DRASS: It’s not a new predicament - to choose to follow traditional practices or trust modern medicine, especially when it comes to safeguarding the health of the mother and child. In the remote mountainous villages of Drass in Jammu and Kashmir’s Kargil district, too, this is the constant struggle.

On the one hand are women like Zakiya Bano, 23, who recently gave birth to her fourth child, and Yangchan Dolma, 22, who lost her first baby to a cold virus but decided to become pregnant again within a short time anyway, on the other are doctors like Dr Anwar Husain, a paediatrician, and Dr Fatima Nissa, a gynaecologist, serving at the district hospital in Kargil, who, despite concerted efforts, are finding it difficult to convince them to plan their family, or not do very heavy work during their term, or take care of their diet, or come in for their ante natal checkups.

Zakiya, who hails from Goshan village, was referred to the District Hospital Kargil by her doctor at the Sub-District Hospital in Drass after she became pregnant because she was anaemic and it was likely that she would have complications during delivery. Lying on the hospital bed, she looks completely washed out, although there is a slight smile on her face as she watches over her little one. “I had a caesarean. The baby is weak and unable to take breastfeed.” Nargis Bano, her aunt (Ama-tse in Ladakhi), who has been feeding the four-day-old infant from a bottle, looks up and says, “She has three children now. You know she lost the child that was delivered at home? There isn’t much gap between them though the doctor had told her it is necessary.”

Why did she not pay heed to this sound advice? Doctors practicing in the area reveal that while women are aware that planning families is beneficial for them and their children’s health they are reluctant to go in for proper spacing between births because they “do not want to go against the will of god”. Giving an insight into the mindset of the locals, largely comprising Muslims and Buddhists, Mohammad Hussain from Kaksar village remarks, “In the olden days, there was no health care service in villages. A woman would give birth to nine children or even more and they would all be healthy. God decides how many children one should have. We leave our children’s future to His mercy.”

Apart from blind faith there’s another reason for a general unwillingness to listen to reason. Couples feel that it’s simpler for them to have children in quick succession so that their parents are active enough to help out in care giving. Much to the relief of her mother Sonam Dolma, 54, Yangchan, who lives in Sapi village, decided to not wait long before trying for another child even though she lost her first baby to a cold virus. Nodding her approval the older woman says, “It’s good that my daughter did not wait long before she got pregnant again. She will be giving birth soon and at least we will be able to look after the child before we grow too old.”

In any case, traditional beliefs and societal practices, which may otherwise be detrimental to the health of the mother and child, are quite deep rooted and communities are hesitant to keep an open mind towards changes. “Even if one does heavy work during pregnancy, nothing adverse will happen to the baby,” says Neru Nigar, 50, confidently, adding, “In fact, we believe that this will only aid in an easy delivery.”

Indeed, this is an argument that his patients often put before Dr Husain when he counsels them to take it easy particularly early in their term as well as the last few months leading up to their delivery. “Working outside the home for hours on end affects the health of an expectant mother because invariably she overlooks her food intake which can make her anaemic. In the first trimester this increases chances of miscarriage while in the third trimester it could result in premature labour,” he explains.

Dr Fatima Nissa seconds her colleague’s concerns regarding proper nutritional intake. She points out, “Many women do not pay attention to their diet. They tend to grab a quick bite in any of the small eating joints that serve junk foods like noodles or potato chips. Moreover, they drink vast quantities of salty tea that has high amount of tannins. This reduces the absorption of iron in the body which, in turn, affects foetal growth.”

Clearly, not only is there a lack of awareness about reproductive health among the women but perhaps also a resistance to new practices. And this can become very frustrating for the medical practitioners responsible for their wellbeing. “Even if we tell them to take iron tablets with water, they will insist on having it with milk,” rues Dr Nissa, sharing that due to connectivity issues most women from remote areas still deliver babies at home and are unable to come for their ante-natal checkups.

Consequently, the maternal and child health indicators for the district are not the best around this region and there have been fluctuations in both Maternal Mortality and Infant Mortality rates. Whereas four maternal deaths (per 100,000 live births) were recorded in 2009-10 this rose to seven in 2012-13 but again declined to two in 2014-15. Infant Mortality Rate (per thousand live births), too, has been see-sawing over the last decade – it was 56 in 2006-07 declined to 22 in 2012-13 but again rose to 32 in 2014-15.

According to Drs Hussain and Nissa things will improve further, especially the IMR numbers, if correct breastfeeding and hygiene practices are adhered to. “The neonatal deaths could reduce by a whopping 80 per cent,” emphasises Dr Hussain.

Providing the silver lining to this largely difficult situation are the dedicated healthcare providers who make sure that the women are able to avail of government schemes like the Janani Shishu Suraksha Karyakram (JSSK) and Navjat Shishu Suraksha Karyakram (NSSK), which, fortunately for them, are in place. The two schemes offer a host of key services, including cashless delivery, free c-section, free transport between facilities in case of referral, expert neonatal care, that are aimed at reducing MMR and IMR.

Finally, it comes down to making concerted efforts towards creating awareness for bringing about a much-needed change in attitudes to address the needs of the mother and child.

(Womens Feature Service)