No abstract

Ramadan is a widely observed practice of Muslim communities across the world. In April 2022, millions of people will undergo a month of radical change, withholding from all food and drink during daylight hours and giving more in charity and reflection. Ramadan can be challenging to those with chronic health conditions. Islamic law places an emphasis on the preservation of life: those who are likely to come to harm through fasting are religiously exempt.Nonetheless, the desire to fast is strong for many, not least due to the strong communal experience that Ramadan brings; patients often persist despite medical advice to the contrary. 1 Appointments and work schedules are rearranged outside the month to maximise the Ramadan experience, including women who are due for their smear tests and mammograms.Muslim women have a mandatory religious exemption from fasting during the menstruation or lochial phase. Women who are pregnant/breastfeeding may not fast if they fear harm to them or their child. The change in routine during Ramadan may cause erratic menstrual cycles, particularly with longer fasts and significantly altered sleep/food intake. Some women may wish to control their periods with medication to allow for more (predictable) days of fasting in Ramadan. Pregnant and breastfeeding women may also wish to fast if they feel able to and should be supported where it is safe to do so through practical guidance that is published around this and for chronic diseases. 1,2 Fasting for consecutive days in Ramadan is not the only option that Muslim patients may take. Alternate-day fasting or fasting for a portion of the month is also possible, with options to make up fasting straight after Ramadan or in the winter months where shorter days and cooler weather help those who may find it intolerable otherwise. 3 Patient-centred shared decision making is the hallmark of general practice and empowering patients is the key to productive clinician-patient relationships. 1 Muslim women have one of the poorest patient satisfaction experiences and outcomes, especially around maternal health. 4 Through greater awareness of issues such as Ramadan, we can redress the lack of equity and move to improve these health inequalities.