Love In Turmoil

Kashmir is not only a huge family planning story but an emerging market for aphrodiacs as well. However, in-between lies the larger reality that how over two decades of strife has fundamentally shifted the biology of people who never might have known what premature ovarian failure is! A Kashmir Life report

Cover-Chinar-and-RomanceRafia was just 14 when security men barged into her residence looking for her brother. Before they (security men) left, they fired inside the house. A bullet hit Rafia. The images of the day remained etched in her memory ever since. She survived but as she reached her puberty, she was diagnosed with Polycystic Ovarian Syndrome (PCOS) also known as Hirsutism, a major endocrine disorder that renders women infertile.

Similarly, Rukaiya, a middle class housewife who lives in the city outskirts, had to abort three times despite conceiving successfully after her brother died in a cross fire. She consulted doctors who diagnosed her with Post Traumatic Stress Disorder (PTSD), a phenomenon detected in 20 per cent of people visiting state run psychiatric hospital.

On the other hand, increased stress levels in males trigger erectile dysfunction, decreased sperm count and decreased libido. “Almost one third of the total infertility cases in Kashmir are due to male factors with low semen count being major issue,” says Dr Sharik Masoodi.

Premature Ovarian Failure (POF) is another reason for female infertility which is also largely attributed to stress related disorders. Rotunda-Hygiea IVF Clinic in Srinagar conducted a clinical screening of around 2000 women (below 40-age group) with infertility symptoms and put the incidence of POF at 26 per cent which is alarmingly high compared to the national average of 1-5 per cent. Doctors blame stress for such alarming increase in infertility cases, but say, further studies are needed to determine the exact cause.

“15.7 per cent women in Kashmir who fall in child-bearing age will never have a child without clinical intervention,” claims Dr Ashraf Ganai, Kashmir’s renowned endocrinologist who now works in AIIMS at New Delhi.

Dr Ashraf was part of a study carried out by SKIMS in 1997 which involved 10063 married couples. “The study has revealed that 90% of female infertility is due to PCOS and related diseases, 5% are due to POF and another 5% due to other stresses in our lives,” says Dr Ashraf.  Another survey that was conducted from 2007 to 2012 showed the hospital prevalence (not community prevalence) of primary infertility at around 20 per cent.

“It is a lifestyle crisis and metabolic disorder that is aided by stress,” asserts Dr Ashraf. “It obviously is on the increase. I have documented cases of 2050 women in Kashmir and around 550 in Delhi from AIIMS where I tackle these cases.”

According to Dr Abdul Hameed Zargar, renowned endocrinologist who earlier headed SKIMS, premature menopause has risen to 11 percent which is an increase by two percent since 1990 when the militancy broke out.

Surprisingly, such illnesses were unheard-of in Kashmir just a few decades ago. But, since the onset of militancy in Kashmir in 1989, cases related to infertility saw a huge surge, thus giving rise to a new business: the infertility clinics.

“There are many counseling clinics but right now we have only two infertility clinics,” says Dr Ruheel Nisa, gynecologist who owns Rotunda Hygeia Clinic, Kashmir’s first infertility clinic since 2003.

“We tackle around 100 IVF patients a year and our results are around 40% which is not bad.”  Dr Ruheel says. She flies experts (an embryologist and IVF experts) from Mumbai every month to treat the patients in Kashmir. Dr Ruheel claims that her clinic has successfully delivered more than 300 babies, so far. “We, however, do not do surrogacy because it is forbidden in Islam,” informs Dr Ruheel.

According to Dr Ruheel, the crisis of infertility is so severe in Kashmir that thousands of couples visit clinics outside the valley every year to get treated. But the process outside Kashmir is highly expensive costing couples more than rupees 2.5 lakh with no guarantee of success. “There are couples who have done it as many times as five and failed!” claims Dr Ruheel.

But with just a few options available locally to meet the huge demand of treating infertility related cases, the process is still very costly, making it out of the reach for economically weaker sections of the society.

According to an American study published in April last year, the children born and brought up during turmoil exhibit “stunted growth, poor performance in schools and jobs and poor health conditions.”

The study titled ‘Armed Conflict and Children’s Health -The case of Kashmir’ published by Department of Economics, University of Wisconsin, Milwaukee, US, has revealed that impact of violence has led Kashmir children, mostly in the countryside, to having 2.5 standard deviations shorter as compared to children who were born and brought up in less or no violent situations. “Children in Kashmir are indeed shorter compared to children in Jammu because of the insurgency. They are up to 1.5 standard deviations shorter,” it pointed out.

According to the report, exposure to violence early in life has adverse impacts on children.

Love in Turbulent Times

piles-of-pillsIn an apparently conservative society like Kashmir, it hardly raised eyebrows when in a span of just eight months, 12 female babies were found abandoned outside valley’s lone pediatric hospital.

These ‘unwanted babies’ after staying at the hospital for a while ended up in an orphanage.

The disturbing trend forced authorities to install 51 CCTV cameras in and around the hospital. The initial explanation that suited the situation was shocking revelation made in 2011 census: that a section of Kashmiri parents do not want to rare daughters. For every 1000 males, there are just 883 females, meaning a loss of nine points in last one decade. Shockingly, J&K is second to Haryana only, which has 877 females against every 1000 males, in terms of sex ratio. The situation is alarming at the infant level (0-6 age group) with sex ration in this group going down from 941 in 2001 to just 859 in 2011.

Once the finding of 2011 census became public, authorities were forced to act against illegally run ultrasound clinics spread across J&K to make pre-determination of fetal gender impossible.

It brought back memories of Dr Ghulam Nabi Bhat, nicknamed Dr Death who infamously conducted thousands of abortions, sometimes, under candle light. It is said that he was frequented by unmarried couples seeking help after exhausting all other options of aborting a fetus.

Though, police arrested Dr Death in early 2012, for the fourth time, but he is not the only one involved in this dirty business.

There are many Dr Death’s active in Kashmir who are doing brisk business by serving to a society that has probably come of age. It took no time to understand that such clinics survived, and made huge profits by serving the hidden or otherwise tabooed desires of the society. The reason: people like Dr Death survive under the shadow for so long is probably that they have become indispensable for the society. Ironically, most of the babies found outside hospitals and famous Sufi shrines are born out of the wedlock. “It is shameful but it is true,” admits Dr MS, who heads a Public Health Centre in Srinagar outskirts. “The number of these (teenage) cases is increasing with each passing year.”

Most of the doctors agree that around 95 per cent of the cases never reach them as they are managed locally. “They dispose off most of the cases using traditional methods,” says another doctor who wished not to be named.

“Such patients reach hospitals only when they are in labour pain,” says a gynecologist working in Lal Ded maternity hospital, Kashmir’s women exclusive obstetrics facility.

“At the time of admissions, they are writhing in pain so no questions can be asked. Once they deliver, they are nowhere and sometimes, they leave their babies in the hospital.”

If market figures are to be believed then one can clearly understand how Kashmiris are conducting the oldest and basic functions of life.  In last few years, Kashmiri markets are flooded with ‘pleasure drugs’.

These drugs which are not recommended by the doctors disappear from medical shop shelves like hotcakes. “The real volume of business is very difficult,” says Raheel Ahmad who does business with one of the main pleasure drug companies. “My estimation is that the overall turnover must be around two crore rupees a year excluding the margins that retailers have.

“Kashmiris are consuming these drugs like never before,” says Shabir Ahmad, a super-stockiest of another pharma company that specializes in pleasure drugs. Aijaz Ahmad, its regional manager put the monthly sales between Rs 4 to Rs 4.50 lakh.

There are many players in the market but the one who offers a larger cut to the retailer stays on the top as it is he who recommends and not the doctors.  For a population of nearly seven million souls half of which are minors and elderly, such intake of ‘pleasure drugs’ is huge.

On the other hand contraception is a major business that is growing quite fast in Kashmir. “We serve the most under-privileged lot of population and demand for our contraceptives is growing. We distributed 624702 condoms in 2010, 771908 in 2011 and 898910 in 2012,” said Ms Raheela, a senior Family Welfare officer. “Economically better classes are served by market directly.” Kashmir consumes around 32 lakh pieces of condoms from five different manufacturers a year by sourcing it from open market.

However, women are increasingly taking to pills and even injections. Ms Raheela said they distributed 369193 oral pills to the economically weaker sections in three years ending March 2013. It is market that takes care of the rest of the requirement. “During last year, we sold nearly 768000 Saheli tablets and around half a million Mala-D tablets,” a senior executive working with the Hindustan Latex said. “The demand is obviously growing by leaps and bounds as many others players are also into it.”

But the story has a brighter side too as J&K is emerging as one of the best states on the family control front. The last Family Health Survey carried out in 2005-06 suggested the overall use of contraceptives has reached 52.6 per cent in Kashmir.

And 26.3 per cent women had undergone sterilization, use of pill had improved to 4.7 per cent, 2.7 per cent, had planted IUDs, 0.8 per cent were using certain injectables as the use of condoms is at 8 per cent. Prevalence of condoms is 6.5 per cent in rural and 11.8 per cent in urban Kashmir.

It seems that in last two and half decades of conflict, the apparently conservative Kashmiri society has learned the art of staying happy!

1 COMMENT

  1. I think you are not fully informed dear reporter. Don’t think I am on the side of use of these contraceptive pills but didn’t your experts tell you these contraceptive drugs are given as treatment to the unmarried women who have a lot of gynecological problems like the PCOS and other related diseases.
    Besides that the market of pleasure drugs is also on rise but why didn’t you mention that most of those drugs are taken by those males, who were tortured in their private parts during these years of conflict. In that case you can also refer to http://www.tehelka.com/in-the-valley-after-the-trauma-the-cost-loss-of-sex-drive-2/
    I think it was very important to give both sides of the story.

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