Research Statement
There is no doubt that Ramadan fasting among Muslim women has long-term effects on the wellbeing of unborn babies. Majority of studies done on this issue have only addressed the short-term outcomes of Ramadan fasting among pregnant Muslim women. For example, Arab and Nasrollahi (2001) conducted a cross-sectional study to determine the relationship between foetal birth weight and fasting during pregnancy (p.91). Although the findings of the study revealed a positive correlation between foetal birth weight and fasting during pregnancy, the outcomes were only based on the assessment of participants during Ramadan (Arab & Nasrollahi, 2001, p.91). In another cross-sectional study done by Kamyabi and Naderi (2004), participants were assessed to determine the effect of Ramadan fasting on amniotic fluid (p.45). However, this study only reported the short-term effects of Ramadan fasting on amniotic fluid (Kamyabi & Naderi, 2004, p.46). The short-term effects of Ramadan fasting do not give comprehensive impacts of fasting on the foetus and babies, thus necessitating studies that examine long-term effects of fasting.
Fasting among pregnant women is likely to affect the normal growth and development of babies in later years. Therefore, the principal aim of this research is to investigate and analyze the long-term effects of Ramadan fasting on unborn babies among pregnant Muslim women. This research topic is significant because it will create awareness among policy makers and prenatal caregivers. For example, this research topic will enable healthcare administrators in advising pregnant fasting women on the appropriate measures to be taken in order to protect their unborn babies from long-term effects of Ramadan fasting. Moreover, this research topic will be used as a knowledge base for future studies on the long-term effects of Ramadan fasting on the unborn babies among pregnant Muslim women. The objective of the research is to establish if any significant difference exists in growth and development of babies born by pregnant women, who fasted and who did not fast during the month of Ramadan. Furthermore, research objective is to establish if Ramadan fasting interferes with health care that a foetus and baby deserves for effective growth and development.
Objectives
- To examine if Ramadan fasting has significant impact on growth and development of babies born as long-term effect of fasting.
- To establish whether Ramadan fasting affects prenatal care, which mothers receive during pregnancy period, and subsequently if it interferes with growth and development of foetus.
- To study effects of Ramadan fasting on antenatal care that both mothers and babies receive in relation to growth and development of babies.
- To assess if significant difference exists in growth and development of babies whose mothers fasted at different periods of their pregnancy.
- To monitor weight changes of babies during the first year to establish trend of growth on three groups of subjects due to influence of Ramadan fasting.
- To assess development of children by quantitatively determining nature and extent of movements that babies progressively make during the first one year.
- To observe the number and nature of illness that babies get during the first year of their growth and development, to establish if Ramadan fasting is a factor that determines susceptibility to illness.
- To make relevant recommendation that healthcare system needs to consider while offering prenatal and antenatal care to Muslim women.
Importance of the Research
The research will be of significant benefit to healthcare system because it is going to provide relevant information, which is essential in updating healthcare policies. According to Moradi (2011), healthcare system has been lacking sufficient information regarding the effect of Ramadan fasting on growth and development of both foetuses and babies (p.167). Thus, research findings will help healthcare system to make evidenced-based policies that are going to enhance the lives of not only foetuses but also children. Since growth and development of children determines health status of a nation, formulation and implementation of policies that protect human growth and development will significantly boost lifespan of population.
Since the research hypothesizes that Ramadan fasting influence growth and development of children, it implies that the healthcare system needs to implement educational programs to sensitize pregnant women on the effects of fasting on growth and development of children. Joosoph, Abu, and Yu (2004) advise that, although fasting may seem to have no immediate impact on foetus, pregnant women need to consider long-term impacts because fasting cause physiological disturbances that affect growth and development of foetus (p.584). Given that Muslim women who are pregnant prefer following their religious teachings rather than having concern about their health and that of foetus, healthcare system needs to institute educational programs.
The study will also add to the growing body of knowledge relating to prenatal and antenatal care. Van Ewijk (2011) asserts that, pregnant women who fast increases susceptibility of their children to illness (p.2). Hence, the study will further add that fasting during pregnancy does not only have short-term impact, but also long-term impact. Since gynaecologists and paediatricians are grappling with diseases that affect children and their mothers, the study is going to provide them with new information, which shows that fasting during pregnancy has long-term impact on growth and development of children. Therefore, prenatal and antenatal care services should provide essential information to pregnant women regarding effects of fasting on growth and development of children in light of new findings.
Methodology
Participants
The study will select pregnant Muslim women between the ages of 20 and 30 because they are young and actively participate in religious festivals. According to Irfan (2003), Islamic religion recommends that young people and pregnant women, during their early stages of pregnancy, need to fast (p.3). Therefore, pregnant Muslim women who are at the ages between 20 and 30 are appropriate subjects of study because they fully comply with Islamic teachings. Moreover, since Ramadan fasting is a religious requirement that every Muslim has to comply with, young people often find it difficult to skip this period of Ramadan in spite of acceptable reasons that allows them to compensate at their own time. Thus, to avoid so many inconveniences such as creating time to fast alone in compensation of Ramadan, most pregnant women prefer fasting during Ramadan. Hence, to assess long-term effects of Ramadan fasting on growth and development of babies, the study targets pregnant Muslim women between the ages of 20 and 30 who strictly obey Islamic teachings.
To obtain a large number of subjects who can participate effectively in the study and enhance the validity of the findings, the study is targeting Riyadh, Saudi Arabia, a locality in which Muslims form significant number of population. A region with high population of Muslims is critical for the study because pregnant women, who are the subjects of study, are quite rare in the general population. Moreover, since pregnant women require prenatal care services, the study also targets healthcare institution, King Khalid Hospital in Riyadh, Saudi Arabia, which offers these services, for they have comprehensive records regarding medical history of mother and baby. To obtain relevant information about the number of pregnant women who seek prenatal, as well as antenatal services, healthcare institution is essential because they will help researchers in selecting an appropriate number of subjects that the study requires.
Sampling Frame
Since the study requires a large number of subjects to enhance external validity of the research, it will employ convenience method of sampling to accommodate all pregnant Muslim women so long as they are within required age bracket of 20 to 30 years. Convenience sampling is the most appropriate method of sampling because it has no bias in selecting participants for the study. According Yoon and Horne (2004), convenience sampling enables researchers to minimize errors associated with sampling bias, and thus increases both external and internal validity of the research (p.2). Since pregnant Muslim women are rare in the target population, convenience-sampling method is going to ensure that pregnant women who are readily available become subjects of the study. In conjunction with King Riyadh Hospital, the researchers will also ensure that they obtain the maximum number of subjects possible to enhance credibility and generalizability of the findings.
Using convenience sampling, researchers will select 30 subjects, who are pregnant Muslim women. The subjects should be at different trimesters of pregnancy for researchers to examine how Ramadan fasting influence the way babies grow and develop immediately after birth. Ziaee (2010) argues that, fasting affects physiological functions in a mother, and thus interferes with how foetus receives nutrition (p.182). Basing on Ramadan as a point of reference, the study will classify subjects into three groups. The first group of subjects is pregnant women who will give birth within the first three months after Ramadan period. The second group of subjects is pregnant women who will give birth between 3rd and 6th month after Ramadan. The third group of subjects is pregnant women who will give birth between the 6th and 9th month after Ramadan.
Method
The objective of the study is to establish long-term effects of Ramadan fasting on babies born during the first 9 months after Ramadan period. To achieve its objectives, the study will conduct a prospective study that assesses how babies grow and develop when born by mothers who fasted during Ramadan season. According to Robinson and Raisler (2005), even though pregnant women value fasting during Ramadan period, they predispose themselves to serious health conditions such as malnutrition, which has a significant impact on growth and development of foetus (p.101). Therefore, it means that health status of foetus will affect how babies grow and develop. To assess growth and development of babies effectively, the study will select 30 subjects from the target population. The 30 subjects will consist of pregnant Muslim women who claim to observe strictly Ramadan fasting despite their condition of pregnancy. Hoskins (1992) argues that, most pregnant women prefer fasting during Ramadan despite the fact that Islamic teachings exempt them because they do not want to fast at their own time alone (p. 1247). Hence, great deal of pregnant Muslim women observe Ramadan fasting, particularly the young because they are strong and can withstand stresses that come with fasting when one is pregnant.
Since foetus has different developmental stages that occur in the three trimesters, the study will group subjects according to their pregnancy periods. Concerning the effect of Ramadan fasting, the study hypothesizes that fasting has different impacts on growth and development of foetus, which concomitantly influence growth and development of babies. Almond and Mazumder (2008) assert that, Ramadan fasting results into reduced gestation period and low birth weight, which influence how babies grow and develop after birth (p.23). Hence, it is indisputable that fasting has a significant effect on the foetus and consequently determines how babies growth and develop in spite of antenatal care. Basing on the hypothesis, the study will select 30 subjects and group them into three groups. The first group of subjects will consist of pregnant women who will give birth within the first three months after Ramadan fasting. The second group of subjects will consist of pregnant women who will give birth between 3rd and 6th month after Ramadan fasting, while the third group will compose of pregnant women who will give birth between the 6th and 9th month after Ramadan. According to Naderi and Kamyabi (2004), fasting has different effects on foetus depending on trimester (p.811). Differential birth periods are essential for the study because they will illustrate how fasting have a differential impact on the foetus and subsequently growth and development of babies.
To determine the impact of fasting on growth and development of babies, the study will conduct quantitative assessment of babies from birth up to a period of one year. Shaarawy, Shobokshia, and El-Nouria (1996) argue that, fasting affects homeostasis mechanism of the body through endocrine system by influencing release of hormones such as insulin, glucagon, lactogen, somatostatin and growth hormone (p.456). In this case, somatostatin and growth hormone play a significant role in growth and development of the foetus and babies. Thus, a period of one year is critical for the study because it does not only help in enhancing credibility of the study but also improve its external validity since time will not be a limiting factor.
To assess growth and development of babies, the study will use structured questionnaires and birth records obtained from different health institutions, which pregnant women obtain prenatal services or mothers get antenatal services. According to Bowling (2002), structured questionnaires are suitable for quantitative research because it gives freedom researchers to obtain accurate information that is easy to analyse using statistical tools (p. 23). Through structured questionnaires, the researchers will seek information regarding date of birth, birth weight and continually monitor weight progress of a baby for a period of one year. Rate of gaining weight depicts whether a baby is developing normally or abnormally relative to recommended weight gain by the health institutions. To assess how children develop, researchers will administer questionnaires to mothers to obtain relevant information that shows the period during which a baby takes to perform activities such as turning alone in bed, crawling, standing, laughing and uttering audible words amongst others. At the end of the year, study will analyze qualitative data using Statistical Package for Social Science (SPSS) tool.
Ethical issues
Given that issues of pregnancy and childbirth are quite sensitive to every society, the study seeks to approach subjects of the study through King Riyadh Hospital, Riyadh, Saudi Arabia, to create a rapport and dispel any fears that may hamper collection of relevant information. To obtain permission of conducting research, the study will seek clearance from Saudi Arabia Ministry of Health through maternity and paediatrics department. In accordance with ethics, researchers will assure subjects that information that they are going to give is highly confidential by limiting the use of data collected to the study. Thus, confidentiality of information is an ethical issue that the study will consider complying with during and after the research.
Moreover, since research ethics demands that subjects should have informed consent, the study will ensure that every subject receives enough information regarding the purpose of the study and roles that they should play as research subjects so that they can make informed decisions lest they become subjects of research obliviously. Valiathan (2006) argues that, informed consent protects people against becoming subjects of study by default due their health condition (p.21). In this case, not all pregnant women can be subjects of study, unless they consent to it after reading and understanding the purpose of the study. Additionally, since subjects are pregnant Muslim women, researchers need to restrain themselves from indulging into issues that may compromise their religious beliefs. In this view, the study will not tape-record the subjects, but use structured questionnaires to collect quantitative data. Thus, religious beliefs and cultural factors need consideration in preparation of questionnaires.
Data Analysis
At the end of the year, the study will have collected comprehensive quantitative data that contain different weights showing growth of babies and periods showing their development. Since the objective of the study is to ascertain if a significant difference exists in terms of growth and development of babies among the three groups of subjects, the study will employ SPSS in carrying out basic t-test. Simple t-test will analyze is there is any significant variation in growth and development between any two groups of subjects. As the study hypothesized that Ramadan fasting by pregnant women affect growth and development of babies, which is the long-term effect, simple t-test will give clear analysis of how fasting influence the way foetus grow and develop in each trimester. Thus, existence of difference in growth and development will signifies that Ramadan fasting by pregnant has long-term effects on health status of children, and by extension adult people.
Stakeholders and Community Involvement
The study of long-term effects of Ramadan fasting on growth and development of babies is a significant health issue that deserve participation of community, healthcare institutions and religious leaders. Since the study touches on the community, researchers should inform community members on the essence of the research so that they can allow their pregnant women to participate freely without any restrictions. Moreover, healthcare institutions are also critical stakeholders for they mediate between researchers and subjects of the study. Through their mediation, researchers are able liaise effectively with pregnant women in the society, thus enhance the validity of the findings. Given that study requires some infrastructure of performing research, healthcare institutions are the most appropriate, thus limiting expenses that researchers would incur in constructing new infrastructure. Ultimately, religious leaders are also integral stakeholders because they have overwhelming influence on participation of the subjects. Thus, participation of religious leaders in the study will enhance the number of subjects in the study.
Timeline
References
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Bowling, A. (2002). Research Methods in Health: Investigating Health and Health Services. Buckingham: Open University Press.
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