Understanding the Veil: Non-Stranger Sexual Assault of a Muslim Woman January 19, 2016 By Angela Frederick Amar, PhD, RN, FAAN, is the assistant dean for BSN Education and associate professor at Emory University’s Nell Hodgson Woodruff School of Nursing. As one of the fastest growing religions in the United States, there are approximately 6 - 7.5 million Muslims living in America. Islam, the religion, is a comprehensive way of life, meaning that Muslims, those who practice Islam, reflect these beliefs in their daily lives. While variations of beliefs and practices related to geographical origin and tribal affiliations do exist, some beliefs are consistent throughout the Muslim world. Several beliefs are critical in understanding non-stranger sexual assault (NSA) experiences. Perhaps the most critical factor to explain is that dating does not exist for Muslims. Practicing Muslims do not have romantic relationships before marriage. Further, it is not permissible for unrelated men and women to be alone together, so little mixing of young men and women occurs. Even with engaged couples who do spend time together, there must always be a third person present, usually a family member. These gender restrictions preclude men and women from being alone in private. Recognizing different belief systems is essential in healing #DUForensics2016 https://t.co/mohcBv9XnQ #OfftheCharts pic.twitter.com/1njWJ6rERi — Drexel CNHP (@DrexelCNHP) January 20, 2016 Another relevant belief is that of modesty or hejab. Modesty prohibits revealing private parts of the body or even discussing them with the opposite gender. Both men and women are to dress modestly. For women, this means covering the hair and body with loose clothing and for men, covering at least between the navel and knees. Men are instructed in the Qur'an to lower their gaze so as not to stare at a women's body. It is acknowledged that man is weak so temptation much be avoided. The "veil" covers the woman with respectability and communicates that women are not to be seen as sexual objects. Chastity before marriage is stressed and extramarital sex is not permitted. Muslims are encouraged to consider sex with respect and restrict it to the confines of marriage. Thus, premarital sex is not permitted and young people are actively protected from opportunity. For health care providers in general, recognizing and respecting different value and belief systems are essential components of successful intervention. On an individual level, self-awareness and in-depth examination of one's own beliefs is an important first step in developing cultural sensitivity. Specifically, it is imperative to be attuned to individual cultural beliefs related to sexual assault. This awareness includes reflecting on how, knowingly and unconsciously, beliefs are communicated within practice and the effect it has on others. To interact in a caring way that builds a trusting rapport, respect for patients must be openly communicated regarding their spiritual beliefs. Listening and offering support are essential to building patient trust. Gathering information about the victim's family, friends, and faith allows the health care provider to determine the level of psychological and spiritual trauma and how much her life is affected. By listening with interest and remaining nonjudgmental, the health care provider can avoid offending the patient. Establishing an open dialogue between health care provider and victim breaks the silence and helps shift the emphasis from society to the victim. By demonstrating understanding of the factors that make disclosure difficult, the health care provider helps the client to develop trust. As the woman talks about her experience, the provider can help her to realize that the act committed against her is indeed a crime. The provider uses knowledge of the positive values of Islam to help the client reframe her experience. As the Muslim woman gives voice to her own thoughts, she receives validation from the health care provider which creates a sense of empowerment. In these situations, practicing self-awareness of beliefs and biases enables health care providers to demonstrate respect for differing world-views. Patients are helped by establishing dialogue and open communication as well as promoting trust. Helping an individual deal with disenfranchisement involves assessing the degree of alienation and identifying alternative opportunities for support and resources. While many NSA victims may carry blame and stigma for their victimization, in this case the stigmatization may be sanctioned by the important social institutions of the victim's cultural and religious group. Further, the formal structures one usually turns to in crisis are often not available for this crisis. Because the family is such an important social structure for Muslims, a young woman's honor is a reflection of her family and its loss can bring disgrace for many generations. Thus, a young woman can be very hesitant to disclose to her family. Faith or spiritual beliefs are coping strategies that many find effective for managing life's stressors. The health care provider can initiate a discussion of the young woman's faith and encourage her to think of faith practices that are comforting to her. Consultation with Muslim clergy, an Imam or Sheikh, or a respected member of the faith community can be helpful in mapping out potential resources. Health care providers reinforce that the individual has experienced a traumatic event and explore alternative options for social support. Assisting the individual in exploring community resources can be helpful. Islamic faith supports caring and insists that its adherents are compassionate to others. Also, if the family and usual support systems are not involved, the provider plans for longer term follow-up and support. Ongoing education on religious influences of gender-based violence can be helpful. By working through the cultural issues, health care providers are able to provide sensitive, appropriate, and effective care to diverse individuals, including those navigating the chaotic aftermath of sexual assault. Amar will be addressing the complexity of issues related to sexual assault and partner violence currently affecting colleges and universities in her presentation at the upcoming Forensic Trends in Health care Conference being held on April 15-17, 2016.