A noted medic’s recent revelation on the alarming rate of infertility cases in Kashmir has created fresh concerns with patients and doctors painting the dismal picture of the critical health situation.
By – Zaid Bin Shabir
Haunting darkness wrapped the old-fashioned lawns of the Shah House in Srinagar when a dreadful knock on the door raised an alarm.
The clock was yet to turn past 6 pm, but the last night’s melodrama and the vicious verbal abuse were still pounding Shahana’s, restless heart. Like a recluse waiting for her proportion of a peaceful life, she already forgave his sins. But one fussy accusation simply shook her up: “You’re a bloody barren!”
Deep down, she was thinking that it was her existence that had been thrown into an indictment, but it was nothing new for her.
For the past few years, Shahana’s in-laws had already turned the torrent of abuse into normalcy in her life but the latest indictment proved to be the last nail in the coffin of dreams as it came from her beloved.
There were marriages in her family that had fallen apart quite easily as if they had been perforated from the very beginning but that wasn’t the case with her life.
The first two years of her marriage had proved to be a “subtle art of a healthy relationship” but then, the bracing relation adopted an ugly side. The couple tried every medical solution, but to their chagrin, it proved nothing more than a debacle.
And then the childless woman became the freshly inducted sight of taunts. Her relatives asked her to sit far from their children, her in-laws called her barren—even as the test reports had proved otherwise—and her husband termed her existence an evil in his life.
As the nerve-jerking insult of the previous night was still sinking in her, she opened the door. In a flash, a weary man with sunken eyes rushed inside. As he stepped inside the home, Shahana was once again forced to bear the normalized verbal abuse. “You should be ashamed of yourself,” she was greeted. “It’s you who has forced me to do this!”
She was confused over how to react to her husband’s words but stood there staring at him nonchalantly. Even before she could sense a storm that was about to be unleashed, her husband declared: “I’ve married someone else!”
Behind the pomp and show with which people are performing weddings in Kashmir, an elephant in the room is devouring the same sacred institutions in the name of infertility.
The doctors are aghast over the various reasons for the growing crisis raised by the new boogeyman and some have also pointed fingers at the lifestyle changes but, above all, the cases and statistics reveal a different cinema of the augmenting crisis in the valley.
As per the data available in the latest yearly Census of India report—which many refer to as “canary in the coal mine”—the total fertility rate in Jammu & Kashmir has collapsed from an all-time high of 2.400 in 2005 to a record low of 1.600 in 2018, raising the strong apprehensions of an existential crisis for the Kashmir lineage.
The infertility rate has soared in Kashmir, especially over the past two decades where it was first recorded at 12 percent, and has now gone up to 18 percent.
I called Dr. Bilquees Jameel, one of the leading gynecologists of Kashmir who has experience of more than five decades, to ask if there was any good news hiding behind those brutal numbers.
Is Kashmir’s lineage really at risk of extinction? She failed to comfort me.
“Then what does it mean question means extrapolating beyond your data,” Dr. Bilquees told me, “which is always a tricky thing. But you can ask, what does it take when a lineage is in danger? When is our existence threatened? And we are definitely heading towards that path.”
That path in its darkest leads to no more naturally conceived babies and potentially to no babies at all, the matron medic said.
“And maybe,” she added, “the final generation of Kashmir will roam the valley knowing they will be the last of their tribe. There is a clear and present alarm now.”
Out of every 10 cases that Dr. Bilquees receives, five are related to infertility with the higher side depicting female infertility. This is because she explained, numerous women are suffering from polycystic ovarian syndrome (PCOS), anovulation, endometriosis, and fibroids.
“If we are half as fertile as the generation before us, why haven’t we noticed? One answer is that there’s a lot of redundancy built into reproduction: You don’t need 200 million sperm to fertilize an egg, but that’s how many Kashmiri men might devote to the job. Most Kashmiri men can still conceive a child naturally with a depressed sperm count, and those who can’t have a booming fertility-treatment industry ready to help them,” the noted gynecologist informed.
“And though lower sperm counts probably have led to a small decrease in the number of children being conceived, that decline has been masked by sociological changes driving birth rates down even faster. Our people in this concurrently developed Kashmir are choosing to have fewer children, and they are having them later. The obscure crisis is an astonishing and terrifying claim that, were it to be true, would justify the apocalyptic tenor of some of the false claims.”
Apparently, this “apocalyptic tenor” that Kashmiris have been ignoring for the past decade has silently swept its roots into the families and distraught the relations within the blink of an eye.
One pacific floor of the Lal-Ded hospital in Srinagar houses the Assisted Reproductive Centre. The unit is populated not with doctors and researchers hunched over mass spectrometers and gel imagers and the like, but with new parents. I was there to talk to one of the leading gynecologists in Kashmir.
After talking me through the crisis, she mentioned growing infertility among males and females and reproductive health. “The fertility in Kashmir is in full-blown crisis,” she began on an alarming note.
“Here in Kashmir, there’s an epidemic of infertility. Out of 100 male infertility cases, 25 cannot father children, even In-Vitro Fertilization (IVF) [where the egg is fertilized outside the womb] treatment won’t help.”
In an attempt to understand more about infertility in Kashmir through documented data, I approached the Medical Superintendent of Lal Ded hospital, Shabir Siddique, but five minutes down in the conversation suggested that even the doctors are less cautious about embracing any proper explanation on the crisis than expected.
“There’s no data on infertility available,” his reply created a sense of shock in the room. “But, one thing is quite sure, infertility is a new destructive force in Kashmir.”
Perhaps, the same destructive force had played a dominant part in a quadragenarian’s life who had come to a clinic to collect her latest “Fertility” test report.
As a wooden door opened into an archaic clinic, a young woman whispering some prayers stepped in. She walked towards the center-placed reception inside the wooden grilled square. In that sad beige waiting room there were no normal persons but only the deflated faces. She stopped her stride, took good luck of the sad settings around, and started praying relentlessly as if the world would have ceased to exist if her lips would’ve stopped uttering those prayers.
Her face had a stark resemblance to the weathered appearance of that clinic. Her voice was trembling like well-water in a goatskin bucket and her eyes had been apparently pushed into the desolation of an unlit lamp. Among the gallery of test reports lying near the foot of that wooden reception, one thin sheet embraced her name. “Do I’ve something to cherish upon?” the young woman tremblingly asked the receptionists. “Yes!” pat came the reply.
Clad in a cream Shalwar-Kameez, she looked like any other frown face but the moment she received her wished to reply, a shriek of cry broke the barriers of her parched lips. She was no longer a doomed mother waiting to birth a child.
“It’s been more than six years since my husband and I tried to conceive a baby but to our shock, I was found infertile to conceive,” Ruksana Zargar, the woman in the clinic, said with a dejected tone. “Since then, we’ve tried almost every doctor’s cure but nothing worked.”
Almost half a decade back, Ruksana was diagnosed with PCOS—a condition where a woman skips ovulation known as anovulation leading to infertility—and obesity, but she totally sidelined the urgency to get married as had been recommended by a doctor, when the extremely painful periods and continuous breast discharge had become a new monthly compulsion.
But, at 35, she was married to Javaid who was five years younger than her and thus began their struggle to conceive a child.
“Javaid has accepted the fact that we’ll always remain a childless couple but I cannot,” said Ruksana. “I always wanted to have a child and my last resort was IVF treatment. So, perhaps, Javaid was wrong… We’re no longer the childless couple!”
The late marriage menace that doctors believe is a major reason for growing infertility issues in the region, has become extremely common in Kashmir and perhaps adding a considerable share of trouble in the making of the crisis.
“Late marriage is the biggest contributor to the infertility crisis in Kashmir,” Dr. Bilquees Jameela continued a bit defensively.
Bilquees, who had been so gracious and engaged with managing the crisis at her clinic, began to sound a little tired. She rallied that families even after knowing about their daughter’s PCOS problem, still sideline the urgency of her early marriage and then blame her for failing to conceive a child.
“Kashmiris acknowledge that male reproductive health is essential for the survival of the species, but at the same time, the taboo regarding female reproductive health should end, given the alarming rise of fertility decline,” the veteran doctor said.
Many of these are attributable in part to the conflict, which as per Dr. Bilquees acts as a silent killer.
“Undoubtedly,” she said, “conflict creates an impact on the reproductive health of women. In fact, the data has shown that the impact of conflict in any given region is mostly on women because they are more concerned about the safety of their families.”
Perhaps, similar kinds of apprehensions were found to be factual, when in 2015 National Family Health Survey showed around 61 percent of married women in Kashmir reporting one or more reproductive health problems — remarkably higher than the national average which stood at 39 percent.
The study further suggested that 73 percent of Kashmiri women tend to have reported one reproductive health problem.
When I caught up with Dr.Bilquees later, she wasn’t nearly as dismissive as she had sounded earlier. She agreed that there was a big question that infertility was rising but even embraced some of the direst predictions of doctors on IVF treatment.
“The IVF treatment may be one of the only cures available against this problem,” she told me, “but that isn’t a full-time cure for infertility. Globally, its success rate stands at around 40 percent and when we talk about a region like Kashmir, one can only imagine the meager success rate of IVF treatment here.”
When even the skeptics are scared, it’s probably time to pay attention to a natural way of conceiving—early marriages, PCOS awareness, and reproductive inbound healthy lifestyle—rather than waiting for late marriages to destroy everything, the doctor suggested.
However, the fact that Dr. Bilquees didn’t mention was how Kashmir’s barren couples who’ve surfaced almost every nook and corner of the valley in a bid to be able to cherish the sentimental journey of conceiving a child, have apparently found a new door to knock on.
In the bustling urban pocket of Srinagar, Majid and Nida are among the dozens of other couples sitting on the porch of a godman’s abode.
The young couple endearingly looks at the wall of delighted faces of those holding them inside that five-decade-old monument in the Saida Kadal area of the city. The waiting space in the holy man’s dwelling gradually fills in with apparently tired strangers connected by their physiological conditions, befriending each other, and within no time, a bond of friendship is forged.
The tranquil space that is bustling with hope and expectations for a joyous future is conspicuously avoided by a visibly older couple. Majid and Nida have been sitting secluded with an air of a steady resolve around them, evidently, both softened with hope and the prospect of their wish being granted.
After seventeen years of childless marriage with one failed IVF attempt, the couple had traveled about fifteen kilometers to meet the godman, whose ‘dast-e-shifa’ (prayers)—as per the word of mouth—had apparently helped several infertile cases.
When the couple’s turn came, the godman’s buoyant words paved a way towards a cheerful future. “So, what if science has failed,” he defensively told the couple. “Almighty won’t let you down! He’s ghafoor ur raheem!”
Hearing these words, Nida could no longer control her emotions and broke into tears. For her, it felt as if the man sitting in front of her knew exactly what was going wrong.
“Medical science is there to help us but what if that too fails,” the goodman who called himself Sajad Sa’eb, comforted the crowd. “When everything fails, then the only support we have is our creator.”
Couples need to be psychologically, physically as well as emotionally patient, godman Sajad with a sound academic background would tell me.
“Once they get psychologically and emotionally affected, they may go into a prolonged phase of anovulation, which can lead to infertility,” he said.
Sometimes, a couple is fertile enough to produce a child but they can’t and even the medical explanations fail, he said. “But, one needs to understand, there’re certain limitations of science beyond that only our creator can help.”
Apparently, with the same belief and in lieu of relief, Majid and Nida often hire a local traveler to visit the Makhdoom Sahib shrine in Old Srinagar.
Climbing the long-winded stairs, she buys corn kernels to feed the pigeons. As she enters the door of the saint, tears start falling off her face. She sits beside a pillar and her words give life to her agony. A visit to the shrine gives her momentary relief.
When science fails, as godman Sajad said, it’s in this spiritual hope that most childless couples finally seek some solace.