One of the early memories I have studying Fiqh (Islamic law) that made an impression on me was during the section on prayer while travelling. My teacher, Ustadh Adel, noted that if the conditions are met to shorten the prayer, it’s Sunnah to do so, and praying the full version performed by a resident is an abandonment of the Sunnah. He further emphasized that it’s so important to perform the Sunnah of shortening the prayer while traveling, if one finds themselves during a journey in a congregation of residents performing the full prayer, it’s recommended that one stands up after finishing with them to perform the shortened version of the same prayer with the intention of getting the reward of having performed the Sunnah of shortening the prayer while travelling. I found this striking. The Sunnah of shortening the prayer while travelling means one is doing *less* of an act of worship in its absolute physical sense, and in this case, it’s for the act the Beloved ﷺ called ‘imāduddīn, i.e., the foundational pillar of the religion. This challenges one of the proclivities of the human ego when it comes to religious practice; the presumption that when it comes to piety and spirituality, the more difficult, the better.
ثُمَّ قَفَّيْنَا عَلَىٰ آثَارِهِم بِرُسُلِنَا وَقَفَّيْنَا بِعِيسَى ابْنِ مَرْيَمَ وَآتَيْنَاهُ الْإِنجِيلَ وَجَعَلْنَا فِي قُلُوبِ الَّذِينَ اتَّبَعُوهُ رَأْفَةً وَرَحْمَةً وَرَهْبَانِيَّةً ابْتَدَعُوهَا مَا كَتَبْنَاهَا عَلَيْهِمْ إِلَّا ابْتِغَاءَ رِضْوَانِ اللَّهِ فَمَا رَعَوْهَا حَقَّ رِعَايَتِهَا فَآتَيْنَا الَّذِينَ آمَنُوا مِنْهُمْ أَجْرَهُمْ وَكَثِيرٌ مِّنْهُمْ فَاسِقُونَ
Then in the footsteps of these ˹prophets˺, We sent Our messengers, and ˹after them˺ We sent Jesus, son of Mary, and granted him the Gospel, and instilled compassion and mercy into the hearts of his followers. As for monasticism, they made it up—We never ordained it for them—only seeking to please Allah, yet they did not ˹even˺ observe it strictly. So We rewarded those of them who were faithful. But most of them are rebellious. [Quran 57:27]
Recently, a number of posts have been shared around Muslim social media circles on the ruling of fasting during Ramadan for pregnant women. Understandably, this is a subject that can easily stir up emotions and misunderstandings, especially if it doesn’t take into account the nuances of the ruling. Our modern world has gone to great lengths to deny humans the fulfilment of our souls’ and Fitrah’s need to connect with and obey our Lord. This has led many at times to a reactionary response that I’d argue goes against the Sunnah of the Beloved ﷺ who described the way of Islam as al-Hanīfiyyah as-Samha (the beautiful and easy religion).
It’s important to note something about fasting Ramadan that Allah ﷻ points out for us:
شَهْرُ رَمَضَانَ الَّذِي أُنزِلَ فِيهِ الْقُرْآنُ هُدًى لِّلنَّاسِ وَبَيِّنَاتٍ مِّنَ الْهُدَىٰ وَالْفُرْقَانِ فَمَن شَهِدَ مِنكُمُ الشَّهْرَ فَلْيَصُمْهُ وَمَن كَانَ مَرِيضًا أَوْ عَلَىٰ سَفَرٍ فَعِدَّةٌ مِّنْ أَيَّامٍ أُخَرَ يُرِيدُ اللَّهُ بِكُمُ الْيُسْرَ وَلَا يُرِيدُ بِكُمُ الْعُسْرَ وَلِتُكْمِلُوا الْعِدَّةَ وَلِتُكَبِّرُوا اللَّهَ عَلَىٰ مَا هَدَاكُمْ وَلَعَلَّكُمْ تَشْكُرُونَ
Ramaḍân is the month in which the Quran was revealed as a guide for humanity with clear proofs of guidance and the standard ˹to distinguish between right and wrong˺. So whoever is present this month, let them fast. But whoever is ill or on a journey, then ˹let them fast˺ an equal number of days ˹after Ramaḍân˺. Allah intends ease for you, not hardship, so that you may complete the prescribed period and proclaim the greatness of Allah for guiding you, and perhaps you will be grateful. [Quran 2:185]
“Allah intends ease for you, not hardship.” There’s an idea many Muslims hold that if someone is making things easy, they’re being “soft”. However, Islam is not a way that stipulates suffering as the path to God:
طه
Ṭâ-Hâ.
مَا أَنزَلْنَا عَلَيْكَ الْقُرْآنَ لِتَشْقَىٰ
We have not revealed the Quran to you ˹O Prophet˺ to cause you distress,
إِلَّا تَذْكِرَةً لِّمَن يَخْشَىٰ
but as a reminder to those in awe ˹of Allah˺. [Quran 20:1-3]
The issue of fasting Ramadan while pregnant is one that has a significant amount of commentary on it by many scholars. For the purposes of this post and given my adherence to this school, I’ll restrict my comments to Maliki sources. What follows are excerpts from a number of authoritative primary texts and commentaries upon them on the ruling of fasting Ramadan while pregnant. I should note that these are not exhaustive and there are more specific details for those wishing to go into a deep dive. However, these should suffice us as representative of the Maliki school’s dominant position on this matter. For brevity, I’ve only included the relevant portions from the excerpts quoted below.
Matn ibn ‘Āshir:
من أفطر الفرض قضاه… *** ……………………………
……………………………. *** …………………………….
……………………..ويباح *** لضرًّ ………………………
Whoever breaks the fast of the obligatory [i.e. Ramadan] must make it up…
… and it’s permissible [to break it] due to harm…
Mayyāra’s commentary:
فرع: قال اللخمي: صوم الحامل إن لم يشق واجب وإن خيف منه حدوث علة عليها أو على ولدها منع، وإن كان الصوم يجهدها ويشق عليها ولا تخشى إن هي صامت شيئاً من ذلك كانت الخيار بين الصوم والفطر، والذي رجع إليه في المدونة أنها إذا أفطرت لشيء من هذه الوجوه التي يكون لها أن تفطر لأجلها كان عليها القضاء دون إطعام لأنها مريضة.
Section: al-Lakhmī said: The fasting of the pregnant one, if it does not cause distress is obligatory, but if there is a fear it will result in a malady for her or her child then it is prohibited. If the fasting tires her and causes her distress, but she does not fear some of this if she were to fast, then she has the choice between fasting and breaking the fast. And what [ibn al-Qāsim] concluded in al-Mudawwana is that if she were to break her fast for any of these perspectives that she is permitted to break her fast for, she must make up the days without having to pay expiation because she [falls under the category of being] ill.
Risalat ibn Abī Zayd:
وإذا خافت الحامل على ما في بطنها أفطرت ولم تطعم، وقد قيل تطعم.
And if the pregnant one fears for what is in her abdomen she is to break her fast and is not [required to] feed [i.e., pay an expiation], and it was said she does feed [i.e., she does have to pay expiation].
an-Nafrāwī’s commentary:
(أفطرت) وجوباً ولو في صيام رمضان حيث خافت هلاكاً أو شديد أذىً وندباً فيما دون ذلك…الخوف المجوز للفطر هو المستند صاحبه إلى قول طبيب ثقة حاذق، أو لتجربة من نفسه أو لإخبار ممن هو موافق له في المزاج
(she is to break her fast) meaning it’s obligatory [to break her fast] even if it’s the fasting of Ramadan if she fears death or great harm, and is encouraged [to break her fast] in case of a lesser fear than that…[and] the fear that permits breaking the fast is one in which the fearful one is relying upon the statement of a trusted and very skilled doctor, or previous experience from themselves, or the informing of one whose temperament is in agreement with theirs.
Zarrūq’s commentary:
وللحامل ثلاث حالات حالة تصوم وجوباً وحالة تفطر وجوباً وحالة مخيرة ففي أول حملها ولا يجهدها الصوم لا تفطر وإن خافت على نفسها أو على ما في بطنها الهلاك لزمها الإفطار وإن كان يجهدها جهد مشقة لا تهلك معها لا هي ولا ولدها ولا تخاف ذلك فهي مخيرة
And for the pregnant one are three cases: a case in which she is obligated to fast, a case in which she is obligated to break her fast, and a case in which she is given the choice. At the beginning of her pregnancy and fasting does not exhaust her she does not break her fast. If she fears for herself or for what is in her abdomen, she is obligated to break her fast. And if fasting tires her to a degree of discomfort that she nor her child are not endangered by and she does not fear it then she is given the choice [to fast or not].
Mukhtasar Khalīl
ولمرض خاف زيادته أو تماديه ووجب إن خاف هلاكاً، أو أذًى شديداً: كحامل، ومرضعٍ لم يمكنها استئجارٌ أو غيره إن خافتا على ولديهما
[It’s encouraged to break the fast] for an illness that one fears would be exacerbated or prolonged [by fasting], and it becomes obligatory [to break it] if one fears death or great harm: such as for a pregnant one, or a nursing one who was not able to hire someone or find an alternative if they fear for their child.
ad-Dusūqī supracommentary on Dardīr’s commentary
(هلاكاً أو أذىً شديداً) كتعطيل منفعة من سمعٍ أو بصرٍ أو غيرهما لوجوب حفظ النفس
(death or great harm) meaning the crippling of a benefit [such as] from hearing or sight or other than them due to the obligation of preserving life.
The common thread running through the primary texts and commentaries on them regarding fasting while pregnant is the physical impact it would have on the mother, the child, or both. The ruling on pregnancy treats it the same as having an illness. This is a legal point, not a moral judgment. The commentators also go further into the specific timing of the fast, demonstrating a concern about the difference of impact based on how far along the pregnancy the woman is. Hence, we need to have a clear picture describing how pregnancy changes the mother’s physiology, and how the growing baby is impacting and being impacted by it. Of specific relevance to us are:
- The nutritional requirements of the mother during pregnancy
- The critical periods of prenatal development during which the baby is most vulnerable to structural or functional abnormalities if nutritional requirements are not met
In terms of nutrition, studies show the basal metabolic rate during pregnancy increases by about 20%. During pregnancy, the baby relies on the mother for the following essential nutrients:
- Folate for normal brain and spinal cord development
- Choline for normal DNA expression in the fetal brain
- Calcium for healthy muscular and nervous system function
- Vitamin D, which is a hormone and not actually a vitamin, for bone and teeth development, as well as healthy functioning of the immune system
- Protein to promote fetal growth
- Iron for the blood to have adequate oxygen-carrying capacity
Generally, structural anomalies result if nutritional requirements are not met during the first 8 weeks of fetal development. If nutritional deficits are encountered by the baby after this period, there may not be obvious anomalies in his or her physical appearance, but functional anomalies may result. Of most concern is brain development, which begins to be sensitive to environmental triggers from around the 3rd week of gestation and continues to be so well into late teens and early twenties.
It’s important to note that the above are the *essential* nutrients. Having these is the bare minimum requirement. However, if the goal is to have a thriving, healthy, intelligent baby, and minimizing undue environmental stress to him or her that would adversely impact development, a mother will need more than the bare essentials. A balanced diet that meets the increased metabolic demands of the mother, exercise, and reducing sources of negative stress are all important.
Although Ramadan is an immensely spiritual time, it nevertheless is a time of nutritional deprivation. From the break of dawn until sunset, a Muslim is not permitted to have any oral intake during that entire time unless they have an excuse to break their fast. Depending on where one resides, this can range from 11 to 16 hours every day for 29 or 30 consecutive days. This is roughly 4 weeks of pregnancy, or 10% of fetal development. Hence, careful consideration has to be given to the potential impact of this period of deprivation.
In addition to having adequate nutrition, it’s also important to note that the fetus is sensitive to hormonal changes in the mother’s body. For example, hunger triggers the release of ghrelin, which plays a number of roles including the reduction of insulin secretion, regulation of glucose storage and breakdown, and regulation of bone formation and metabolism [1]. The long-term consequence of prolonged hunger if associated with undernutrition on the fetus is something we’ve only begun to appreciate. A number of studies on undernutrition early in the pregnancy and poor growth in utero show it to be associated with epigenetic changes leading to increased risk for the child of developing coronary disease, hypertension, type 2 diabetes and obesity in adulthood [2]. The most extreme example of the impact undernutrition can have on long-term outcomes in adults who were deprived during their fetal development as their mothers went hungry is the Dutch Hunger Winter in 1944-1945, the consequences of which extended into the third generation of children [3]. It’s important to note that for many Muslims, their total daily caloric intake in Ramadan does not go as low as it did in the Dutch Hunger Winter when it was as low as 580 calories by the end of it, and Ramadan lasts for 1 month compared with the 7 months the Dutch famine lasted for. Nevertheless, it demonstrates the negative impact prolonged hunger and undernutrition not only on the offspring of the mothers, but also on the grandchildren.
Studies looking into how Ramadan specifically impacts fetal development are mixed and of varying degrees of quality, with a limited number being of high quality. For example, a 2014 study out of the Netherlands concluded that fasting early in pregnancy led to a reduction in birth weight that was statistically significant compared with babies born to Muslim mothers who did not fast. This difference in birth weight was not observed if the fasting took place later in pregnancy [4]. A follow up study in 2020 by the same group that applied more rigorous methods to remove confounders found no difference in birth weight, gestational length, newborn’s sex, perinatal mortality, Apgar score, or presence of congenital anomalies [5]. A 2017 study from Bradford showed that infants conceived during Ramadan, and thus were exposed to fasting conditions during the first trimester, did not differ in birth weight from infants not exposed to fasting, and did not have a higher likelihood of premature birth [6].
This may seem encouraging. However, single studies are difficult to draw overarching conclusions from. A 2021 systematic literature review of 16 studies with the aim of identifying the long-term outcomes of in utero Ramadan exposure concluded that most studies suggest negative consequences on health later in adult life. These include higher under-five years old mortality rate, higher mortality under three months old, and under one year old, shorter stature, lower body mass index, increased incidence of vision, hearing, and learning disabilities, and lower mathematics, writing and reading scores [7]. It should be noted that systematic reviews are as good as the studies being reviewed. Making definitive conclusions about the impact of fasting Ramadan on pregnancy remains elusive.
What’s the bottom line?
From an Islamic legal standpoint, pregnancy is a valid excuse to not fast during Ramadan. In some cases, it may even be impermissible to fast if it will lead to harm to the mother or child. This will require a trained medical doctor’s input. The dominant position in the Maliki school is that a pregnant woman who chooses to not fast during Ramadan is not sinning by doing so and does not have to pay an expiation, but she does have to make up the days she missed at a later time when she’s able to.
In terms of the impact that fasting Ramadan has on fetal development, the evidence is mixed, and no one can unequivocally give a general conclusion or recommendation for all women in all locations. What can be said, however, is that it appears fasting early in pregnancy in a geographical location where the fasting period is closer to 16 hours, may lead to negative short- and long-term outcomes for the baby. The decision to fast will need to be made on an individual basis after consultation with a primary care physician and a full nutritional screen to ensure the mother is not deficient in any essential nutrients and no other risk factors are present.
Some women may be towards the latter part of their pregnancy when most of the critical periods of fetal development have taken place and decide to fast the entire month. Others may be residing in locations where the fast lasts for 11 hours and have ample time after sunset to replenish their bodies with adequate nutrition. Some may decide they can handle fasting on alternate days, giving themselves a day to replenish after a day of fasting. Others may choose to not fast the entire month and make it up at a later time when they’re not pregnant or breastfeeding. Regardless of the decision a pregnant woman makes, it’s important to recognize that it does not make her more pious if she decides to fast, she should not be made to feel guilty if she decides to not fast, and the Sharia is concerned with protecting life and the development of the child and this needs to be taken into account today as our scholars have in the past.
That and Allah ﷻ knows best
_____________________
[1] Pradhan et al. (2013) Ghrelin: much more than a hunger hormone. Curr Opin Clin Nutr Metab Care 16(6): 619-624 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049314/ [2] Lee (2015) Impact of Maternal Diet on the Epigenome during In Utero Life and the Developmental Programming of Diseases in Childhood and Adulthood. Nutrients 7(11): 9492-9507 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4663595/ [3] Heijmans et al. (2008) Persistent epigenetic differences associated with prenatal exposure to famine in humans. Proc Nail Acad Sci U S A 105(44): 17046-17049 https://www.pnas.org/doi/10.1073/pnas.0806560105 [4] Savitri et al (2014) Ramadan fasting and newborn’s birth weight in pregnant Muslim women in The Netherlands. Br J Nutr 112(9): 1503-1509 https://pubmed.ncbi.nlm.nih.gov/25231606/ [5] Savitri et al (2020) Ramadan exposure and birth outcomes: a population-based study from the Netherlands. J Dev Orig Health Dis 11(6): 664-671 https://pubmed.ncbi.nlm.nih.gov/31822318/ [6] Daily et al (2017) Are babies conceived during Ramadan born smaller and sooner than babies conceived at other times of the year? A Born in Bradford Cohort Study. J Epidemiol Community Health 71(7): 722-728 https://pubmed.ncbi.nlm.nih.gov/25261183/ [7] Mahanani et al (2021) Long-Term Outcomes of in Utero Ramadan Exposure: A Systematic Literature Review. Nutrients 13(12): 4511 https://pubmed.ncbi.nlm.nih.gov/34960063/