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
Islam 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 Hijab Strongly Recommended (Sunnah) 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 Quran 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 (Salah) 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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