Report: Muslim women being held back in careers by NHS dress codes

A new study has found that Muslim women who work in National Health Service experience bullying and harassment in the workplace because of their religious observance.

The research was carried out by the British Islamic Medical Association and The Bridge Institute on the NHS’s “Bare Below the Elbows” policy, which advises against the covering of arms for hygiene reasons, as well as head coverings in surgical theatres.

The results were published in the BMJ Open and showed a lack of awareness and implementation of existing Department of Health Uniforms and Workwear guidance for faith groups. The findings also highlighted the absence of clear national guidance on surgical head coverings in theatres.

Wearing a headscarf was significant to Muslim female healthcare professionals in adhering to their religious dress code, according to the study, yet over half experienced problems trying to wear a headscarf in theatre. Some women felt embarrassed, anxious and bullied due to lack of clarity regarding NHS dress code policy.

Women described being discouraged from pursuing acute medical and surgical careers and instead opting for primary care roles due to pressures in complying with hospital dress codes.

The findings reveal that:

  • 56.3% felt their religious practice in covering their arms was not respected by their NHS Trust.
  • 74% were not happy with their Trust’s Bare Below the Elbows uniform policy alternative.
  • 14.3% of respondents reporting an impact on their career choice due to BBE policy and surgical head coverings.

Dr Emma Wiley, a microbiology registrar, said: “It is disappointing that Muslim women are being held back in their careers due to dress code policies. They feel there are no safe spaces to voice this and no one to speak to if they are being bullied on this issue.  Speaking out about BBE as an individual is challenging when it results in escalation to Trust management and forms part of hospital inspections.”

Dr Sharif Al-Ghazal, President of BIMA added: “This data from this important research suggests for the first time that dress code policies such as Bare Below the Elbows contribute towards the indirect discrimination of faith groups. Our research has highlighted the impact on Muslim women, and this may well affect other faith communities as well as our patients. We need inclusive policy, processes and systems that support women to succeed in their careers rather than holding them back.”

The BIMA is now calling for the effective implementation of a national dress code policy which meets both infection control and faith requirements.

Key recommendations from the research are:

  • A national dress code policy to be implemented with immediate effect. This must provide clear and inclusive guidance for all faith groups and address surgical head coverings in theatres.
  • All NHS Trust Equality and Diversity Steering Groups to review local dress code policies and undertake an equality impact assessment including the provision of specific guidance for faith groups.
  • Stakeholders such as Royal Colleges, Health Education England, the BMA, NHS Employers, Trusts and educators to provide and signpost faith-sensitive support for Muslim women affected by these issues.

Dr Abida Malik, Director of the Bridge Institute for Research and Policy, said: “We do hope that our dress code policy recommendations will be considered and adopted by national stakeholders in order to improve the experiences of staff and students who come from BAME minorities within a healthcare work setting.”

The Department of Health has updated its dress code guidance, calling upon trusts to address indirect discrimination by implementing a range of options for Muslim female healthcare professionals, including providing staff with disposable sleeves.

But there is still no national guidance relating to the wearing of head coverings. In surgical theatres, the default head garment is a semi-transparent scrub cap. This default provision may be challenging for faith groups including Sikhs who wear turbans and for Muslim women who wear a hijab.

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