Born in the forest: the women giving birth alone in the Kashmiri mountains | Maternal health

Dawn had just crossed the trail through the Pir Panjal mountains when Fatima Deader felt the first pains of childbirth. She and her family had almost reached the halfway point of their 215 km trek from Rajouri in Jammu to the highest pastures of Kashmir. Mist clung to the forest and the ground was slippery beneath the feet of the caravan of about 70 ranchers who had stopped to camp together the night before.

A week after her due date, she was traveling on horseback and thought the discomfort she felt was fatigue – until the pain tore through her body.

“There was no clinic, no nurse, no doctor,” says Deader, 23. Only her mother and a midwife, Saira Begum, were with her in a damp canvas tent, murmuring prayers. Hours after her son was born, still weak and bleeding, Fatima had to ride again, her baby carefully tied to the horse with her, as the group’s journey continued through dense forest, home to tigers and bears.

The 3,500 meter high Pir Panjal Pass, also called Peer Ki Gali, connects the Jammu region to the Kashmir Valley via the centuries-old Mughal Road, and every year, when the snow melts, nearly a million nomadic Gujjar and Bakarwal herders set out with their goats, sheep and horses on journeys that can last months.

For those who become pregnant during migration, they still have to carry heavy loads and rest in tents pitched on damp ground. Babies are born under trees, on the banks of rivers or in forest shelters.

Some women give birth after days without adequate meals. Those who arrive at district hospitals often arrive exhausted, anemic or suffering from an infection.

Fozia Choudhary was 16 when she gave birth in 2016. “I was still a child myself,” she says. Married to her cousin at 14 – early marriage is common in tribal families – she often had nothing to eat but a cup of milk and a single roast flatbread every day. By the time labor began, she was dangerously weak.

Choudhary was one of the lucky ones who made it to the hospital, but doctors were shocked by her condition. “They shouted at my husband, asking him how I had survived so long,” she said.

The teenager needed a blood transfusion – “four bottles” – before she could give birth safely. Recovery was slow and painful.

For these women, survival often depends on traditional midwives. At 63, Begum helped deliver dozens of babies along mountain roads. “Sometimes there is so much blood loss that we cannot save the mother,” she says.

“I remember [a woman called] Gulnaz. We were in Doodhpathri, at the top of the hills, in 2021. The nearest hospital was six miles away and we were out of food and water. She was eight months pregnant, already ill with a liver problem. She died there, before we could get her any help.

“We only have the knowledge that has been passed down to us – no medicines, no doctors,” she adds. “If I get sick or get too old, who will help these women?

A 2022 government study estimated Jammu and Kashmir’s maternal mortality rate (MMR) – the number of women dying from pregnancy-related causes per 100,000 live births – at 46, better than India’s national figure and well below the global average of 224 deaths. But these figures obscure the experiences of nomadic women, whose lives remain largely ignored in official health data.

Dr Mushtaq Wani, a public health researcher in Srinagar who works with nomadic communities, says: “The state’s MMR figures come from hospital deliveries. Women on migratory routes rarely reach clinics on time, so preventable deaths go unrecorded.”

Dr Yasin Rather, a local Kashmiri politician and doctor, says that for decades, successive administrations in the territory have promised mobile healthcare to the women of Gujjar and Bakarwal, but their support has never materialized.

A senior health official of the Jammu and Kashmir government, who wished to remain anonymous, admitted that staff, funding and terrain made medical support difficult.

Doctors from district hospitals confirm the consequences. “Many women arrive after walking or riding 10 to 15 km during labor,” says a doctor from Baramulla, who also requested anonymity. “By the time they reach us, it is often too late to prevent complications, or even to save the mother. Severe anemia, infections and obstructed labor are common.”

The health care gap is compounded by poverty, early marriage and malnutrition. Many women, especially girls married young, enter pregnancy undernourished and physically underdeveloped, increasing the risk of maternal and neonatal complications.

International organizations say this is not unique to the region. The United Nations Population Fund (UNFPA) notes similar trends among pastoral women in other countries where migration routes leave those at risk of giving birth beyond the reach of conventional health care. Pilot projects in Mongolia, Ethiopia and Somalia have attempted to address the lack of resources for nomadic women.

In Mongolia, an outreach initiative using mobile clinics – part of a broader health program supported by the World Health Organization (WHO) targeting isolated communities – is providing preventive care and ultrasounds to livestock herders. areas several hours from clinics.

Ethiopia’s mobile health program in Afar and Somali regions provides antenatal, immunization and nutrition services to hard-to-reach pastoral communities through mobile health teams.

Back in the forest, Begum folds her clothes after helping another young woman give birth. “What else do you have in the jungle except the hands of an old woman?” she asks.

New mother, Fatima, cradles her newborn in the firelight, echoing her sentiment. “We survive by luck,” she said. “But every year another woman doesn’t.”