The impact of healthcare provision on immigrant pregnancy behaviors: the case of Ramadan fasting in Germany.

Germany and other Western countries are home to a growing number of Muslims. This implies that health-related behaviors more common among Muslims are becoming increasingly important in routine healthcare. For example, Ramadan during pregnancy has been shown to be associated with adverse offspring health outcomes along the life course. At the same time, a high share of pregnant Muslims worldwide chooses to fast. In this study, we investigate the dynamics underlying Ramadan fasting during pregnancy in Germany, using survey data (N=326) of Muslims delivering after being pregnant during a Ramadan. In this sample, 36.5 % of women fasted during their recent pregnancy, for an average of 17 days. Respondents generally did not regard fasting during pregnancy as obligatory and women tended to make their own, independent decisions about whether to fast. Most women did not expect fasting to be associated with impaired offspring health, even though many women actively searched for information on Ramadan during pregnancy. They often did so on the internet or by talking to family and friends. Only about one-third of women consulted with their prenatal caregiver about fasting. These consultations were associated with a reduction in days fasted by about 11 days. A sensitization of healthcare providers to Ramadan during pregnancy, and routinely addressing the issue with Muslim families of reproductive age can have important public health benefits.