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How ongoing conflict in Kashmir has affected women’s reproductive health

South China Morning Post logo South China Morning Post 3 days ago
a group of people walking down the street: Women are seen shopping in Srinagar, the summer capital of Indian Kashmir, as coronavirus restrictions were eased ahead of the Eid-ul-Adha religious festival. Women have borne the brunt of the ongoing conflict in Kashmir. Photo: EPA © EPA-EFE Women are seen shopping in Srinagar, the summer capital of Indian Kashmir, as coronavirus restrictions were eased ahead of the Eid-ul-Adha religious festival. Women have borne the brunt of the ongoing conflict in Kashmir. Photo: EPA

As Covid-19 spread across India in March this year, Sumayya, 38, found herself worrying for a different reason.

Married for seven years, she had finally managed to conceive a baby through in vitro fertilisation (IVF), with the help of a clinic in the capital New Delhi, over 800km from her home in Kashmir.

Her two previous IVF attempts had failed. She had lost hope, money and peace of mind, causing a strain in her marriage. The couple's inability to conceive naturally was mainly attributed to their increased stress levels.

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To ensure a successful pregnancy, doctors scheduled regular physical check-ups during the first trimester at the clinic in Delhi. But the strict lockdown imposed by the Narendra Modi-led BJP government in March made that difficult.

a group of people walking down a dirt road: Schoolchildren have returned to open-air schools in Kashmir, after the coronavirus lockdown disrupted education in the region. Photo: AFP © Provided by South China Morning Post Schoolchildren have returned to open-air schools in Kashmir, after the coronavirus lockdown disrupted education in the region. Photo: AFP

Confined to rented accommodation in Delhi for three months, Sumayya's stress worsened and depression set in. She got through it by having telephonic consultations with her gynaecologist and psychiatrist.

After the lockdown was eased, she was able to fly back home to Kashmir in June. Here she met Dr Bilques Jamila, 78, a gynaecologist and obstetrician who has been practising medicine for over 50 years, both as an active witness and participant in the region's reproductive health history.

"Women in Kashmir are always fearful of the uncertainty prevailing in this region. It has had a direct impact on their psychological and reproductive health," Jamila said.

Sumayya's struggle to conceive and the stress induced by the political situation in Kashmir is a reflection of the larger reproductive health crisis faced by the women in the Kashmir Valley, which is home to around 7 million people and has one of the world's worst health care systems.

Hundreds of thousands of Kashmiris have died violently after an insurgency against India's rule erupted in 1989. India responded to the rebellion with brute force. As the violence exploded, its worst victims have been Kashmiri women, who even faced abuse and violation at the hands of government forces in the 1990s.

a boy wearing a hat: Dr Bilques Jamila, 78, a gynaecologist and obstetrician who has been practising medicine in Kashmir for over 50 years. Photo: Arif Bashir Wani © Provided by South China Morning Post Dr Bilques Jamila, 78, a gynaecologist and obstetrician who has been practising medicine in Kashmir for over 50 years. Photo: Arif Bashir Wani

A National Family Health Survey conducted across India revealed that 60 per cent of married women in Jammu and Kashmir reported at least one reproductive health problem, which was highest in the country.

"From pre-labour uterine ruptures and vaginal bleeding in the pre-1990s, reproductive issues among women in Kashmir were witnessing a change with acute depression during pregnancy, infertility and sexual dysfunction because of the trauma experienced," said Jamila.

The situation deteriorated even further after August 5, 2019, when the Modi-led government revoked the semi-autonomous status of Jammu and Kashmir to annex the territory and bring it under direct central rule. The clampdown and communication blockade imposed to control any dissent made it difficult for women to even reach nearby hospitals or health care facilities. And just as Kashmir was limping back to a routine, in March another lockdown was imposed, this time to control the spread of Covid-19.

The conflict has grilled us to work in crisis
Dr Bilques Jamila

Again, pregnant women suffered the most. While around 550 expectant mothers tested positive for coronavirus in Kashmir, a few died of alleged medical negligence at hospitals and many others were unable to access proper treatment and care.

Despite this, Jamila did not stop seeing patients. "People say Covid-19 is World War III in which doctors and health care workers are the frontline warriors. We cannot leave the battlefield even if it is dangerous," she said. Her career is a testimony to this fact. Even as people were killed in shoot-outs, skirmishes and roadside bombs just outside her hospital, she kept on bringing new life into the world.

"The conflict has grilled us to work in crisis. I have performed surgeries under lantern during my career. I have operated on women who had lost their husbands in firing incidents or were in prison after 1990," said Jamila, who was among the first batch of doctors from the oldest Government Medical College in Kashmir, established in 1958.

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She recalls how many pregnant women suffered as the ambulances carrying them were stopped and searched by government forces, and sometimes even attacked.

A 2017 study published in the International Journal of Reproduction, Contraception, Obstetrics and Gynaecology revealed that 26 per cent of the pregnant women in a tertiary care hospital in Kashmir suffered from depressive disorder.

a group of people in a room: Dr Bilques Jamila and other medical staff attend to a patient in Kashmir. Photo: Arif Bashir Wani © Provided by South China Morning Post Dr Bilques Jamila and other medical staff attend to a patient in Kashmir. Photo: Arif Bashir Wani

A hospital administrator in Kashmir said one of the key indicators of stress among pregnant women is the increased number of caesarean sections instead of normal deliveries.

"Rarely is any woman prepared mentally for the normal delivery," Jamila said.

Another study conducted at Government Medical College in Srinagar Kashmir on the use of antidepressants by married women in the region found that 62 per cent of them felt decreased sexual desire, 34 per cent experienced orgasmic delay and 20 per cent reported difficult vaginal lubrication. The percentage varied with different antidepressant drugs.

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"Conflict has kept our women in a survival mode rather than in a progressive or reformative mode. Delayed marriage is a problem as well. Women under stress have irregular ovulatory cycles constantly which manifests later as infertility and miscarriages," said Dr Syed Naseer, a leading infertility expert and associate professor at Sher-i-Kashmir Institute of Medical Sciences in Kashmir.

The reproductive challenges faced by women in Kashmir have attracted the attention of health care businesses across India, especially fertility clinics, and they have started aggressive advertising campaigns in the region. Many travel to Kashmir to offer consultations and a large number of Kashmiri women visit their facilities elsewhere in India.

Summaya was one of the regular visitors of these clinics, but she hopes this will no longer be necessary. Under the supervision of Dr Jamila, she believes her pregnancy will be successful and she will finally realise her dream of motherhood.

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This article originally appeared on the South China Morning Post (www.scmp.com), the leading news media reporting on China and Asia.

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