It is like any other day at the valley’s leading gynecologist’s clinic: Crowded and packed with impulsive patients, who have come from different part of Kashmir to the summer capital, Srinagar.
For 17-year-old Maleeha, however, the day has brought anxiousness and worry. On her first visit to the doctor, Maleeha has been diagnosed of severe Polycystic Ovarian Syndrome (PCOS) which she fears will make her infertile.
“I am extremely worried about this problem as it is known to cause infertility,” says Maleeha, who belongs to Baramullah.
Another patient, Andleeb, who has been married for six years, has been visiting the doctor for two years. She suffers from infertility, the cause for which remains unknown.
“I have got every test done but the doctors have not been able to find the reason for my inability to bear children. It has ruined my life,” she says.
Thousands of women in Kashmir are increasingly suffering from infertility. Couples are finding hard to fight the problem which has saddened hundreds of families across the valley.
Leading gynecologist Dr Farhat Hameed says infertility is affecting the younger age group at an alarming rate.
She cites late marriages, hormonal imbalance, unhealthy lifestyles and stress as major reasons for infertility-related problems.
“The marital age for Kashmiri women has risen from 18-21 to 27-35 years. Girls prefer quality education and a good career before marriage. This has affected their child-bearing capacity,” Dr Farhat insists.
Studies at the premier Sher-e-Kashmir Institute of Medical Science (SKIMS) indicate 15.7 per cent women at childbearing age will never have an offspring without clinical intervention. A further 14 per cent of women are unable to conceive because of unknown medical conditions.
Dr Farhat added that conflict also gave way to infertility problems for women in the disputed region, due to increased stress levels.
“Conflict has resulted in many psychiatric problems in women, including depression, Post Traumatic Stress Disorder (PTSD) and anxiety, which directly affect child birth.”
According to psychiatric research, 800,000 people in Kashmir – including women – are affected by PTSD.
The problem, once unknown in Kashmir, now affects 10 per cent of its female population, including teenagers and young women.
Gynecologist Dr Sameena says that PCOS is one of the most common disease affecting young women of Kashmir.
“The number of patients diagnosed with PCOS is adding with each day.”
PCOS is a major endocrine disorder which affects women of reproductive age. It is one of the leading causes of infertility across the world.
A SKIMS study of 112 young and adolescent PCOS women found that 65 to 70 per cent of them suffered from psychiatric illnesses, eight patients suffered from obsessive compulsive disorder (OCD), five had PTSD, and 27 were depressed.
Over the years, In- Vitro Fertilization (IVF) clinics have raised some hopes for childless women. Kashmir had none until 2003.
IVF procedures, however, are expensive. They cost between Rs.200,000 to 300,000, making them out of reach for majority of the population.
“My husband is a clerk and does not earn much,” says Afsana. “We cannot afford IVF or similar treatments. I am reconciled to not having a child.”
Dr Farhat who runs an IVF clinic admits to the high costs but says “we do provide some concession to poor patients.”
Making things worse for the women are the social ramifications of infertility. Childless women are stigmatised and are looked down upon. Married women face the wrath of in-laws and husbands while unwedded girls fear marriage.
Such fear forces Tasleema Begum to take her 23-year-old daughter, Amber, to another district for infertility treatment to avoid being seen by her family.
“I do not want people to know Amber suffers from PCOS,” says her mother. “Such things are not socially acceptable.”
Thirty-five-year-old Saima who is childless after four years of marriage is regularly abused. “Not a day passes when I don’t face abuse from my husband and in-laws for not bearing children,” she says.
“For me, the torture is two-fold.” The misbehaviour of in-laws hurts her more than childlessness.
“I am trying the best medication and doctors but the rest is in God’s hands,” she says. “Why should women be blamed for it?”
Many women are divorced over their inability to bear children, a trend common in rural areas.
The story about the health of women in Kashmir does not end here. Besides the sick reproductive health, the general health of Kashmir women is fasting deteriorating. Hypertension and orthopedic problems have become common.
According to Dr M.A.Kamili, a leading physician, one of every 10 women above the age of 40 years are hypertensive . Fifty percent of women above the age-group of 60 years are hypertensive. However, the ratio of female hypertensive patients below 40 years of age is 15-20 percent.
Besides age, obesity, excessive intake of salt and unhealthy lifestyles have given rise to hypertension to women in the valley.
“Though the salt requirement of our body is six grams, which is fulfilled by any food we take be it fruit or vegetables, an average Kashmiri takes 20-22 grams of salt. This has resulted in rising ratio of hypertension here,” notes Dr Kamli.
Amongst the orthopedic problem, knee aches and lower back pain are common amongst women, besides osteoporosis. Osteoporosis is a disease of bone that leads to an increased risk of fracture. In osteoporosis the bone mineral density (BMD) is reduced, the microarchitecture of the bones is disrupted, and the amount and variety of proteins in bone are altered.
This is attributed to lack of required intake of calcium during and post pregnancy, during lactation period and after menopause. Adding to the causes is overwork, lifting of heavy objects and lack of appropriate exercise.
“Knee ache, back ache and lack of calcium, which lead to osteoporosis” states Dr Manzoor Ahmad Halwai, a local orthopaedician.
According to him, 40 percent of women in Kashmir suffer from calcium deficiency. The problem is more urban than rural because of the sedentary lifestyle in urban cities.
Gynecologist, Dr Afroza Jan reveals that a lack of awareness amongst the women of Kashmir regarding the calcium requirement of their body at various stages has resulted in orthopedic problems.
“Calcium gained from food does not suffice a woman’s requirements. This is because of her biological pressure during pregnancy and lactation period.”
She adds that during pregnancy, a lot of calcium is needed for the health of the child and mother. It is the same during the lactation period.
“But women here do not take calcium supplements at these crucial stages, the result is severe calcium deficiency giving way to orthopedic problems, commonly osteoporosis,” reveals Dr Afroza.