Walker: Tell us about postpartum care in Muslim families. In your experience, how is a woman supported by her family when she comes home? Are postpartum doulas ever employed?

Hajara: From a purely religious standpoint, postpartum women are exempt from performing the five daily prayers and are not to engage in conjugal relations for forty to sixty days after birth - that in itself is a huge relief! There are however, no specific Islamic guidelines on how a woman should be cared for postpartum by the family.

And so again, where there is no religious guideline on a given matter, people are free to and often will follow the protocol of the culture they most identify with. And so this is why you'll find Muslim women of East Indian origin moving in with their moms' for the first couple of weeks up until a month.

In terms of if postpartum doulas are ever used, though I don't personally know of any Muslim couples that have opted for a postpartum doula, there is nothing really preventing Muslim couples from employing one.

Walker: Can you tell us what, if any, differences there are regarding choice or preference to breastfeed?

Hajara: There are actually a few Islamic guidelines on the issue of breastfeeding. Firstly, breast milk in Islam is considered the newborn's birth right, something he/she is entitled to. And secondly, moms are allowed to nurse their baby up until the age of 2, at which point they should wean their baby.

All that being said, it needs to be noted that if a mom is not able to breastfeed for reasons like insufficient milk production, physical issues, mental health concerns or because she has to return to work, she is Islamically exempt from breastfeeding duty. In such cases, a woman can opt to provide: a milk-nurse for her baby (think of Salma Hayek's trip to Sierra Leone in 2009), a healthy alternative like formula* or opt for a combo of some sort like pumping and supplementing (if the issue is due to return to work).

Walker: Regarding emotional health in the postpartum period, what is your experience of supporting Muslim women who have a perinatal mood disorder?

Hajara: My experience supporting Muslim women with a perinatal mood disorder has been somewhat (no pun intended) depressing.

To better explain what I mean, it's important to understand how Islam views mental illness in general. If you actually look at Islamic history, you'll see that many of Islam's greatest scholars and physicians were among the first to view mental illness as actual medical conditions. And this was at a time when most of the world opted to view mental illness as evidence of demonic possession.

In fact, two Muslim giants made some of the greatest contributions to the field of psychiatry at the time: with Avicenna (considered the father of modern medicine) including mental illnesses in his Canon of Medicine and Rhazes being the first to open a psychiatric ward.

Muslims were also among the first to treat those with mental illness compassionately as dictated by the Qur'an, use baths, drug treatments and even use music therapy to help treat mental illness!

Now the depressing part: practically no one, no Muslim I've ever met, including Muslim women with perinatal mood disorders and their families that I have had to support, knows what Islam's view on this topic is.

Not only do they not know how supportive their faith is about this topic, a good majority of Muslims tend to believe quite the opposite: that the Islamic perspective on mental illness is that it is due to a lack of faith, punishment, or my all-time favorite, demon possession!

Because of this, in my experience, a lot of Muslim women don't want to admit to any of the symptoms of a perinatal mood or anxiety disorder, thinking it means they are not committed enough to God, etc.

I have also come across families that have simply watched their loved one spiral into postpartum psychosis and done nothing believing their loved one is possessed!

And so, my experience in supporting Muslim women with perinatal mood disorders has been fraught with an additional layer of stigma and ignorance that has to be chipped away at.

Though it is truly unfortunate, I can't blame people for not knowing about the Islamic viewpoint on mental illness. Having done my studies in Psychology, never once was I even exposed to what anyone outside of Europe believed about mental illness. And this was at a University known for being left-leaning!

Closing thoughts...
Increasing our knowledge of the cultural context of maternity care is essential to addressing the full spectrum of reproductive health on the global scale. My gratitude to Hajara for her participation, knowledge, and steadfast commitment to the perinatal mental health advocacy movement.

Hajara Kutty is an educator and postpartum mental health advocate. She is also the Greater Toronto Area Coordinator for Postpartum Support International. Her articles on the topic of postpartum mental illness have appeared in media outlets across Canada. She lives in Toronto with her husband, daughter and cat.

Published: April 28, 2011

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