Don’t use an instrument of oppression as a symbol of diversity and inclusion

As a pediatric surgeon, I admit I would not typically have gravitated toward the excellent article in CMAJ by Drs. Bloch and Rozmovits¹ if it wasn’t for the image that accompanied it — a picture of 2 girls, probably about 3 or 4 years old, reading together. One of them is covered in a hijab.

The image shocked and infuriated many. Yasmine Mohammed, a Vancouver activist who has championed equality for Muslim women, tweeted, “The cover of @CMAJ features a little girl in hijab. How disheartening to see my so-called liberal society condone something that is only happening in the most extremist of religious homes.”² Another Muslim woman, a surgical trainee who wishes to remain anonymous, messaged me to express her horror at seeing the image, which triggered painful childhood memories of growing up in a fundamentalist Islamic society, where she was forced to wear the hijab from early childhood and taught that her body was desired by the opposite sex and should be covered. She later shared her perspective in a private conversation with the CMAJ interim editor-in-chief and publisher.

It has become “liberal” to see the hijab as a symbol of equity, diversity and inclusion. Out of the best intentions, the CMAJ editors probably chose this picture to accompany an article on the application of such principles in medical care.

I work in an urban tertiary academic children’s hospital embedded in an extremely multicultural environment. Many of my trainees, colleagues and patients’ parents (and some adolescent patients) wear the hijab. I respect each woman I interact with, as well as any woman’s choice to express her identity as she desires. Some women face harassment and discrimination for their choice to wear the hijab. That is real, and it is also wrong.

But respect does not alter the fact that the hijab, the niqab and the burka are also instruments of oppression for millions of girls and women around the world who are not allowed to make a choice. We are currently being reminded of this daily, as we see the tragic return of the Taliban in Afghanistan, and its effect on the subjugation of women and girls. Girls as old as those in the picture are being sold into marriage to old men — institutionalized child rape. The mentality that allows this to happen shares much with the one that leads to covering up a toddler. But even in so-called moderate Islamic countries, such as the one I grew up in, societal pressures heavily marginalize women who choose not to wear the hijab. In addition, women in these countries who are not Muslim and do not wear the hijab are often subject to intense harassment and discrimination. I know that, because some of these women are in my family. I respect the women who see the hijab as liberating. But we must also remember the women and girls who find it oppressive and misogynistic.

Ironically, the article explores evaluating interventions to address social risks to health. A young girl such as the one depicted in the image is typically also banned from riding a bike, swimming or participating in other activities that characterize a healthy childhood. She is taught, directly or indirectly, from an early age that she is a sexual object, and it is her responsibility to hide her features from the opposite sex, lest she attract them. A heavy burden for modesty is placed squarely on her shoulders. So many women have been traumatized by such an upbringing, which, I believe, frankly borders on child abuse. Is that not a social risk to health? Are these children not a vulnerable population?