Why Depression Is Key To The Infertility In Kashmir Women?

by Jeelani Saima Habeeb

It is right time for the people of Kashmir to recognize the essence of early marriage rather timely marriage if we cannot prevent ourselves from conflict-related traumatic and stress disorders that is not with us, but at least, we must exercise utmost inclusiveness towards timely marriage proposals and must not deny many.

Students at Women College MA Road Srinagar.

The 1989 uprising launched by Kashmiris has morphed into a long-standing resistance movement that has left deep scars on Kashmiri society.  As a result, the area known as the Kashmir Valley, tucked in between towering mountain ranges in the northern Indian state of Jammu and Kashmir, is witnessing an alarming increase in childlessness and infertility among local women.

Infertility is a growing problem in Kashmir during the last two decades. It is a tragedy as at present the infertility rate is reported 15.7 per cent in Kashmir which is alarming and understanding of infertility is too narrow. Thus infertility is becoming increasingly common among young Kashmiri women, who are suffering from stress and trauma due to the long-standing conflict in the region. “The mental stress due to ongoing conflict has taken a toll on the physical health of young women, especially their maternal health,” explains Dr Mushtaq Margoob, one of the senior Kashmir psychiatrists.

Physical and mental health experts cite conflict-related stress as the main cause of the health crisis among women, which has robbed thousands of their fertility.

Institute of Mental Health and Neuro Sciences Kashmir (IMHANS)

If recent research, if the statistics are to be believed, infertility among Kashmiri women is rising owing to lifestyle changes and rising stress levels among the female population. According to psychiatric research, 800,000 people in Kashmir including women are affected by post-traumatic stress disorder (PTSD). So, does it have any role in potentiating the problem of infertility among women? PTSD, like many other mental health disorders, directly affects women’s childbearing capacity.

It is like any other day at the valley’s leading gynaecologist’s clinics crowded and packed with impulsive patients, who have come from different parts of Kashmir to the summer capital, Srinagar complaining of delayed periods, misconceptions and miscarriages.

Various studies have been conducted in Kashmir which puts the percentage of women suffering from PCOS anywhere between 5-10 per cent and still increasing which really is a disturbing trend.

The most recent Indian National Family Survey (NFHS) indicates that at least 60 per cent of Kashmiri married women report one PCOS or more reproductive health problems which is significantly higher in comparison to the national average of 40 per cent. The question is – why it occurs so in Kashmiri women population? The percentage of POF (premature ovarian failure) among infertile women below 40 years of age is also abnormally high – 20 to 50 per cent when compared to the nationwide rate of one to five per cent.

Leading Kashmir gynaecologists have their say that infertility is affecting the younger age group at an alarming rate which is worrisome.

We see that younger girls complain of delayed periods because of PCOS and other associated disorders. This rising prevalence of PCOS and infertility related disorders among younger and newly-wed couples can be attributed to changing lifestyle, food habits, increasing stress levels due to one reason or other, and the biggest contributor, in this case, is the armed conflict in Kashmir that have directly or indirectly increased the stress among the local population especially among younger girls and women and families that are worst hit, leading to pre-marriage stress-induced reproductive disorders and miscarriages among married women.

Doctor’s too cite 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.

“Stress causes structural changes in the brain and disturbs the secretion of various neurotransmitters. These changes lead to various physical ailments including thyroid malfunction, which in turn can cause infertility among women of childbearing age,” Dr Margoob said.

In Kashmir, psychiatry OPDs are run at two hospitals – the Shri Maharaja Hari Singh (SMHS) facility in Srinagar, and the Government Psychiatric Diseases hospital – six days a week. Of almost 100 patients seen at each OPD every day, 75 are females.

Nazir Ahmad Pala, an endocrinologist at SKIMS, says that more and more young females visit the endocrinology department for various disorders. A good number of disorders, he says, are born from depression. In the past, the department received mostly older patients but now around 20 per cent of our patients are school and college going girls with endocrine abnormalities. This trend is disturbing.

The young girls mostly complain of obesity and ovulatory disturbances that bring a temporary halt in their menstrual cycles.  The condition is called Central Hypogonadism and is common in depressed women, explains the doctor.

Another equally frequent ailment is galactorrhea, a spontaneous secretion of milk from the mammary glands due to an abnormal increase of prolactin levels in the body caused by antidepressant intake.

“Unfortunately most of the [conditions], in one way or the other, lead to infertility. And the root cause of all these [conditions] is the stressful life that women have been living in the post-conflict era.

Another conflict-related cause of infertility among Kashmiri women is late marriages. Over the war years, the marital age has risen from an average of 18-21 to 27-35 years. Because of economic insecurity and anxiety over the prospect of losing male breadwinners, women are choosing education and employment over marriage. “Economic instability and insecurity is eating our society like termites”. The cut-throat competition in schools and colleges to earn a secure future has hugely disturbed the mental health of young girls as well.

Dissociative Disorders (DD), marked by disruptions or breakdowns in identity, memory or perception, are rapidly increasing in young school- and college-going girls, along with conditions like Panic Disorder, all of which interrupt the “smooth journey to motherhood”, Margoob says.

Childless women are stigmatised and are looked down upon. Married women face the wrath of in-laws and husbands while unwedded girls fear marriage. 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 fast deteriorating. Hypertension and orthopaedic problems have become common.

We see Kashmiri boys and girls prefer higher education, permanent government jobs and many others that lead to late marriages contributing to rising stress levels and hormonal changes that ultimately reduce their birth-giving and conceiving ability among females and reproductive potential among males.

This disturbing trend is conceptually and logically worrisome and if the current trend continues, time is not far away when we will see more number of childless married couples than the opposite.

Saima Habeeb

So it is right time for the people of Kashmir to recognize the essence of early marriage rather timely marriage if we cannot prevent ourselves from conflict-related traumatic and stress disorders that is not with us, but at least, we must exercise utmost inclusiveness towards timely marriage proposals and must not deny many.

Parents also have a responsibility to timely wed their siblings and shoulder their responsibility. If we are to live our post-marriage lives with happiness, we are duty-bound to act right now.

“Women who have been either directly or indirectly affected by conflict today suffer from various mental health ailments. It seems to me that we are heading towards a major mental health disaster and we are unable to do anything to reverse its impact.”

(The author is PhD nursing scholar (Obstetrics and Gynecology) Jamia Hamdard New Dehli. She is currently working as a tutor at the nursing department of the BGSBU Rajouri. The opinions expressed in this article are those of the author’s and do not purport to reflect the opinions or views of Kashmir Life.)

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