Tsering Dolkar
The exasperation on the face of Dr. Fatima Nissar, Gynaecologist at District Hospital, Kargil is evident as she says, “”Women here drink vast quantities of salty tea that has high amount of tannins. This reduces absorption of iron that in turn affects foetal growth.” She believes that women in the district lack awareness and yet are reluctant to adopt established norms of reproductive health. “Even if we tell them to take iron with water, they take it with milk.” the doctor rues. Not only that. Many pregnant women do not pay attention to their nutrition. They grab a quick bite in any of the small eating joints serving junk food such as local chowmein, or packaged stuff such as Maggi noodles and potato chips.
Most women from remote areas deliver babies at home and do not come for their ante-natal checkups. According to Dr. Nissar, the high number of maternal deaths can be attributed to this negligence. This is indeed unfortunate. According to Dr Anwar Hussain, Paediatrician at District Hospital Kargil correct breastfeeding and hygiene practices could reduce neonatal deaths by a whopping 80%. Sadly even globally proven community-based practices elude large sections of the community in rural Ladakh.
The resistance to adopt proven practices to follow simple steps to improved maternal and child health is deep-rooted in Ladakhi society. It stems from traditional beliefs and societal practices that in fact are detrimental to the health of mother and child. “Chintelaschonangchangchaa cha min, Las chokan la aasanchadug (Even if one does heavy work in pregnancy, nothing adverse happens to the baby, infact, we believe that this leads to easy delivery).”, says Neru Nigar, 50. Nothing could be further from the truth. Says Dr. Husain, “Activities especially outside the home could be one of the reasons for anaemia among pregnant mothers. He adds, “In the first trimester this increases chances of abortion and in the third trimester could result in premature labour.”
The combination of poor levels of awareness and traditional mindsets affects the adoption of family planning measures as well. Muslims and Buddhists, amongst the largest groups in Kargil district hold the belief that limiting births is going against the will of God. Says Iqbal Hussain, Kaksar village, (name changed) “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 we should have. We leave our children’s future to His mercy.”
There are also pragmatic reasons. Joint families are common in the region and grand-parents have a role to play in the rearing of grand-children. It makes sense for a young couple to have children in quick succession so that while their children are growing up, their own parents are relatively young. Yangchan Dolma 22, from Sapi village who lost her first baby after she contracted a cold virus, became pregnant again, very soon.Nodding wisely, Yangchan’s mother, Sonam Dolma, 54 said, ” Bar maborbaskechugsen, gyogspaskenanachamargaste stet (After losing her first born, my daughter did not wait long before she got pregnant a second time. She will give birth soon and atleast we will be able to look after the child before we grow old).
Despite all the factors that work against a healthy environment for pregnant women and their infants, there is a ray of hope.The National Rural Health Mission (NRHM, now NHM) launched in 2005 has been ploughing in resources and providing services across Kargil district. In critical indicators there have been dips but overall a positive trend is visible. Infant Mortality Rate (per thousand live births) was 51 in 2005-06 and 56 in 2006-07.
This declined to 25 in 2009-10. It further declined to 22 in 2012-13 but again rose to 32 ( per 1,000 live births) in 2014-15. Government programmes and schemes such as Janani- Shishu (JSSK) and Navjat Shishu Suraksha Karyakaram (NSSK) are in place. District Health Indicators show fluctuations in both MMR and IMR. Only four maternal deaths (per 100,000 live births) were recorded in 2009-10. This rose to seven in 2012-13 but declined to two in 2014-15.
However, challenges remain. Unless mindsets change, health services and proven practices will still remain unheeded or at any rate poorly heeded and thus poorly adopted. The push needs to come from within the community, from amongst women who want to create a safe, healthy environment for their infants and for themselves. In the process they would be contributing to building a promising future for the mothers and children of Ladakh.
(Charkha Features)
This article has been written under the Sanjoy Ghose Rural Reporting Award ( 2015-16)
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