Muslim Women's Preferences in the Medical Setting: How Might They Contribute to Disparities in Health Outcomes?

Much research has explored the association of race, ethnicity, language, and socioeconomic status with health inequities. Less has been written about the role of religion. In part, this may be because religious identification is fluid and cuts across diverse demographic lines. Yet religion can profoundly affect health beliefs and behavior, and thus may significantly influence disparities in health outcomes. ¹

Given the rapidly changing composition of religious affiliation in the United States—as well as the increasingly public expression of biases against people of different religions—it is important to elucidate how this identification affects people's interaction with the health system. In this issue of the Journal of Women's Health, Vu et al., ² discuss their study of the association between religion-related factors and delayed care seeking among Muslim women in Chicago. ² Using a community-based approach, the researchers conducted a cross-sectional survey of more than 250 Muslim women attending community and religious events. In keeping with Islam's racial and ethnic diversity, the sample contained Arab Americans, South Asians, and African Americans. The survey included assessments of religious fatalism, religiosity, perceived discrimination, personal modesty, worship practices, and use of alternative medicine. The researchers investigated the association of each measure with the statement “I have delayed seeking medical care when no woman doctor is available to see me.” Delayed care is highly relevant, since it has been associated with poorer health outcomes in a variety of conditions. ^3,4

Most strikingly, more than half of the survey's respondents indicated they had delayed care because there was no female doctor available. Those who reported delaying care were more likely to be highly religious and also more likely to have high personal modesty. They were more likely to have lived in the United States for fewer than 20 years. The authors' findings reinforce the importance of gender diversity in the health workforce as an important factor influencing health outcomes.

The U.S. Islamic population is rapidly growing, ⁵ yet understudied. The Pew Research Center has estimated there are more than 3 million Muslims living in the United States, representing about 1% of the overall population. ⁵ Overall, Muslims in the United States are more likely to be immigrants and are younger than the U.S. population as a whole. ⁵ Past research indicates that providers often lack awareness of the strong preferences many Muslim women have for modesty and for a female provider, particularly with regard to breast, rectal, and gynecological examinations. ⁶ This lack of understanding may heighten healthcare-associated anxiety for these patients. Muslim women in the United States are also less likely than other women to undergo screening for breast and cervical cancer. ^7,8 Some suggestions for addressing Muslim women's concerns include having female providers available, designing more concealing hospital gowns, and cultural competency training for students and health professionals. ⁷ It is important that we continue to improve our knowledge about how to provide optimal care for these patients.