'A lack of culturally sensitive care': Muslim women face stark inequalities in the UK's healthcare system

Discrimination and religious and cultural insensitivity mean that the healthcare system continues to fail patients of Muslim origin, according to a new report into health inequalities among ethnic minorities in the UK.

The report by the independent watchdog, the NHS Race and Health Observatory (NHSRHO) which mainly focused on maternity care and mental health, found “overwhelming evidence of ethnic health inequality through the lens of racism.”

According to the review, there was a widespread failure to accommodate important religious and cultural differences including diet, concepts of modesty and touch restriction, and alcohol intake restrictions. Racial and religious discrimination also meant patients of ethnic backgrounds were facing poorer health outcomes.  

"The report also highlighted the intersectionality of poverty and race which has been a particular area of concern as women living in the most deprived areas. In these areas, which often have a sizable Muslim community, women are three times more likely to die in childbirth"

Dr Habib Naqvi, director of the NHS Race and Health Observatory, who wrote the report told The New Arab, “Few data exist that are specific to health inequalities for Muslim communities."

Part of the issue here is that the Muslim community is not homogeneous – religion and belief cut across geography, race and ethnicity, sex and other characteristics. However, there is emerging research outlining the consequences of “Islamophobia” for the physical and mental health and health care of Muslim communities.

“While addressing religious discrimination involves action not only from the healthcare sector but also in other parts of society, healthcare systems have a crucial role to play. We need to ensure that adjustments are made to meet the diverse needs of our diverse communities within healthcare settings, and further action-focused research is undertaken to provide evidence-based policy recommendations to help address health inequalities for our growing and diverse populations.”

Maternity care is a time when many women are at their most vulnerable, yet many Muslim women felt they faced stereotyping and Arab women in particular described how they felt their Muslim clothing put them at risk of discrimination.

There was also often a clash between healthcare information and practices and cultural practices. This creates a vicious circle where a lack of trust within Muslim communities is creating poorer access and engagement with services.

The report also highlighted the intersectionality of poverty and race which has been a particular area of concern as women living in the most deprived areas – which often have a sizable Muslim community – are three times as likely to die in childbirth.

"The lack of understanding of the religious and cultural context around mental health is a massive barrier towards getting the correct support"

 “Women’s social, cultural and economic circumstances can affect the choices made in pregnancy. Religion has a profound influence on women’s choices,” said Dr Tasneema Firdous, Leeds Teaching Hospital, who was one of the researchers of the report.

“Statistics tend to be reported by ethnicity rather than religion, however, within Muslim groups, there is similar evidence of poor communication, stereotyping, cultural misassumptions and a lack of culturally sensitive care.” 

Mother of two, Ayesha Siddiqui from Leeds said: “I wear a hijab and definitely feel people have preconceived ideas about you. It’s uncomfortable to have male medical staff and if you say anything, they think you are being fussy.”

The report also painted a damning picture of mental health care and said racism and socioeconomic inequalities were creating “dire” health outcomes for ethnic minority people facing mental health issues.

Racial discrimination within the health care system coupled with the cultural stigma within Muslim communities about mental health, create a double-edged sword where Muslim communities, particularly of South Asian origin often fail to gain access to the specialist mental health services they need.

What has been worrying is that many people from ethnic communities feel that history is repeating itself with parents reporting that their children face the same barriers to accessing mental health services.

Adeela K.* (who wished to stay anonymous) said she felt “half the battle was to get therapists to understand the religious and cultural context” when dealing with mental health issues.

“I was abused by a relative when I was younger and a lot of my trauma and difficulties processing it was tied to cultural issues like family honour, ideas around virginity and arranged marriages and my counsellor just didn’t get it. Half my time was wasted trying to explain the cultural issues and her response was, tell your dad, that will make you feel better about it. Telling my dad was the last thing I could do. I never went back.”

"A lack of cultural understanding, Western bias and language barrier are the key factors I  heard from my own clients who have faced active discrimination and prejudice"

The lack of understanding of the religious and cultural context around mental health is a massive barrier towards getting the correct support said psychologist Lily Sabir.

“A lack of cultural understanding, Western bias and language barrier are the key factors I have heard from my own clients who have faced active discrimination and prejudice from professionals who generally do not have experience in treating diverse young and old adults. Their interventions can only go so far and it isn’t long before clients feel a complete lack of trust when being treated for mental health/physical health concerns,” she explained.

“It’s a combination of fear of not finding a therapist who speaks their native tongue and doesn’t understand the kinds of issues they may be facing from a cultural perspective. Trauma is trauma but it can come from specific cultural experiences. But also, we should feel fortunate that until some of these issues are rectified within care systems the pharmaceutical approach is in place but its not enough," Lily Sabir continued.

"Psychodynamic approaches and CBT have been relatively utilised in Western care systems rather than in developing nations and I have seen the NHS in England do take steps to match clients with therapists who could relate to them from a cultural understanding but more needs to be done."

An NHS spokesperson said: “The pandemic has shone a stark light on health inequalities across the country and the NHS is already taking action to improve the experiences of patients and access to services."

Alia Waheed is a freelance journalist specialising in issues affecting Asian women in the UK and the Indian subcontinent.

Follow her on Twitter: @AliaWaheed