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Over 20 000 babies are born annually to a population of approximately two million Muslims in the United Kingdom.1The overwhelming majority of British Muslims will respect the rites of passage recommended by Islamic teaching. The customs are many, and may seem unnecessarily rigid and prescriptive; however, to those within the tradition, they are deeply symbolic, coherent, and complementary. We give an insider's perspective here for the uninitiated.
The rights of the child
Children have many rights that are clearly articulated in Islamic Law, and for the most part these are well respected. Beginning before conception, they have the right to be born through a legitimate union, with full knowledge of their parentage. The social experiments currently taking place in some countries, facilitating the use of donor sperms and eggs to help barren couples to conceive are therefore categorically prohibited by Islam. Also due to the child are the rights to a good name, to be suckled, to be educated, and above all, to be reared in a stable and loving environment.
It is customary for the father, or a respected member of the local community, to whisper the Adhan into the baby's right ear. These words include the name of Allah the Creator and is followed by the Declaration of Faith: “There is no deity but Allah; Muhammad is the Messenger of Allah.” Both of these fundamental pronouncements serve as the pivot around which the life of a Muslim rotates, hence their symbolic significance at birth. Ideally Adhan should be performed as soon as possible after birth; the entire ceremony takes only a few minutes, and it is generally appreciated if parents are allowed the opportunity to perform this rite in privacy.
Soon after birth, and preferably before the infant is fed, a small piece of softened date is gently rubbed into his/her upper palate. Where dates are not easily available, substitutes such as honey may be used. A respected member of the family often performs this, in the hope that some of his/her positive attributes will be transmitted to the fledgling infant. Restricting access to the delivery ward to partners only would affect this practice.
The Taweez is a black piece of string with a small pouch containing a prayer, which is tied around the baby's wrist or neck. This practice is particularly common among Muslims from the Indian subcontinent, who believe that it protects the baby from ill health. For obvious reasons, it is important that the Taweez be handled with respect at all times.
Male circumcision continues to excite a good deal of interest and discussion within both the medical and lay press. Sharply conflicting customs are seen in Western countries, with circumcision being performed on an almost routine basis in the United States,2 whereas in Britain the practice is viewed by many with scorn.3 ,4 For Muslims,5 as for the Jewish community,6 religious law sanctions only male circumcision. Female circumcision continues to be practised in some countries such as Sudan and Egypt.7 It is believed that this practice is cultural and was present before the advent of Islam. Muslims consider male circumcision important mainly for hygienic purposes, so that when the child matures and begins to offer prayers, there is no danger of his clothes becoming soiled from small amounts of urine held up in the foreskin—an important consideration because soiled clothes nullify prayer. Circumcision also decreases the incidence of cancer of the penis.8
Difficulties in obtaining circumcision on the NHS mean that it is usually performed in the private sector, at a cost of between £50 and £100. The plastic ring method is most often used, with the procedure performed under a local anaesthetic. Although most practitioners seem to be aware of the need to delay circumcision in jaundiced infants, because of the potential risk of prolonged bleeding, it is important to remind parents of this. Babies born with hypospadias should also not be subjected to circumcision until a surgical opinion has been sought.9 Because of the frequency of complications following circumcision by non-professionals, some health authorities have tried to regulate the practice by establishing special clinics for religious circumcision.10 Others such as Sandwell Health Authority now offer free circumcision to boys under the age of 2 years (J Rao, Director of Public Health Authority of West Midlands, 2000, personal communication). Such initiatives that recognise cultural pluralism are welcome and should be replicated in other parts of the country.
Circumcision is usually performed within a few weeks of birth. Frequent nappy changing is advised, together with the liberal use of barrier creams, to minimise the risk of ammoniacal dermatitis and the associated risks of meatal stenosis and ulceration during wound healing.11 ,12
A sheep is offered in sacrifice for every newborn child as a sign of gratitude to Allah. This is usually performed on the seventh day, and the meat is distributed among family members and the poor. Many will arrange for the sacrifice to be performed in their countries of origin, thus allowing the meat to be distributed where there is greater need, simultaneously enabling disparate family members to partake in the celebrations.
SHAVING THE HAIR
Scalp hair that has grown in utero is removed, traditionally on the seventh day of life, and an equivalent weight in silver is given to charity.
CHOOSING A NAME
The choice of a good name is a fundamental childhood right. It is hoped that the name will both inspire self respect and give the child something to aspire towards in the years that lie ahead. It may be a few days before the infant is named, as it is usual to seek the advice, and approval, of members of the extended family. Tables 1 and 2 present some examples of common female and male names, together with their meanings.
In the Gujarati Muslim community and among Muslims that trace their origins to Central Africa, as well as in urban regions of the Indian subcontinent, the system of naming often follows that found in Britain. Families will use clan or group names as a surname—for example, Khan or Chaudhry. For many, however, a more traditional method of naming is used, and it is usually a failure to understand this system that leads to confusion, and occasionally chaos, with clinic records.
Boys may have a personal name, which is either preceded or followed by a religious title—for example, Muhammad Siddiq, where Muhammad is a religious title, and Siddiq the personal name. In the case of his brother, Altaf Hussain, Altaf is the personal name, and Hussain the title. For medical records in the United Kingdom, the final name is often used as a surname and this would explain why two Muslim brothers may have different surnames!
An alternative method of recording family names is to use the child's personal name followed by his father's personal name, the latter being used as a surname—for example, Muhammad Siddiq and Altaf Hussain, the sons of Abdul Rashid, would be recorded as Siddiq Rashid and Altaf Rashid, because Abdul is a title (table 3). Only a handful of titles are commonly used. Such a system could therefore be implemented with relatively little training for record clerks. The potential problems of using different names on hospital records and other important documentation such as passports, driving licenses, and insurance forms would, however, need to be thoroughly explored in advance of any such changes. Anecdotal discussions suggest that there would not be much resistance among the Muslim community to a change of this kind; nonetheless, it is clearly important that the views of a representative group from the Muslim community are adequately sought.
Many Pakistani and Bangladeshi Muslim women will use a personal name followed by a title—for example, Razia Bibi or Razia Begum, where Razia is the personal name, and Bibi and Begum are titles denoting marital status (Mrs and Miss respectively). A similar practice could be adopted for recording female names—that is, their personal name followed by their father's or husband's personal name. Razia Begum, the wife of Abdul Rashid, could then be recorded as Razia Rashid (table3).
SOME HELP IN RECOGNISING MUSLIM NAMES
These are usually Arabic in origin, the language of the Qur'an. Muslim names are easily identifiable to the trained eye. For those less familiar with Arabic, title names can be very useful. Commonly used titles include Muhammad, Hussain, Abdul, Ali, Ahmad, Bibi, Begum, and Khatoon, and therefore anyone with a name incorporating one of these titles can confidently be identified as a Muslim.
Breast feeding and weaning
Breast feeding is positively encouraged by religious teachings, with the recommendation that it should ideally continue for a period of two years.13 Although many mothers may wish to breast feed, the insufficient privacy offered by some postnatal wards is an important barrier. Muslim etiquette demands that women should not expose certain bodily parts to anyone except their husbands. This includes the breasts, and in order to observe this privacy while in hospital, it is often deemed convenient to bottle feed; this could adversely affect milk production later. If breast milk is ever shared with another child, then the two children would be considered siblings and therefore could not marry each other when older.
There is a commonly held belief, among some sections of the Muslim community, that colostrum is either harmful to the baby, or that it has poor nutritional value.14 ,15 Supplements of honey and water are often used for the first few days of life.16 As an example of a practice that contradicts religious teaching, this dissonance offers a very useful window for the development of educational campaigns directed towards Muslim mothers, with the support of religious leaders and Muslim organisations.
Prolonged breast feeding (greater than six months) is the norm among Bangladeshis.17 Iron deficiency anaemia and rickets may ensue if breast feeding is not supplemented with an appropriately balanced diet. Most Asian families change from an infant formula to “doorstep” milk at about 5 to 6 months.16 This is contrary to the Department of Health recommendation that reconstituted infant formulae should be continued beyond six months in order to prevent deficiencies of iron and vitamins A, C, and D.18
Except for Bangladeshis, most British Muslim infants are weaned between the ages of 3 and 6 months. Proprietary tinned foods are most commonly used, probably more as a reflection of the poor socioeconomic status of many Muslim households, rather than anything to do with religious teaching. Islamic teaching encourages “wholesome food”,19 and initiatives could, and perhaps should, be developed using an appropriate cultural framework to encourage greater use of fresh fruit and vegetables during weaning. It is, however, worth remembering that babies are often fed by hand, and children may be positively encouraged to hand feed. Such a child's spoon handling skills may be poorly developed—something that needs to be borne in mind if using a spoon is incorporated into the “developmental assessment screening tests”.
Stillbirth and neonatal death
Even if a baby is stillborn, a name is given before disposal. Although these babies in the United Kingdom are buried in the cemetery religiously, they do not require a full funeral service and in theory do not necessarily have to be buried in a cemetery. In fact, burial in non-consecrated grounds such as a garden or the woods is not unusual in the Indian subcontinent. Neither the ritual wash nor the shrouding is necessary for these babies. Placental tissue is considered part of the human body and should therefore be buried and not incinerated as presently happens in the United Kingdom. If this practice was widely known among the Muslims, they may take exception.
Muslims are always buried and never cremated. When death is imminent or a baby is very ill, parents or relatives may wish to administer Holy water called Zam Zam. The staff should be aware of the presence of this water on the wards. Ideally the face of the baby after death should be turned towards Mecca (South East in the United Kingdom), but turning the head to the right will suffice. Arms and legs should be straightened and the eyes and mouth closed. It is a religious requirement for the burial to take place soon after birth, and therefore problems often arise if death has occurred at the weekend when there is difficulty in providing the death certificate. Parents will very rarely agree to a post mortem, as it is not religiously allowed unless the law of the country demands it. It is a religious requirement for the baby to be ritually washed and draped in a white shroud made up of two pieces of cloth. It may take up to half an hour for this entire procedure which can be carried out in a mortuary if the facilities are made available.
The Muslim child has a number of Allah given rights; these include the right to be born through a legitimate union, to know fully one's parentage, to be suckled, and to be reared with kindness and respect. There are a number of birth customs common to Muslims, an appreciation of which provides unique insights into the lives of Muslims.