Ramadan fasting raises health and ethical questions for Muslim women who are pregnant, nursing or menstruating. Women who miss some of this year’s fast can make up for it next year. First in a series on women and Islam.

Muslim women pray during Ramadan.

NEW YORK (WOMENSENEWS)–Muslim women are exempt from fasting during the month-long holiday of Ramadan and many doctors discourage it.

"If God has given a permission or exemption, the right thing is to avail that permission and thank God for giving that permission," said Dr. Shahid Athar, former chair of medical ethics at the Islamic Medical Association of North America in Indianapolis.

But it’s easy to find women who don’t follow that advice.

Last month two stood side by side with small sons outside the Al-Farooq mosque in the commercial Muslim pocket of Atlantic Avenue in Brooklyn, N.Y.

One wore a beige hijab (veil) and the other was in a niqab, the conservative Islamic black garment that covers everything but a woman’s eyes.

"My son was born one month after Ramadan and he weighed 10 pounds," said 33-year-old Halima, who comes from Morocco and kept the Ramadan fast during both her pregnancies. She said fasting can be particularly hard during the early months of pregnancy, when women commonly suffer the worst nausea and are advised to eat lightly to offset it.

But Halima–who asked that only her first name be used–said that pregnant women have the right to choose to fast during the holiday. "Ramadan is for yourself. If you can fast, you fast. If you can’t, you can’t, but all Arabic people love Ramadan so they don’t want to miss out on the fast."

The woman next to Halima, an Azeri who converted to Islam in her home country and landed in the United States bundled in black, expressed the same attitude towards fasting while breastfeeding.

"If a woman is in good health and the child is a few months old and eating soft foods she should attempt the fast," she said, lowering a gauze veil over her eyes as some men stepped out of al-Farooq mosque. "But you only do it if it’s easy. God will not accept things done in hardship." She asked to remain anonymous.

Women Want to Keep the Fast

Daisy Khan, executive director of the American Society for Muslim Advancement in New York, said that for many women exemption from fasting can seem more like a hardship than a relief.

"Ramadan puts you into a different state because you are abstaining from many pleasures in your life. You feel centered because you are doing nothing but the glorification of God. It’s like Thanksgiving everyday. To break this rhythm, smack in the middle of Ramadan, that’s what women do not like." Khan says women enjoy the season’s heightened social interactions and cooking iftars, the meals that break the fast. During Ramadan, Khan says women say more prayers, feel closer to God and are intellectually more stimulated because they are reading the Qu’ran every day.

While Ramadan provides some flexibility for women’s childbearing and menstrual cycles, fast days missed must be made up. Women have until the following Ramadan to catch up with their fasting. But sometimes, pregnant women unable to fast during Ramadan one year find themselves nursing and not fasting the following year. In such situations they may compensate by offering charity, such as donating one day’s worth of food for each day that they’ve missed.

"You are not really exempt from fasting," said Khan. "You are just exempt from causing more hardship to yourself. Either you make up the fast or you give aid in the form of charity." In North America, Ramadan 2007 ends on Oct. 12 and Ramadan 2008 begins onSept. 2.

Mixed Messages on Breastfeeding

Muslim women who are breastfeeding receive contradictory messages. On the one hand, they are entreated to fast if they are in good health. A Muslim woman should only break the fast if she "fears for herself or the child," says one set of guidelines compiled in 2004 by a committee of Muslim doctors and Islamic scholars. On the other hand, Islam prioritizes the needs of the infant and recommends that mothers breastfeed until the child is 2 years old. In some Muslim countries, women rely on wet nurses to meet this standard.

Ramadan fasts can be a hardship for some Muslim women.

One recent study published in the American Journal of Perinatology links fasting to a higher frequency of induced labor, caesarians, and admission to the special care baby unit. Another study, conducted in the UAE, indicated that fetal breathing movement decreases during maternal fasting. Fasting also negatively alters milk composition. Vitamin levels drop, more so when the woman fails to keep a balanced diet during the non-fasting hours. Ramadan also puts mothers at greater risk for gestational diabetes.

Ramadan, the ninth month in the lunar Islamic calendar, brings added challenges when it falls in the summer. The days are hotter and longer so pregnant women, in particular, struggle with their cravings, while nursing women may find that they lactate less. Fasting can cause dehydration and malnutrition to the mother as well as the child, according to small sample medical studies conducted in Yemen, the United Arab Emirates and Egypt.

Medical studies conducted in the Middle East show that pregnant and nursing women often persist in fasting even when they are fatigued. In the United States this practice is less common, according to Athar and Khan.

Some Mandatory Restrictions

Certain situations prevent Muslim women from fasting during Ramadan, whether they want to or not.

In Islam, it is forbidden for a woman to fast if she has post-partum or menstrual bleeding as this interferes with ritual purity and cleanliness. Halima, for example, could not fast for 20 days during the 2001 Ramadan because she gave birth to her daughter right before that fast. She made up for the missed days with additional fasting the following year.

Women’s menstrual cycle typically cuts the 29-30 day fast short. To avoid this, some women try to alter or postpone the timing of their period by taking the contraceptive pill. Young Muslim women frequenting Islamic jurisprudence or "fatwa" sites online commonly ask whether it is permitted to manipulate the contraceptive pill in order to keep the fast.

One opinion espoused by an Islamic scholar, mufti Ebrahim Desai, in a posting on the Every Muslim website–and endorsed by Athar–is that unmarried women should not use contraception solely for keeping the fast because it disturbs their natural cycle. The pill, they maintain, should only be used for medical reasons.

Dominique Soguel is the Arabic editor for Women’s eNews.

This series is supported by the Rockefeller Brothers Fund and the Carnegie Corporation of New York.

For more information:

American Society for Muslim Advancement:

Islamic Society of North America:

Islamic Medical Association of North America:

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