Pregnant Muslim Women Should Know their Options and their Rights
By Janelle Carlson
Jul/Aug 25
Giving birth is the culmination of nine months of work, using both body and mind in shaping a pregnancy. Surprisingly perhaps, maternal and infant death rates in the United States today are on a slow rise (Justina Petrullo, US Has Highest Infant, Maternal Mortality Rates Despite the Most Health Care Spending, The American Journal of Managed Care, Jan. 31, 2023), while maternal and infant health rates have been steadily improving in many other parts of the world.
Maternal mortality refers to the death of a woman during pregnancy, childbirth, or within the postpartum period following childbirth or the termination of a pregnancy. These deaths can be caused by conditions such as excessive bleeding, seizures, or other medical conditions that are related to pregnancy.
A recent study from the Centers for Disease Control found the maternal mortality rate in the U.S. increased by 27% between 2018 and 2022. The U.S. has an average of 22.3 maternal deaths per 100,000 live births. By contrast, in Canada, the number of maternal deaths is around 10 per 100,000 live births.
Glaring Gaps in Maternal Care in the United States
There are many reasons why the U.S is falling behind the rest of the world in maternal and infant health. Prevailing causes include a lack of access to health care combined with persistent health inequities. These issues go deeper for Muslim women. Muslim women who are pregnant in the U.S. not only struggle to find access to quality maternal health care, they are also more likely to face discrimination and cultural insensitivities.
In an article for the University of Southern California Annenberg Center for Health Journalism, Tasmiha Khan discussed the lack of regard for Muslim women’s modesty and bodily autonomy in the hospital system. She recalled an appointment during her own pregnancy at which no women doctors were available to examine her. Her male doctor entered the room while a woman technician performed her ultrasound, a circumstance which denied her privacy and violated her modesty.
“I felt like I was being asked to compromise my beliefs. And no real measures were taken to ensure I would be comfortable – not even when I was near tears,” Khan said.
This disregard may be an aftereffect of misogyny, racism, Islamophobia, or an overworked medical system. Regardless, oversights like this one can cause Muslim mothers to hesitate to seek care.
The Institute for Social Policy and Understanding (ISPU) found that Muslims are one of the most likely groups to face discrimination in institutional settings like hospitals.
Women of color must also contend with systemic racism in the health care industry which affects their access to life-saving treatments and increases the risk of maternal mortality. Women in rural areas are the most likely to suffer from maternal care deserts. These are communities without hospitals with maternity wards or birthing centers. Some women in these deserts are forced to drive 100 miles in search of care.
There are many reasons for the existence of maternal care deserts. There are fewer hospitals in rural areas compared to urban areas while the hospitals that do exist may not perform enough births to justify maintaining maternity wards. And both hospitals and birth centers have to confront the fact that, in rural areas, Medicaid covers about 50% of all births and has notoriously low reimbursement rates.
Many women have no choice but to give in to the system because delaying care can increase the likelihood of harmful, and sometimes fatal, outcomes.
Midwives, Accommodations, and Hospital Friends
Many Muslim women believe God is the final determiner of health and that answers to health struggles may be found in faith. In terms of maternal health, this belief system may prompt patients to arrange for female health care providers in advance.
While female doctors and midwives are often in short supply, seeking them out can be worthwhile. Research shows women generally feel more secure with a female doctor, and midwives have been “associated with fewer interventions (epidurals, episiotomies, instrumental births), higher patient satisfaction, and comparable or lower rates of maternal or infant adverse outcomes than other care models.” Moreover, midwives are often able to oversee home births, allowing mothers and families more control over the birthing process.
When looking for a female practitioner or midwife, sooner is almost always better. It also may mean preparing for a longer drive and additional planning in case of an emergency. And while there are a handful of Muslim licensed midwives scattered across the U.S., they are more present in some states than in others.
“As a Muslim woman and mother of seven, I would recommend [hiring] a doula and [knowing] your patients’ rights,” said Boston-based midwife Shafia Monroe, who MadameNoire named “Queen Mother of a Midwife Movement.”
“Your accommodations are part of your rights. You can ask for a female to be in the room with you. It’s the law [for the hospital to accommodate you]. If you have to go to the hospital, walk in with prayer and good intentions.”
Additionally, Monroe said mothers should not be afraid to ask for someone to accompany them, whether a family member or a female member of the medical staff. This female advocate may be present during exams to request an explanation of care being given or to ensure halal foods get delivered to the patient.
For those looking to hire a midwife, Shannon Greika at Divine Birth Midwifery in Greenwood, Ind., suggested looking into the legislation around midwifery as licensing requirements differ from state to state. She also recommends being prepared to travel. She, herself, is willing to travel within a 100-mile radius outside of Indianapolis for prospective clients but often has to turn down women who live in rural Indiana. For those she cannot serve, she recommends looking for a doula through websites like Doula-Match. This lack of nearby maternal care makes finding both a provider and/or a midwife a hard task, and even if both can be found, emergencies happen.
A More Mother-Inclusive Society
In many ways, the maternal health crisis in the United States goes beyond individual action. Obtaining a degree in obstetrics or becoming a midwife in the U.S., where there are only four midwives per 1000 births, has an outsized impact. Moreover, being a provider or a midwife who is aware of the importance of religious beliefs allows these beliefs to become integrated into care.
Shannon and Monroe offer courses for those wishing to enter this field. They consider their roles important in filling the gap in Muslim-centric maternal care.
But there are other ways to create a more mother-welcoming society. The Quran (2:33) informs that children should be nursed until the age of 2. But the modern workplace remains hostile toward nursing mothers as many places of business still do not have a designated space for nursing.
In 2018, the U.S. delegation to the World Health Assembly caused outrage for its attempts to oppose resolutions promoting breastfeeding. In fact, the U.S. went so far as to threaten delegates from Ecuador with trade penalties and the withdrawal of military aid if they refused to drop the resolution.
Improving Maternal Health in the United States
Organizations like The Journal of the American Medical Association (JAMA) note that the U.S. is one of the only wealthy countries that does not provide paid parental leave and medical insurance typically does not cover midwives. Still, there is support for initiatives and programs that increase maternal health. Importantly, some mosques, like the Richardson, Texas-based Islamic Association of North Texas, have stepped in to help tackle some of the health disparities that account for high maternal mortality rates.
The federal Family and Medical Leave Act (FMLA) only provides 12 weeks of unpaid leave and for certain eligible employees in the United States.
But at the Richland, Texas-based Muslim Community Center for Human Services (MCCHS), underserved community members can access primary care and social support including a domestic violence support group. And at the moment, they are fundraising for a mobile clinic to provide care to more rural communities.
MCCHS Program Director Nikki Emadi notes that even though they are unable to provide all the services they would like, they are still able to make a difference. She recounts a Tunisian woman who came to their clinic while pregnant, and while they were obliged to refer her to another care provider, they were able to provide domestic violence counseling, help her make her appointments, and facilitated her application for U.S. citizenship.
These kinds of initiatives may just be the answer for America’s existing maternal health care gap.
Janelle Carlson has an MA in Development Studies and Sociology. Her writing focuses on human rights and food security. Her work is available at Responsible Statecraft, Ambrook Research, and Nonprofit Quarterly among others.
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