Perinatal Cultural and Religious Practices of U.S. Muslim Women Venus Mahmoodi, M.S. Palo Alto University

Islam and Muslims

 Islamic practices vary by country of origin and personal preference

 in the U.S.  6 – 8 Million Muslims in the U.S.  Immigrants, US-born Muslims, Converts

 Islam seen as a positive force in Muslim’s life

Some Tenets of Islam

 Obligatory (Fard)  5 Pillars  Five Daily Prayers (exception: menstruation and postnatal bleeding)  Fasting During Ramadan  Strongly Recommended ()  Extra prayers

 Extra (Nafila)

1 Psychological Distress in Muslims

 Increased Violence against Muslims  Following 9/11  Increased activities of ISIL  Presidential Candidates

 Perceptions of Muslim, especially Muslim women

 Acculturation

Muslims and PPD

 Muslim Women and PPD  Prevalence Rates (Alharbi & Abdulghani, 2014; Eloul et al., 2009)

 Conceptualization Among Muslim (Hanley, 2007; Walpole et al., 2013).

 Focus on somatic symptoms

 Cultural understanding of PPD

 Jinn

 Evil Eye

 Magic

Predictors of PPD in Muslim Women  Social Support  Baby’s Gender  Relationship with Mother-in-law  Gender Roles

 Gender Roles in Islam

 Islamic Communities (Abroad and U.S.) and Psychological Distress

2 Religious and Cultural Practices  Religious Practices  Obligatory – caring for self and baby while in utero  All others are just encouraged (Sunnah and Nafila):

 Exposure to in utero – reading, listening

 Immediately following birth of child –

 Call to Prayer (Adhan) whispered in baby’s ear

 Putting chewed up date in baby’s gums (Tahneek)

 Boys – circumcision

Religious and Cultural Practices

 Cultural Practice  40-day lying-in period

 Overlap between religious and cultural practice:  Breastfeeding – strongly encouraged in Quran for 2 years, but often told it is obligatory  Modesty – Hijab, cultural  Disclosure of pregnancy  Birthing Process

Perinatal Practices and PPD

 Religious  Religiosity has a strong negative correlation with PPD  E.G. Algerian and Kuwaiti samples and religiosity

 Cultural  40-day lying in  Social support – lower level of PPD, especially mother’s help  Mother-in-law’s help – higher levels of PPD

3 Muslim Postpartum Study

 No study focuses on Muslim women’s perinatal experiences

 What are factors that play a role in postpartum depression and life satisfaction in Muslim women in the U.S.?

 What were the supportive and challenging cultural practices during pregnancy?

 What were supportive and challenging cultural practices during postpartum?

Method

 Participants  Self-Identified Muslim Women  Living in the U.S.  Reproductive Age (18-45)  At least 2 weeks – 3 years postpartum

 Procedure  Recruitment:  Obstetricians, Doulas, and Midwives with Muslim patients  Muslim Listserves

 Online Survey Using Qualtrics

Measures

 Demographic Information (age, race/ethnicity, income, level of education)

 Perinatal Health Information (gestational age, baby’s gender, mode of delivery, parity, gestational diabetes)

 Risk During Pregnancy

4 Measures

 Personality  Tolerance of Ambiguity

 Islamic Religiosity

 Gender Role Orientation

 Outcome Variables  Postpartum Depression  Life Satisfaction

Perinatal Practices

 Religious Practices during pregnancy, contractions, and postpartum  Reading Quran  5 Daily Prayers ()  Remembrance of God (Dhikr)  Supplication (Du’a)  Pre-dawn Prayer (Tahajjud)

 Cultural Practices  Participants asked to describe challenging and supportive cultural practices

Quantitative Results

Correlations  Cultural Practices  40-day lying in – not a significant predictor of PPD or life satisfaction  Religiosity  Postpartum Depression: r = -.17, n = 254, p <.01  Life Satisfaction: r = .28, n = 236, p <.001  Specific Religious Practice  Tahajjud: r = -.13, n = 258, p < .05  Other (e.g. Tahneek, charity for baby, Supplication for baby): r = -.13, n = 242, p <.05

5 Quantitative Results

 Religiosity was significant in predicting postpartum depression.

β= -.148, p < .05

 Religiosity was significant in predicting life satisfaction. β= .213, p < .001

Qualitative Results

 Pregnancy  Supportive

 Family Support

“Pakistani culture has a strong emphasis on parents taking care of their pregnant daughter. My father wouldn’t let me lift any heavy objects and my mother would help me with household chores.”

 Nutrient-Filled Foods

“My mother fed me traditional pregnancy ‘strength’ food.”

Qualitative Results

 Pregnancy  Challenging

 Unrealistic Expectations

 Unsolicited Advice

 Old Wives Tales

“…unneeded and people telling ridiculous facts about pregnancy and how to deal with them. people [sic] believing in old wives tales more than what the doctors say [sic]”

6 Qualitative Results

 Postpartum  Supportive

 Family Support, primarily mother’s help

“My parent [sic] came and help me in the first 3 month of the baby. It helps to relieve my burden alot [sic]. It's a practice in our culture that parent of the mother help out after the mother deliver the baby.”

 Instilling strong personality traits

“[Being] strongly individualustic [sic] meant that I try to do things for myself quickly and that helps me get strength back soon. Masha Allah (God has willed it).”

Qualitative Results

 Postpartum  Challenging

 Fulfilling Social Obligations

“Having in laws fly in and felt pressure to have house clean, fresh meals daily. I wasn't told to do those things, but I didn't want to give a bad impression or have my mother in law cook when she was visiting and a guest on our home”

 Not Feeling Supported

“I felt like my husband abadanoned [sic] me and our child at the hospital. He only visited 2 times instead of staying with me and the baby and only came to pick me up after 2 visits. And then he complained while picking me up cuz [sic] it was Jumuah (Friday prayers) and he said I made him miss Jumuah (Friday prayers) cuz [sic] i [sic] was being discharged at the hospital”

Conclusions

 Religiosity and culture play an important role in the lives of Muslim women.

 Women who have a strong religious identity are at lower risk of developing PPD

 Find out about your patient’s cultural and religious values and how important it is to complete each one.

 Some Muslim women feel like their wishes are not considered, by just listening you can make them feel heard.

7 Clinical Implications

 Better serve Muslim women in hospitals, birthing centers, and even at home.

 Create a safe space for Muslim women to disclose challenges they’re feeling.

 Develop support groups and educate community at large about implications of the role of cultural and religious practice on mental health.

Future Directions

 Need more data on specific experiences with healthcare professionals (OBs, Nurses, Midwives)

 Educational workshops on Islam and ways to interact with Muslim community for Healthcare Professionals

 Educational workshops for Muslim women on PPD and how to seek help

References

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8 References cont.

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