama- breathing movements due to the low level of blood glucose dan. To avoid this, many Muslim women use oral contra- concentration in fasting pregnant mothers. In a more recent ceptives to postpone their menstrual cycle as they fi nd it study, Mirghani, Weerasinghe, Smith, and Ezimokhani more diffi cult to fast alone at a later time to make up the (2004) found a reduction in fetal biophysical profi le in missed days (Zaidi, 2003). fasting pregnant mothers, which could indicate a certain level of fetal compromise. Finally, Bandyopadhyay, Pregnancy Thakur, Ray, and Kumar (2005) stated that insuffi cient Many published and online sources confi rm that Muslim fl uid intake during pregnancy due to fasting increases women are exempt from fasting Ramadan during preg- Muslim women’s prevalence of urinary tract infections. nancy (Josooph et al., 2004; Malik, Mubarik, & Hussain, Other studies demonstrated that fasting has no effect 1996; Pearce & Mayho, 2004; Sulimani, 1991). This ex- on the unborn baby. For example, Cross, Eminson, and emption is likely based on the interpretation that fasting Wharton (1990) found that maternal fasting during during pregnancy causes hardship and diffi culties the Ramadan did not affect the birthweight of babies born at same way illness does. The Qur’an states “[fasting for] a full term. In another study by Kavehmanesh and Abol- limited number of days. So whoever among you is ill, or ghasemi (2004) maternal fasting, during Ramadan, did on a journey [during them]—then an equal number of not affect neonatal birthweight. Finally, Dikensoy et al. other days [are to be made up]. And upon those who are (2008) found that maternal fasting did not lead to keto- able [to fast but with hardship]—a ransom [as substitute] nemia or ketonuria in pregnant women. They also found of feeding a poor person [each day]” (The Qur’an, 2007; that it did not affect intrauterine fetal development or the S 2, V 183). fetus’s health. A clear exemption for pregnant women was found in Regardless of the effect of fasting on the health status the Hadith Sharif referred to by Abdullah Ibn Abbas “If of the mothers and their unborn babies, some pregnant a pregnant women fears for herself (i.e., for her health) or Muslim women may choose to fast. For example, in a the breastfeeding woman fears for her child in Ramadan, study by Josooph et al. (2004) most Muslim women they should break their fast and feed a poor person for chose to fast during pregnancy with support from their each day (they miss) and they do not have to make up the spouses and other family members. However, these women fast” (Hallaq, 2007, p. 550). Hadith Sharif is a report of lacked the basic religious knowledge regarding Islamic law saying based on the teachings and of fasting during pregnancy. In an- practices of the prophet Muham- other study by Robinson and Raisler mad. It is considered to be a main (2005), pregnant Muslim women source of religious law after Qur’an. Many published and online avoided discussing fasting with Islam protects the child even their healthcare providers for fear before its birth which explains sources confirm that of being treated disrespectfully or why Muslim scholars exempt a Muslim women are exempt advised against fasting pregnant woman if she believes that fasting may cause harm to her from fasting Ramadan Breastfeeding health and/or to her unborn baby As in pregnancy, there is no clear (Josooph et al., 2004). Some schol- during pregnancy. mention of exemption in the Qur’an ars emphasize the need to make up for breastfeeding women from fast- the missed days once the pregnancy ing Ramadan. Based on the Qur’an, is over while others emphasize it is clear that Muslim women who giving money and food to the poor are breastfeeding during postpar- or needy or the ransom. tum are exempt from fasting due to A limited number of studies lack of purity, during this period, as have investigated the unclear effect in menstruation (Kridli, 2002). A of fasting on the health status of clear exemption for breastfeeding the mother and her unborn baby women was found in the Hadith during pregnancy. Some research sheriff referred to by Anas Ibn Malik fi ndings demonstrated negative Al-Kabi “Draw near and I shall tell effects of fasting on the mother you about prayer and fasting.
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