For Muslim women to get the health care they deserve, doctors need to listen

The story was originally published in The Emancipator with support from our 2023 Impact Fund for Reporting on Health Equity and Health Systems.

I was 20 weeks pregnant when my OB/GYN recommended I go to a male doctor across town for an ultrasound. I mentally ticked off reasons why this was a bad idea. I didn’t want to see a new doctor in my second trimester; the new office was far away; it would be more expensive because his practice was not covered by my insurance.

Still, one thing stood above all that: I’m a Muslim woman who observes hijab for more than two decades. In Islam, observing the hijab, which means “veil” in Arabic, represents a commitment to modesty that is not limited to the attire one wears but also one’s mannerisms. It can include covering everything but your face, hands and sometimes feet in the presence of men.

After unsuccessfully requesting a female doctor, I reluctantly scheduled an appointment with a male doctor. On the day of my ultrasound, the staff reassured me that the ultrasound technician would be a woman and the doctor would only come in toward the end of my appointment to explain the results. However, during the exam, the male doctor came in without knocking. He barely seemed to register my panic as I scrambled to find something to cover myself with. He took a look at the ultrasound screen, and I mustered up the courage to ask if anything was wrong. “Nope, looks good,” he said casually. But nothing was good. What should have been one of the most exciting times of my life had been watered down by fear. 

Even though the U.S. prides itself on consumer choice, I’d become a patient with no real say in my treatment. My experience made it clear to me the health care system was failing Muslim women. And recent data supports this, with almost one-third of Muslims reporting they’ve experienced discrimination in health care settings. 

I never expected to encounter this reluctance to make space for my religious beliefs at a doctor’s office, and it was unclear whether it was due to carelessness or anti-Muslim bias. No matter the reasoning, though, 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. 

Going to the doctor while expecting a child can be fraught, even when you are a White woman. That said, Black and Indigenous patients are two to three times more likely than their White counterparts to die from pregnancy-related causes, according to the Centers for Disease Control and Prevention. Although Muslims span a wide variety of races and ethnicities, research shows that if Muslims wear religious markers such as a headscarf, they are sometimes discriminated against by their physical appearance. In the year after the Sept. 11 attacks, for instance, a researcher observed an increase in low birth weights for pregnant women with Arab-presenting names. Many Muslim women also often delay or avoid care due to the lack of culturally sensitive care, according to Dr. Aasim Padela, head of the Initiative on Islam and Medicine, often because of a lack of awareness of Muslim patients’ needs.

While Islamophobia shows up explicitly (yet still too frequently) in daily life, awkward or uncomfortable interactions with health care practitioners can leave Muslim women scratching their heads, wondering whether they’re the victims of bias or simply imagining things. 

Yomna ElSiddig felt uncomfortable discussing her religious or cultural concerns about her pregnancy with her health care providers. “I purposefully did not share that I am Muslim because I am also Black, and our maternal mortality is high,” Elsiddig said. “I did not want to manage double discrimination.” 

As Muslim American woman living in Illinois, Safa Khudeira believes the nurses treated her differently on the day she came into the hospital to give birth when they saw her relatives wearing headscarves. A nurse who had previously provided help no longer offered the same assistance. “I had so many wires and tubes connected to me,” she said. “I asked the nurse for help to turn over, and she said, ‘You can do it yourself.’”

While Muslim women know doctors are short on time, they often wonder if their religious identity might be why they feel like they’re getting less attention. Fatima Saied, executive director of the Muslim Women’s Organization (MWO), described the challenges and lack of support she experienced during her own pregnancies in an Orlando hospital. “I felt invisible,” said the mother of five. “Like I didn’t exist. They weren’t coming to check on me. They weren’t proactively asking.” 

MWO offers a series of regular workshops, including one that provides a medical perspective on contraception. The workshops combine religious and secular viewpoints on contraception, miscarriages, abortion and fertility treatments. In her role with MWO, Saied advocates for creating spaces where women can openly talk about taboo topics like birth control and pregnancy, despite her own struggles discussing pregnancy-related issues in the past.

“There was this taboo around talking about your body,” Saied said. “That was something I had to get over. That’s why, with these programs, we try to create spaces to talk about these things before you deal with an issue.” Discrimination compounds the harmful effects of cultural taboos, particularly regarding women’s health. Despite strides in breaking these barriers, many communities still stigmatize discussions around contraception, miscarriages, abortion and fertility treatments.

I purposefully did not share with the doctor that I am Muslim because I am also Black, and our maternal mortality is high. I did not want to manage double discrimination.

Samia Abdelnabi, a midwife and postdoctoral fellow at the University of Michigan, said she grew up in a culture where it was taboo to talk about women’s health. “Even our moms wouldn’t tell us about our menstrual cycle,” she said. “You had your period and didn’t understand what it meant.”

Abdelnabi is frustrated by stereotypes associated with wearing a hijab. The main thing she finds is that once a Muslim woman observes hijab, there is “the automatic assumption that you’re oppressed, you don’t speak the language. It gets irritating.”

As a Palestinian American, Abdelnabi said she also worries about how the current situation in Gaza could negatively affect Muslim patients and health care professionals. “We already have Islamophobia. We have anti-Muslim rhetoric. We have areas where people don’t care who you are or what your educational background is,” she said. “They see your hijab, and they make their assumption, and they’re going to treat you poorly. I’m worried that it will spill onto our patients from our physician colleagues.”

Umm Ahmed, a Palestinian Muslim mother, feels her doctors ignored her for days after giving birth in the hospital before finally receiving medical attention. She refused to leave until her concerns were addressed. “I am a Muslim; I do wear hijab, and I experienced, in my opinion, what felt to be racism,” she said. “I experienced dizziness — severe dizziness.” Despite assurances from various doctors that her condition would be investigated, days passed without resolution. It wasn’t until the fourth day that she finally encountered a neurologist willing to look into her symptoms. The doctors found evidence of a stroke on the left side of her brain.

“They were not taking me seriously,” Ahmed said. The dismissive attitude stung even deeper due to her identity as a Muslim woman, where her religious and cultural preferences were routinely overlooked. The experience made her reconsider if she even wanted another child.

Cultural competency requires a long-term commitment from all partners in the health care system. The U.S. Department of Health and Human Services provides clear guidance on what that means: “The ability to provide services to clients that honor different cultural beliefs, interpersonal styles, attitudes and behaviors and the use of multicultural staff in the policy development, administration and provision of those services.” 

Muslims are not the only health care patients who may have concerns about modesty in the exam room. Women in Amish and Mennonite communities have successfully requested similar accommodations. “We all want to be treated with respect and dignity,” says Dr. Melissa Thomas, professor at the Heritage College of Osteopathic Medicine at Ohio University. Part of Thomas’ practice involves encouraging health care professionals to avoid assumptions when working with populations they are not accustomed to and to ask questions when in doubt. She also developed an agreement with health care partners such as hospitals, universities and agencies to outline how to approach patients with dignity and respect.

One agreement with a hospital system provided instructions on handling post-screening follow-ups of Amish and Mennonite women that involved delegating a nurse and using a Mennonite community health worker. Sometimes they would drive to a woman’s home and provide a phone for a patient to receive medical results. Before the agreement, hospitals often unsuccessfully tried emailing or calling Amish or Mennonite patients or provided links to web portals they never visited. The agreement ensured cultural considerations of the community came first, led by trained community members who served as a bridge.

Instituting similar practices for Muslim women who want to adhere to such modesty standards can empower Muslim patients to feel respected and valued during one of the most intimate and vulnerable moments of their lives. By accommodating Islamic standards, hospitals and healthcare providers are not only meeting the religious and cultural needs of their patients but also fostering an environment of inclusivity and understanding in healthcare settings.

Dr. Heba Abolaban teaches workshops on how health care providers can better listen to Muslim patients’ needs. A former public health physician from the Muslim Mental Health and Islamic Psychology Lab at Stanford University’s medical school, Aboloban said it is possible for women who wear hijabs to keep them on without sacrificing the patient experience. For example, she recommends doctors allow women who observe hijab to keep it on during physical exams unless it is essential for a specific test. Abolaban also designed a “modesty gown” that provides full-body coverage and can be worn instead of a traditional hospital gown during childbirth or routine screenings. 

 “The first concern is for this population to acknowledge the challenges associated with their perinatal experiences,” says Dr. Venus Mahmoodi, an assistant professor from Columbia University who specializes in reproductive mental health. “We as clinicians are responsible for managing expectations of pregnant and parenting Muslim women…and clinicians also need to be educated on Muslim women’s experiences as well.”

When I finally gave birth, I repeatedly asked to be seen only by women but was told it was not possible. I was told that there was no control over who the on-call doctor was, even though I opted only to receive care from my original female OB. Additionally, I was told the anesthesiologist would be a male when I elected to get an epidural. 

I felt defeated and ignored. After being in labor for more than 12 hours, my calls for receiving more information seemed to fall on deaf ears. Exhausted and worried about the safety of my first baby, I had no choice but to give in. My original OB eventually showed up and called for a C-section. “No, please…” I cried.

“Do you want to walk out of this hospital with a live baby or not?” she asked me, shaking her head. I felt like I was being kept in the dark. The lack of information coupled with the nurse’s dismissive attitude didn’t help.

While I’m grateful my son was OK, to this day I have PTSD when passing by the OB’s clinic or hospital. But the experience has allowed me to help other Muslim women who feel like they are ignored in the medical space. Years later, I sought the advice of midwives and doulas and realized that birthing can be a beautiful experience. You need to be equipped with the right knowledge and have a supportive team — and you cannot let others dictate how you feel. While this whole experience was frustrating, it helped me realize I am my own best advocate.

This story was supported by the USC Annenberg Center for Health Journalism’s 2023 Impact Fund for Reporting on Health Equity and Health Systems along with a health justice fellowship from the Los Angeles chapter of the Asian American Journalists Association.