Kashmir conflict is over three decades old and so is Kashmiri women’s struggle with the health implications of this conflict. Where the conflict has affected every sphere of life in the Valley, it has shown adverse impact on the fertility among several young women.
As per the experts, conflict-related stress has affected the reproductivehealth as well as ability to conceive in scores of women in Kashmir. In fact,infertility has been affecting the younger generation at an alarming rate.
“Infertility has soared in Kashmir, especially over the past two to threedecades. Earlier it was 12 percent, which has now gone up by 18 percent,”reveals Dr Syed Naseer, Associate Professor, SKIMS Medical College, Srinagar.
The leading gynaecologist and infertility specialist underlines thatinfertility clinics in Kashmir generally have more patient rush than antenatalclinics. “At least 60 percent of the patients I see in my clinics areinfertile,” Dr Naseer divulges. This is because, he adds, numerous womennowadays are suffering from Polycystic Ovarian Syndrome (PCOS), anovulation(ovaries not releasing eggs), endometriosis (when bits of the tissue that linesthe uterus grow on other pelvic organs), fibroids (noncancerous growths of theuterus), so on and so forth.
The experts attribute several reproductive issues in women to conflict,which, they say, acts as a silent killer. “Conflict definitely has an impact onthe reproductive health of women. In fact, the impact of conflict in any regionis mostly on women because they are more concerned about the safety of theirfamilies,” says Dr Naseer.
According to the National Family Health Survey (2015-16), 61 percent ofmarried women in Kashmir report one or more reproductive health problems. Thisis substantially higher than India’s national average of 39 percent. The samesurvey revealed that overall 73 percent of women in Kashmir report reproductivehealth problems.
Studies at the Sher-e-Kashmir Institute of Medical Science (SKIMS),Srinagar, indicate that 15.7 percent women of childbearing age cannot have anoffspring without clinical intervention. A further 14 percent of women areunable to conceive because of unknown medical conditions. Therefore, it can besaid without any doubt that thousands of women in Kashmir are suffering frominfertility.
Stress hormones suppress fertility
Experts opine that conflict-generated stress can cause hormonalimbalances in the body and produces certain hormones that suppress fertility inwomen. “During stress, a hormone called cortisol is released, which can lead tohypercortisolemia—a condition that causes hormonal changes in body, which inturn affects the reproductive health,” says Dr Sabreena Qadri, Lecturer,Department of Psychiatry, Government Medical College, Srinagar.
Another psychiatrist and Registrar, Institute of Mental Health andNeurosciences (IMHANS), Kashmir, Dr Insha Rauf, says, stress hinders fertilityalso since it acts on hypothalamic and pituitary glands. “Whenever a stressresponse is triggered, the hypothalamus at the base of the brain is activatedand stimulates the pituitary gland, which as the mediator of stress management,could be highly affected by stress dysregulation,” she elaborates. “That iswhat is believed to cause anxiety disorders in women.”
Seconding the claim of psychiatrists, Dr Naseer says, “Yes, stress is amajor factor that affects conception.” He asserts that women need to bepsychologically, physically as well as emotionally at ease “so as to harbournext generation.” “Once they get psychologically and emotionally deranged, theymay go into a prolonged phase of anovulation, which can lead to infertility,”he says. The condition is then followed by medications and endless visits todoctors, which, he says, becomes a financial burden for the patient, hencefurther adding to the stress.
“But if you are living in a peaceful and harmonious environment, you tendto think in a harmonious way, which will definitely reduce the risks ofinfertility,” assures Dr Naseer.
As per some research studies, conflict-related stress is one of thesignificant factors responsible for triggering Polycystic Ovarian Syndrome(PCOS)—an endocrine disorder that can hinder ovulation—among young Kashmirigirls, which is highly widespread nowadays. Many of these girls are presumed tobe unable to conceive in future. PCOS, which mainly affects females between 15and 25 years of age, begins soon after puberty but may manifest duringreproductive period.
PCOS and psychiatric illness
Conflict has also resulted in many psychiatric disorders in women,including depression, Post Traumatic Stress Disorder (PTSD) and anxiety, whichagain directly affect the child bearing. Studies have shown a high prevalenceof psychiatric disorders in patients with PCOS. More recently a higher risk ofmood and anxiety disorders has been reported in women with this disorder.
“This is something called MACPCOS (Mood and Anxiety Complex of PolycysticOvarian Syndrome), which is actually caused by the stress,” says Dr Rauf,adding that the condition is highly common in Kashmir.
Dr Qadri adds that in one of the studies, they attempted to find out therelation between PCOS and Bipolar Affective Disorder, which is a mood disorder.”We found that stress plays a significant role in triggering PCOS, wherein onecan have tremendous mood disturbances for it causes hormonal changes that aredirectly related to mood changes,” she says and adds that there is also a riskof infertility in PCOS.
A study of SKIMS carried out on 112 young women suffering from PCOS foundthat 65 to 70 percent of them suffered from psychiatric illnesses. This againproves that there is a direct connection between the two.
Chairperson Help Foundation, a non-governmental organisation dealing withwomen in distress, Nighat Shafi Pandit, recalls that during the initial yearsof the current millennium, they had found that the uteruses of some youngwidows of conflict at Gopalpora village in district Kulgam had been removed aspart of a scam by some agencies after these women had complained of abdominalpain. “However, when we intervened, we found that there was no need of removingthe uteruses, for the pain was the result of acute depression they weresuffering from following the untimely death of their husbands,” she says. “Suchis the impact of depression on women’s physiology.”
The experts further say that hormonal changes cause menstrualdisturbances that can also lead to infertility. “Some women are direct victimsof conflict, say when any of their close relatives is killed. The menstrualcycle of these women sometimes gets irregular due to depression or constantstress,” says Dr Naseer.
“Sometimes their cycles go on and on. This condition may also lead toanaemia. And sometimes they may go in a prolonged phase of amenorrhoea, wherebythey don’t get cycles for several months,” he explains.
Lasting impact
Shahida (name changed), then 19, lost her father to a stray bullet at LalChowk, Srinagar, right before her eyes. Seeing him writhing in pain beforebreathing his last, she fell unconscious. The incident, however, left a lastingimpact on her psyche. Soon she developed recurrent episodes of loss ofconsciousness, chest pain, fatigue and headache.
At psychiatric hospital, Shahida was diagnosed with PTSD and later onPCOS. As if this was not enough, two years after her marriage, her doctordeclared that she would not be able to conceive naturally owing to chronicanovulation. “I could not afford the infertility treatment and medications,which deprived me of the biggest joy of one’s life,” says Shahida. “Not just Ilost my father to conflict, I lost my motherhood as well.”
The viciousness of conflict does not end here. More often marriages getdelayed after somebody’s father or brother gets killed or house is destroyed inan untoward incident. “When marriages are delayed beyond a certain age, thecapability to bear children is also affected,” says Dr Lubna, a gynaecologist.”It becomes difficult to treat a woman for infertility beyond the age of 35 or40. And then, the treatment being quite expensive, not everyone can affordthat,” she adds.
In a conflict-ridden region like Kashmir, women are definitelyvulnerable. While most of them bear the brunt of conflict in more than one way,it is both the partners who find hard fighting infertility, which hasdistressed thousands of families across the Valley.
(Dr Rabia Noor is a media fellow with Nature India and Wellcome Trust/DBTIndia Alliance. The story is a part of India Science Media Fellowshipprogramme).