We must do more to protect Muslim women in the UK
By Integrated Care Journal-
Dr Hina Shahid, GP and Chair of the Muslim Doctors Association, calls out the mistreatment of Muslim women in the UK and specifically in our medical workforce.
The importance of intersectionality
Intersectionality has become a ‘buzz’ word in recent years, and rightly so. The term describes an analytical framework for understanding how aspects of a person’s social, biological and political identity combine to create sites of discrimination or privilege. As Dr Hina Shahid says: “we are not all equal. Our experiences are not all equal. We have multiple identities and attributes and any one of those or several of them can be the subject of discrimination and oppression. ” Treating people ‘equally’ is therefore inadequate: to recognise intersectionality is to recognise that we do not all start from the same place in life.
Nowhere is intersectionality more important than in healthcare. “We talk about women’s health disparities, but we don’t talk about when religion is added into the mix, or the migration experience. Those factors also influence health and health outcomes. ” The knottiness and complexities of identity means healthcare policies and outcomes will never be a one-size-fits-all approach. “Unless we start having those nuanced conversations and developing those holistic and tailored approaches to address them, we will never be able to eliminate them. ”
Religion as a determinant of health
During the first wave of the pandemic, Dr Shahid campaigned to ensure religion was recognised as a determinant of health in Covid-19 data. The results of ONS data published in June showed that Muslims have the highest risk of dying from Covid-19 and the fact that most of this excess risk is explained by social deprivation and ethnicity, highlights Islamophobia being an intersectional form of structural discrimination and racism.
“Religion is an overlooked determinant of health and the pandemic has absolutely highlighted this. We don’t have data that is routinely collected by religion on health outcomes across the spectrum. We have faith communities and government working to roll out the vaccine, but how can we effectively deliver an intervention when we don’t know what the needs are? ”
The NHS recognises that religion is a protected characteristic, yet data is not routinely collected. “As religion is a protected characteristic, people who belong to those groups are by default vulnerable and must be protected, but if we do not measure these experiences, we essentially ‘invisiblise’ these groups. ”
Multiple penalties: gender, religion and race
Dr Shahid says a double pronged perspective is needed to understand the intersectionality of the female Muslim experience, looking at both population level and at NHS level. On a population level, the fact that over 90 percent of Pakistani and Bangladeshi communities are Muslim offers a proxy for data on religion, but again lack of specific data means it is hard to fully comprehend the experiences of Muslim women.
Several studies have shown that cervical and breast cancer screening among ethnic minority women are low due to lack of communication around what these tests entail.1 Mental health issues are another problem. “Pakistani and Bangladeshi women face huge barriers in accessing mental health services because they are often not culturally or faith sensitive. So women don’t engage in the services and are left to suffer. ”
Turning to the NHS workforce, “there are multiple penalties suffered by women. If you are woman, your career progression will be slower, you will suffer a gender pay gap and there are huge issues around representation. ” However, ethnic minority women suffer twice over: “if you are from an ethnic minority, you are more likely to face discrimination, bullying and harassment. You are more likely to be struck off or be referred to disciplinary procedures.
“When you work in the NHS and combine both of those discriminatory axes – and you are also visibly Muslim – that penalty becomes even greater. ’ The intersection of religion and medicine is also a problem. ‘If you want to go and pray, you are looked upon as though you are some irrational, unscientific person. ’
While the NHS has a diversity agenda in place, there is much more to be done. Recent data published by the NHS Workforce Equality Standard shows that progress is being made with small but marked increases across the workforce in diversity.2 However much more needs to be done.
“Not all NHS trusts have EDI (Equality, Diversity and Inclusion) frameworks. Up until a year ago, very few primary care trusts had any kind of EDI agenda. There are more and more cropping up across the country, but how much of this is just a box-ticking exercise. It is not enough to have ethnic minority people represented as tokenistic gestures. ”
Dr Shahid argues the Government’s controversial PREVENT programme is actively discriminating against Muslims in the NHS workforce. The PREVENT strategy was launched in 2003 to counter extremism, but there is huge academic, political and public opinion that demonstrates it to be an Islamophobic tool that surveils Muslims.
The health charity Medact has done work on how the PREVENT policy forms a barrier for Muslims seeking healthcare, demonstrating that the policy undermines the duties of healthcare professionals and discriminates against those with mental health conditions.3
“I have to report on things like whether patients have had a sudden change in appearance, are more socially isolated and even whether they have recently converted to Islam. That was a Health Education England training module. ’ As an exceptionally busy clinician with just ten minutes to treat her patients, Dr Shahid says ‘I don’t have time to screen for radicalisation nor do I feel qualified to do that. That is not what myself or my colleagues trained to do. ”
What should be done?
It is clear that Muslim women especially face huge levels of both structural and individual racism and discrimination. ‘When designing policies, we need to have people that represent these supposedly homogenous communities at senior level. The problem is that minority ethnic women are not making NHS policy decisions. ’ Instead, once the policy has filtered down, ‘we have to do this ridiculous training which A) adds nothing to the agenda, and B) can actually have the opposite effect. ’
Dr Shahid argues that any NHS policy being introduced needs to have a holistic equality impact assessment. ‘That means having a range of voices that represent different equality domains at the table to ensure no policy discriminates against a particular group, be that Muslims, LGBT people or ethnic minorities. ’
Individualising a systemic problem must be stopped. Rather than changing NHS policies and structures, individuals are told to change their behaviour, dress code or faith. ‘We need more allies to come forward and in a way that actually empowers ethnic minority women rather than reproducing the saviour narrative. ’
Public Policy Projects is exploring health inequality in more depth in its State of the Globe report A Women's Health Agenda: Redressing the Balance. For more information, please contact email@example.com
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