Health and Sickness

Medical health studies into the Bangladeshi migrant population became popular
from the mid-1980s as families became fully reunited and large communities were
established. Public discourse in the 1980s on ethnic health education focussed on
matters such as high birth rates and congenital defects, in line with the perception that
the health of these ethnic minorities was poor as a result of cultural traditions such as
consanguineous relationships, but did not address other rising health concerns such as
the prevalence of diabetes mellitus.1 Earlier studies had often conflated South Asian
migrants as a homogenous entity, and as a result, notions such as the idea that South
Asians tended to suffer from high blood pressure became popularised. However, later
studies illustrated that high blood pressure was common among Indians and to a lesser
extent Pakistanis, whereas Bangladeshis were in fact more likely to suffer from low blood
pressure.2

Although this move towards specific engagement with ethnic minority groups
may have its merits in regards to tackling health issues, the approach also has often been
accused of pathologising the British Bangladeshi community. Khanum has determined
this discourse towards the health of ethnic minorities, and Bangladeshis in particular, as
culture blaming.3 This approach has interpreted poor health factors as a phenomenon
that arises due to cultural factors that exist within migrant communities. For example, the
high levels of diabetes and cardiovascular diseases among Bangladeshi adults is viewed as
being attributed to a diet high in saturated fats and salt, whilst Asian rickets, prominent
among Bangladeshi women in particular, is seen as a result of veiling and practices of
purdah (female seclusion).4

1 Bhopal, R. (1996) Is Research into Ethnicity and Health Racist, Unsound, or Important
Science?, The British Journal of Medicine, http://www.bmj.com/content/314/7096/1751, date
accessed: 20 November 2016.
2 Agyemang, C. & Bhopal, R. S. (2002) Is the Blood Pressure of South Asian Adults in the UK

Higher or Lower than that of European White Adults? A Review of Cross-Sectional Data,
Journal of Human Hypertension, 16, p. 739.
3Khanum, S.M. (1994) We just buy illness in exchange for hunger experiences of health care,
health and illness among Bangladeshi women in Britain, unpublished PhD thesis, Keele : Keele
University, p. 10.
4Saifullah-Khan, V., Purdah in the British Situation, in Dependence and Exploitation in Work and
Marriage, Allen, S. and Barker, D. L. (eds.), (1976), London : Longman, p. 224-245.

1
 On the other hand, some have proposed that aspects of poor health among
migrant Bangladeshis cannot be comprehended without taking into account institutional
racism that existed and continues to exist within the National Health Service (NHS).5
This argument goes on to explain that there are significant barriers preventing
Bangladeshi communities in the UK from fully benefitting from health care services,
including English language proficiency and cultural biases assumed by health care
professionals.6 Neither the culture blaming approach, nor the approach that emphasises
the limited access to health care by Bangladeshis hindered by racism, however, do not
trace the nuances of the relationship between Bangladeshi migrants in London and
public health services.

These approaches have also diluted the voices of Bangladeshi migrants

themselves, especially in the case of Bangladeshi women who migrated into London
from the 1970s to the 1990s. Therefore, a discussion of health and sickness among first-
wave Bangladeshi migrant women must take into account the perceptions of this
minority group by the NHS and wider public discourses, as well as the perceptions of
state services and the concept of health itself by British Bangladeshis themselves.

In tandem with culture blaming approaches to health and sickness among

Bangladeshi migrants in the UK, is the perception that health and sickness have been
understood by migrants in relation to folk beliefs. John Eade has argued that Kleinmans
three-tier model is appropriate in understanding Bangladeshi migrant experiences with
health care services. Kleinman suggests that although folk beliefs, which emphasise on
the existence of the supernatural, and Islamic teachings form a central part of the
conceptualisation of health and sickness among Bangladeshis, medical diagnoses by
health professionals also play an important part.7 This is particularly significant when
considering the experience of Bangladeshi migrant women with British health care
services, due to the fact that the ways in which one conceptualises ones own health is of

5
Khanum, S.M. (1994) We just buy illness in exchange for hunger experiences of health care,
health and illness among Bangladeshi women in Britain, unpublished PhD thesis, Keele : Keele
University
6 Ibid, p. 11.
7 Eade, J., The Power of the Experts: The Plurality of Beliefss and Practices Concerning Health

and Illness Among Bangladeshis in Contemporary Tower Hamlets, London in Marks, L. &
Wordboys, M. (1997) Migrants, Minorities and Health: Historical and Contemporary Studies, London :
Routeledge, p. 252.

2
paramount importance when considering the experience of health care services. The
adoption of the Kleinman model allows historians to understand the motivations behind
certain opinions that migrant Bangladeshi women have formed, and marks a break from
the idea that Bangladeshi migrants viewed their health through a prism of folk beliefs and
religious understandings.

The historiography of public health has developed from the history of medicine,
which arose in the eighteenth century due to the professionalization of physicians within
Britain. However, the history of medicine and medical practice has since been primarily
concerned with this very process of professionalization, and has often only represented
the history of health from the point of view of physicians themselves. Roy Porter has
been significant in the effort to present the voice of the patient in medical history - this
has been viewed as the development of medical history from below.8 Porters seminal
article in 1985 emphasised that this strand of history must engage more closely with the
two-way patient-physician relationship, rather than collating the views of both parties
and presenting them as separate entities that do not coincide. This chapter shall aim to
do so in the case of first wave Bangladeshi migrant women in London, and their
experience with state health care services.

Public health studies have coincided with theories on the agency of Bangladeshi
migrant women in negotiating their own health and their relationships with health care
services in the UK. Katy Gardners article on death in the Bangladeshi community
proposed the idea that it was male relatives, often husbands, who were the central agents
in regards to the health care of Bangladeshi women in Tower Hamlets.9 This notion of
agency being held by Bangladeshi males extends to the health and sickness of migrant
women more generally, not just when death became a probable factor. Whilst viewing
first wave Bangladeshi migrant women in London only in the role of wife or mother
can be limiting, when considering the history of public health of this group it can be
conducive, as oral history sources demonstrate that the majority of migrant women
experienced the NHS through maternal health services at some point post-migration.
Many women experienced childbirth in the UK within a year of arriving, and comparison
between the births of different children, often articulated by interviewees without

8 Porter, R. (1985) The Patients View: Doing Medical History from Below, Theory and Society,
14:2, 175-198.
9 Gardner, K. (1998) Death, Burial and Bereavement Amongst Bengali Muslims in Tower

Hamlets, East London, Journal of Ethnic and Migration Studies, 24:3, 507-521.

3
prompting, allows historians to view the changes in migrant womens perceptions of
public health services over time. Maternal health services were also public domains where
women expressed clear agency in negotiating their health, which in itself refutes earlier
literature on public health that has depicted Bangladeshi migrant women as tertiary
figures in their health care, shadowed by health care professionals and male relatives who
acted as intermediaries. The ways in which women articulated their experience with
maternity services in oral history sources also makes their agency apparent, as they often
discussed the relationship between themselves and health care professionals directly,
whereas other agents, such as husbands, were either not mentioned, or only referred to
in passing. Women were also able to negotiate their health in other spaces, such as at
their local GP, although discussions of these experiences are less detailed.

Whilst some public health studies have been carried out in regards to the
experiences of health services among Bangladeshi migrant women, many of these studies
are contemporary and much less is available on the experience of first wave Bangladeshi
migrant women. A study conducted among Bangladeshi migrant women of Sylheti origin
in Leeds concluded that women who were more proficient in the English language stated
that they had had a better experience with pre-natal services.10 Experiences of first wave
migrant women, however, do not necessarily align with this argument. The majority of
respondents in the various oral history projects had a very limited understanding of the
English language, and many had little or no formal education in any language. In spite of
this, the response to maternal health care services was overwhelmingly positive, although
concerns were voiced about English language proficiency by some of the interviewees.

When asked about their experiences of maternity health care services post-
migration, all oral history respondents mentioned the length of their stays in hospital
after giving birth.11 The length of their period in hospital was significant for all the
women, and their largely positive reactions to their memories of maternal services
suggests that they believed this extended period of care to be a highly important part of
it. In the Faces of Westminster project, Azizun Khatuns elaboration on the care she
received is indicative that the care migrant Bangladeshi women received in hospitals
following childbirth was compared, consciously or not, to care they would be likely to

DSouza, L., Garcia, J. and Jayaweera, H. (2005) A Local Study of Childbearing Bangladeshi
10

Women in the UK, Midwifery, 21:1, 84-95, p. 92.

11 See R. Bibi interview, 26 October 2016, G. Khatun interview, 2 November 2016 for example.

4
have gotten following giving birth in the Sylheti village.12 Aftabun Nessas responses also
support this idea, as she details the way in which they looked after her baby, right up
until the point of her hospital discharge.13 Rabina Bibis responses to questions on her
initial experience of childbirth in the UK states that, though she had a stillborn and
therefore experienced traumatic labour, she felt she had received good care.14 She also
mentioned the number of days before she was discharged as an element of this positive
experience. Only Gulbahar Khatun did not describe her first experience with maternal
health services as good, although, like the other participants, she found it significant to
state the number of days she stayed in hospital following the birth of her daughter.15 Her
emphasis on being alone whilst in hospital should be noted, as it suggests that unlike
other respondents, she did not feel as if she had a support network provided by NHS
staff that had parallels with the support that would have been available to these women
had they given birth in Bangladesh. The predominantly positive responses to maternal
services among migrant Bangladeshi women who had given birth from the early 1970s to
the mid-1990s illustrates that, contrary to popular discourse, Bangladeshi migrant women
were active participants in negotiating their health in relation to pregnancy, especially
when it came to childbirth and the immediate post-partum care they received. These
positive responses were often related to parallels that women drew between the care they
received from hospital staff in London and the care they would be likely to receive in a
Sylheti village post-childbirth. In contrast to the suggestion made by DSouza16, first
wave migrant women did not have varying opinions on their experience of maternal
health services due to English language proficiency, but rather due to whether they felt
they had a familiar support network or not.

Lack of proficiency in the English language, especially in a spoken form,

nevertheless was an important factor when Bangladeshi migrant women believed their
experience with British public health services from the to have been poor. One of the
interviewees that took part in the Tower Hamlets-based Where I Belong project noted

12Rahman, A. and Toki, R. (eds.)(2016) Faces of Westminster: Hopes and Fears of Bengali Parents in
Raising their Children in Westminster in the 1960s and 70s, London : Central London Youth
Development Trust, p. 99.
13 Aftabun Nessa, Where I Belong: Black and Asian womens lives in Tower Hamlets
14 R. Bibi interview, 26 October 2016.
15 G. Khatun interview, 2 November 2016.
16 DSouza, L., Garcia, J. and Jayaweera, H. (2005) A Local Study of Childbearing Bangladeshi

Women in the UK, Midwifery, 21:1, 84-95.

5
that when she first arrived, her GP had been Bengali, however, her doctors were now
Indian, Pakistani and therefore she was required to use an official interpreter provided
by her GP, or took her daughter along to translate.17 The presence of an interpreter, be
that a stranger or the respondents daughter, undeniably formed part of the reason why
Rohima Begum viewed health care in the past to be better, as translation forms a barrier
between the GP and patient and things can often be miscommunicated. Asiya Khatun of
the The Way we Worked project experienced hospital services caring for her ill son, and
her recollection of how she would only be able to cry outside the incubator was a direct
result of her lack of English language skills.18 This put her in a position as a mother
where she did not have the agency to care for her son herself, something that is valued
highly among Bangladeshi migrant women. The element of communication was also
absent when Rabina Bibi narrated the experience of her second birth in the UK, as the
lack of attention she feels she received from the nurses was exacerbated by the fact that
she or her husband could not coherently communicate in English. She continues to
explain that her husband was only successful in seeking assistance when an Indian,
Bengali doctor was found.19 This highlights the fluctuating agency of Bangladeshi
migrant women in their experiences of maternal health care. These examples show that
agency in health care settings was not constant or a dichotomy, it was fluid and depended
on a number of factors, including the other people present, and English language skills in
particular. This aligns with the argument made by DSouza et al.20 to a certain extent,
however, the varied experiences of the same women shows that although English
language proficiency could negatively affect childbirth, it was this combined with a
general belief that the NHS maternal services have steadily deteriorated over the years.
The comparison of their experiences of childbirth in the UK by all respondents in the
oral history project indicates how these women believed that maternal health services
became poorer over time.21 Rather than the experiences of these women being impaired
by their role of migrant, it is their sense of belonging that they have unconsciously or

17 Rohima Begum, Where I Belong: Black and Asian womens lives in Tower Hamlets.
18Glynn, S. (1999) The way we worked : an oral history by members of St. Hilda's East
Community Centre and Stepney Jewish Community Centre, London, p. 18-19.

R. Bibi interview, 26 October 2016.

19

DSouza, L., Garcia, J. and Jayaweera, H. (2005) A Local Study of Childbearing Bangladeshi
20

Women in the UK, Midwifery, 21:1, 84-95.

21 R. Bibi interview, 26 October 2016, S. Begum interview, 1 November 2016 and G. Khatun
interview, 2 November 2016.

6
consciously obtained over the years that has allowed them to make judgements and
contrasts between their experiences of childbirth.

A key component that has not been addressed from previous studies on public
health experiences among Bangladeshi migrant women, and should be noted, is the case
of anti-black sentiments leading to women articulating their experiences with maternal
health services as poor. Two oral history respondents, when narrating their experiences
of childbirth to their younger children, described stressful situations that were made so
by black Jamaican nurses.22 Anti-blackness in the South Asian community is not a
phenomenon that has arisen post-migration, but is rooted in ideas of caste within the
subcontinent and the colonial experience.23 Stereotypes surrounding the Afro-Caribbean
community within the UK undeniably support these anti-black feelings among South
Asian communities. These stereotypes were especially significant for first wave migrants,
as up until the 1990s, young Afro-Caribbean males were viewed as British folk devils.24
These contrasting images of demonised Afro-Caribbeans and model minority Indians
is clear when Rabina Bibi narrates her childbirth story, where she is saved by the
Indian doctor.25 Shazia Begum elaborated on her negative attitude towards the black
Jamaican nurses. For this respondent, it was the stereotypical image of black women
being loud and rough, combined with her acknowledgement of her own lack of English
language skills that made her experience an unpleasant one. She continues to note that
although the nurses were not caring in the way that she had experienced with her first
childbirth in the UK, the black woman doctor in contrast had been consistently
good.26 This brings to the fore understandings of care based on a professional level
doctors being viewed as more qualified than nurses and this level of education leading
to a more refined character and better understanding of ones role as a health care
professional. These discussions of negative experiences, illustrate that Bangladeshi
migrant women felt like they had a more negative experience of childbirth due to racist
ideas that also impacted their understandings of when their agency was reduced. In both
these narratives, black Jamaican nurses are depicted as dominating figures, whose lack
of care removes agency. In a subverted way, being left alone or being told to look after

22 R. Bibi interview, 26 October 2016 and S. Begum interview, 1 November 2016.

23 Pandey, G. (2013). A history of prejudice : Race, caste, and difference in India and the United States,
Cambridge ; New York: Cambridge University Press.
24 Salgado-Pottier, R. (2008) A Modern Moral Panic: The Representation of British Bangladeshi

and Pakistani Youth in Relation to Violence and Religion, Anthropology Matters, 10:1.
25 R. Bibi interview, 26 October 2016.
26 S. Begum interview, 1 November 2016.

7
ones one child, was viewed as an imposition on these migrant women and they felt as if
they were being subjected to act rather than being free to do so whilst also being under
close supervision and care. The experiences that were depicted as negative, thus,
combined lack of agency due to English language skills, anti-black sentiments and the
removal of a care structure that emulated ones that would be present in Sylheti villages.

Post-partum experiences are also important when considering Bangladeshi

migrant womens perceptions of public health services in the UK. In 1978, Wilson
argued that migrant women from South Asia lost the support of family and kin networks
that would have been in place in their villages of origin to help new mothers following
childbirth.27 This argument remains valid in regards to the experiences of first wave
migrant Bangladeshis, the majority of whom are from rural villages in Sylhet, where most
households are organised as extended family units. In this setting, the new mother would
be encouraged to rest and care for her child in regards to breastfeeding, whilst usually
enjoying being cared for by members of her extended family. Another common practice
post-partum was for the new mother to be allowed to visit and stay in her natal home for
a period of time, as it is suggested that new mothers gain the most assistance from their
own mothers during the early days of their childs life. Gulbahar Khatun was the only
oral history respondent to describe her experience of maternal services in 1976 as not
good.28 When prompted as to why she had this opinion, she emphasised how she was
alone, even though she went on to describe how there were other Bengali women,
English women on the ward with her. Her meaning of alone, however, related to her
lack of kin networks that form the Bangladeshi sense of togetherness. The first
respondent in the Tower Hamlets oral history project also used this notion of being
alone following being discharged from the hospital and elaborated by noting that she
returned to her daily cooking and cleaning duties after this. Syeda Chowdhury, a
participant of the Faces of Westminster project, elaborates on the specific tasks she was
required to carry out in caring for her young children.29 Chowdhury mentions her lack of
sleep at this period of her life, and this correlates with the public health study conducted
in Leeds, where it was concluded that working class Bangladeshi migrant women had a

27 Wilson, A. (1978). Finding a Voice : Asian Women in Britain, London: Virago.

28 G. Khatun interview, 2 November 2016.
29 Rahman, A. and Toki, R. (eds.)(2016) Faces of Westminster: Hopes and Fears of Bengali Parents in

Raising their Children in Westminster in the 1960s and 70s, London : Central London Youth
Development Trust, p. 112.

8
more acute experience of sleep deprivation post-partum.30 Whilst childbirth itself, and
pre-natal care to some extent, involved the NHS significantly, post-partum care for
Bangladeshi migrant women was confined more generally to the private sphere of the
home. Whilst this can be viewed as allowing the migrant women to have had greater
agency in rearing their children, the memories of being alone during this period
demonstrated that women often felt helpless with regards to their migrant status itself,
rather than being passive to other figures of authority. This illustrates that the
proposition made by Wilson continues to be expressed by migrant women, even though
their children are often now in their thirties and forties. The memories of loneliness
remain, and may be exaggerated now that these women have often built up extensive kin
and family networks due to continued migration and family unification, as well as the
growth of their own families through the marriage of their children and subsequent
births of grandchildren. These established networks that allow the Bangladeshi notion of
togetherness to be formed are juxtaposed with the lack of support felt by first wave
migrant women following childbirth, a period of time in a womans life that is
characterised by her kin networks and the ways in which they share caring for a baby.

Demonstrably, first wave Bangladeshi migrant women who moved to London

from the early 1970s had varied experiences with regards to public health services,
although common themes can be traced. The culture blaming approach nor the
emphasis on institutional racism within the NHS do not effectively explain the
experiences of maternal health services, as they focus primarily on the ways in which
health care professionals dealt with migrants. The oral history sources illustrate the ways
in which ideas of support impacted womens opinions of health care following
childbirth, and show the central role that English language proficiency played. Although
Bangladeshi migrant women may not be viewed as figures with complete agency when it
came to health and sickness, the way in which they articulated the process of negotiating
their healthcare whether this was through using interpreters or by facing maternal
health services alone suggests that they themselves view their health as highly
individual.

DSouza, L., Garcia, J. and Jayaweera, H. (2005) A Local Study of Childbearing Bangladeshi
30

Women in the UK, Midwifery, 21:1, p. 93.