Diversity in practice: Sikhism

06 April 2018

Continuing our series on how religion and culture can impact on practice, Professor Eleanor Nesbitt looks at Sikhism.

Sikhfamily Shutterstock

The word ‘Sikh’ means learner. There are 10 Gurus (spiritual teachers), from Guru Nanak (born in 1469) to Guru Gobind Singh (died 1708), who are seen as being one in spirit. The Sikh volume of scripture, Guru Granth Sahib, embodies that spirit, and is viewed as Guru for all time. As taught by the Gurus, Sikhs believe there is only one God and that union with God is possible by selflessly serving others and through God’s grace. Other key religious teachings include the need to overcome ego. This requires constant mindfulness of God, while also shouldering family life’s responsibilities. The view is that once ego takes over, people will give in to lust, anger, greed, materialism and pride. Also, all humans are equal – caste (hereditary status) and gender are seen as irrelevant to spiritual progress.

The gurdwara (public place of worship) houses the enthroned Guru Granth Sahib. Sikhs gather to worship and for langar (rhyming with ‘hunger’), the free vegetarian hospitality, provided daily by community members for all-comers.

Sikhs’ family roots are in Punjab: almost all British Sikhs identify to some extent with India’s (not Pakistan’s) state of Punjab. That said, Sikhs are diverse.

They come from different generations, have differing views, and their upbringing in Britain, India or East Africa has a strong influence.

Sikhs are influenced by the often contradictory pulls of: (a) Punjabi culture (for instance, marrying within caste - in contrast to religious principles, maintaining family honour, respecting elders, the cultural pressure to have lavish weddings); (b) religious demands (such as no hair-cutting, no smoking or alcohol); and (c) modern/western society (so to live independently of parents, marry out of the religion, women drinking alcohol, waxing to remove unwanted hair).

Also, for various reasons, individuals may present differently at different stages of life or in different settings. For example, a man may strictly observe a discipline requiring full beard and uncut hair for years, but at another stage be short-haired and beardless. A woman who is assertive outside may be a deferential daughter-in-law at home. So be prepared for contrasting attitudes, behaviour and appearance within and between families, as well as for similarities. It’s also important for practitioners to be respectful of any mention of Sikh religious teachers and teachings. 

Your guide


A Sikh may present as ‘modern’ and ‘western’ in manner and dress but the cultural values of their home may be strongly Punjabi and Sikh. When faced with crisis or illness, tradition may become more important.

Most Sikhs wear a kara (a steel bangle) on their right wrist. Many men wear turbans: they have uncut hair and do not shave. An increasing minority of women too wear turbans (mainly Khalsa Sikhs).

Most Sikh forenames are unisex. Sikh women’s second name is usually Kaur (princess) and men’s is Singh (lion). These names may be followed by a family name or may be their surname. First names often begin with Bal-, Har-, Jas-, Kul- or Sat-, Sukh. Many forenames end in -deep (or -dip), -inder, -jeet (or -jit), -pal, -preet, -want. Examples are Amarjeet, Balwant, Davinder, Jaspal, Satwant.  

How does this affect you?

Do not assume that a Sikh will be of the same sex as the last person you met with that forename. Look for the names Kaur and Singh, or a middle initial of K or S, as likely indicators of gender. Sikhs may introduce themselves with a nickname rather than their given name.

A turban symbolises a Sikh’s religious identity and removing it is a significant act – not as casual as taking off other sorts of headwear. Never place it on the floor or near shoes. Also, look out for Sikh emblems, the khanda (double-edged sword in a circle, cupped by two other swords) and ‘ik oan kar’ meaning ‘God is one’ – these indicate that a person or a household is Sikh. 

Khalsa Sikhs

A minority of women wear turbans. They and some turban-wearing men who additionally do not trim their beards – it may look shorter because of being skilfully tied up – are usually members of the Khalsa, a community started by Guru Gobind Singh in 1699. Khalsa Sikhs form a minority of the Sikh community overall. They are initiated with holy water (amrit) in a ceremony which is often compared with baptism. However, it’s rare for children to ‘take amrit’ before puberty, as they need to understand the implications of it; there is no upper age limit for initiation (Gatrad et al, 2005). Initiation involves committing to a lifelong discipline which forbids adultery, tobacco, intoxicants and halal meat, and also forbids the removal or shortening of hair. This is understood to mean all bodily hair.

The Khalsa discipline includes keeping on one’s person the Five Ks: kara (steel bangle), kes/kesh (uncut hair), kangha (small wooden comb), kirpan (sword), and kachha/kachahira (cotton shorts worn as underwear).

How does this affect you?

Be prepared for a Khalsa Sikh to have a short, sheathed sword (kirpan) which he or she will be reluctant to remove (it is usually attached to a strap diagonally across the chest, often under his or her outer clothes). Khalsa Sikhs need to know whether any facial, pubic or other hair is to be removed in any procedure and this can influence decisions about accepting surgery. Khalsa Sikhs seek reinitiation if hair 
is removed.


Dietary practice

Many Sikhs eat meat, although most (for cultural reasons) avoid beef. Increasingly, Sikhs eat non-Punjabi food at home and outside. However, food served in the gurdwara and at marriages is Punjabi. Social events often involve men 
consuming alcohol.

That said, most initiated Khalsa Sikhs, and many uninitiated (so not Khalsa Sikhs) also, are strictly vegetarian. They accept dairy products but avoid anything containing meat, animal fats, fish or egg. In the gurdwara Sikhs receive karah prasad, made from wheat flour, sugar, ghee and water.

How does this affect you?

Gelatine capsules or fish oil may be unacceptable. Vegetarian hospital patients may refuse food that has been prepared together with non-vegetarian food. Dietary advice, such as for diabetic or gluten-intolerant patients, needs to recognise that traditionally Punjabi diet is wheat-based (chapatis and other breads). Plenty of salt is used in cooking, and celebrations involve very sweet sweets. You should never take tobacco or cigarettes into a Sikh’s home.

It’s also important to be aware that men (and, less openly, women) can have alcohol-dependency problems, but social stigma can lead to denial and to refusing treatment.  


Family, relationships, childbirth

Family relationships tend to be strong – women are expected to defer to parents-in-law, for example. Gay and lesbian Sikhs may fear coming out – to the extent of accepting a heterosexual marriage to please their parents.

Contraception is accepted, though a woman may not feel able to put off starting a family for long after marriage. Despite religious affirmation of gender equality, a woman who has daughters but no sons often feels a failure if she bears another daughter, and is likely to keep trying to conceive until she has a son. Pressures to marry and to produce a son can include pressure to terminate an unwanted female fetus – this is cultural – so from Punjabi society – and not religious: the Gurus’ condemned female infanticide so would have condemned feticide too.

Sikhism does not prescribe any special rituals for during labour, and Punjabi customs around childbirth have declined; after birth, women are encouraged to rest and recuperate; and breastfeeding is positively encouraged and seen as completely natural (Gatrad et al, 2005). While family practices vary, many Sikhs name their baby on or near the 40th 
day after birth in a simple ceremony in the presence of the Guru Granth Sahib.

How does this affect you?

Practitioners need to be aware of community attitudes. Sikhs may feel more comfortable with a South Asian practitioner – some older Sikhs find English difficult. They may, however, be anxious about the practitioner’s disapproval or fear information getting back to the family.

It’s also important to realise that extended family may be involved in a Sikh’s life; elders’ and in-laws’ expectations 
are part of individuals’ decision-making.

When it comes to childbirth and the postnatal period, since beliefs may vary among Sikhs, you should ask rather than assume what’s important to them. This is especially germane as there are generally no elaborate rituals or ceremonies surrounding childbirth within the Sikh faith (compared with other South Asian religions) (Gatrad et al, 2005). 


More families go to the gurdwara when there’s a festival. In general, celebration consists of congregational worship. Each festival is preceded by a 48-hour reading of the whole Guru Granth Sahib.

Vaisakhi (sometimes called Sikh new year or the birthday of the Khalsa) celebrations often include a street procession, headed by the Guru Granth Sahib on a vehicle, attended by five male Khalsa Sikhs in traditional dress. Divali (which Sikhs increasingly call Bandi Chhor Divas) is a time of fireworks and lights (while Hindus remember Rama and Sita, many Sikhs recall their sixth Guru leaving prison on Divali).

The official Sikh (Nanakshahi) calendar (below) is not agreed by all Sikhs. In practice, festivals may be celebrated on the Sunday following the calendar date. Many dates are the same each year in terms of the secular calendar, though some are still widely observed in accordance with the older (lunar) calendar. Most Sikhs celebrate the late autumn festival of lights, Divali on a November date that shifts from one year to the next. Devout Sikhs also observe many other anniversaries, such as the martyrdom day of the fifth Guru, Arjan Dev, in June.

Eleanor Nesbitt is professor emeritus in religions and education at the University of Warwick, specialising in the religious socialisation of Sikh, Christian and Hindu young people. 

Sikh Festival calendar

It’s important to be aware of the calendar, though it is unlikely to affect clients’ attendance at health appointments.

  • Guru Gobind Singh’s Birthday 5 January
  • Vaisakhi 14 April
  • Bandi Chhor Divas/ Divali 7 November in 2018
  • Guru Nanak’s Birthday 23 November in 2018


  • Caring for a Sikh patient by Harinder Singh, Sikh Healthcare Chaplaincy Group bit.ly/caring_Sikh Also, see the chaplaincy website for more guides bit.ly/Sikh_publications
  • Sikhism, chapter by Eleanor Nesbitt in the Oxford textbook of spirituality in healthcare (2014).
  • Faith guides for higher education: a guide to Sikhism by Eleanor Nesbitt (2005), Subject Centre for Philosophical and Religious Studies. While not aimed at CPs, a useful guide bit.ly/Sikhism_faith_guide
  • Sikhs.org is a useful website on Sikhism 


Gatrad R, Jhutti-Johal J, Gill PS, Sheikh A. (2005) Sikh birth customs. Archives of disease in childhood 90(6)

National Records of Scotland. (2011) Scotland's Census 2011 - National Records of Scotland, Religion (detailed). See: http://www.scotlandscensus.gov.uk/documents/censusresults/release2a/rel2A_Religion_detailed_Scotland.pdf (accessed 23 March 2018).

Northern Ireland Statistic and Research Agency. (2011) Census 2011: Detailed Characteristics for Northern Ireland on Health, Religion and National Identity. See: https://www.nisra.gov.uk/sites/nisra.gov.uk/files/publications/2011-census-results-detailed-characteristics-press-release-16-may-2013.pdf (accessed 23 March 2018).

ONS. (2011) 2011 Census: Religion (Detailed), local authorities in England and Wales. See: https://bit.ly/2JqOmdl (accessed 23 march 2018)

Subscription Content

Click To Return To Homepage

Only current Unite/CPHVA members or Community Practitioner subscribers can access the Community Practitioner journals archive. Please provide your name and membership/subscriber number below to verify access:

Membership number

If you are not already a member of CPHVA and wish to join please click here to JOIN TODAY

Membership of Unite gives you:

  • legal and industrial support on all workplace issues 
  • professional guidance on clinical and professional issues 
  • online information, training and support 
  • advice and support for all health professionals and health support workers
  • access to our membership communities 
  • CPHVA contribution rate is the Unite contribution rate plus £1.25 per month 

Join here https://www.unitetheunion.org/join-unite/

If you are not a member of Unite/CPHVA but would like to purchase an annual print or digital access subscription, please click here