Drass (Jammu and Kashmir), July 22 (ANI): Nargis Bano, sits at the foot of a hospital bed where her niece who has delivered a baby lies wan and feeling quite washed out.
Looking up while feeding the four-day old infant from a bottle Nargis says, " Zakiya has three children now. You know she lost one child who she delivered at home? There isin't much of a gap between them. This was the fourth pregnancy for 23-year-old Zakiya Bano, Goshan village, Drass. She was anaemic and this pregnancy was proving to be a risky one. The doctor at PHC in Drass, did not want to take any chance and referred to District Hospital Kargil.
Women in the child-bearing age in this harsh climate and rough terrain of Ladakh are careless about themselves during their pregnancy. The understanding of how important care, nutrition and rest is during this period, eludes them and their family members. Many 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. Says Dr. Fatima Nissa, a gynaecologist at District Hospital, Kargil,"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."
It is not only a lack of understanding or knowledge of good practices during and post pregnancy. There also is a resistance to new practices and established norms of reproductive health. "Even if we tell them to take iron with water, they take it with milk." rues Dr. Fatima Nissa. She states that most women from remote areas deliver babies at home and do not come for their ante-natal checkups. She attributes the high number of maternal deaths to this negligence.
Traditional beliefs and societal practices that are detrimental to the health of mother and child -are deep rooted.
"Chinte las chonang chang chaa cha min, Las chokan la aasan chadug" (Even if one does heavy work in pregnancy, nothing adverse happens to the baby, in fact, we believe that this leads to easy delivery)," says Neru Nigar, 50.
This however flies in the face of modern healthcare practices. According to Dr. Anwar Husain, Paediatrician at District Hospital Kargil."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."
According to the Charkha Development Communication Network, another major stumbling block in reproductive health in the region is the mindset regarding spacing and limiting births. A common belief held by Muslims and Buddhists alike is that this is against God. Says Mohammad 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 mabor ba skechug sen, gyogspa skena nacha margaste 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 at least we will be able to look after the child before we grow old).
Despite these challenges, things are moving forward in the region. Health services under various government programmes such as Janani- Shishu (JSSK) and Navjat ShishuSuraksha Karyakaram (NSSK) are in place. 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. 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. Although there have been dips, a positive trend is visible in both these critical indicators. The situation has improved since National Rural Health Mission (NRHM, now NHM) was launched in 2005.
Although the availability of services is heartening, it is only half the story. Women in Ladakh especially in rural areas need to take up the gauntlet - to reach out, be open to proven practices in reproductive and child health; to avail of services in a concerted way, and thus, ensure better health outcomes for themselves and their infants. This would of course call for a more informed support and care from family members and the community at large. In a sense, it could transform the way, society in rural Ladakh cares for its mothers and children. (Charkha Features)
This article has been written by Mr. Tsering Dolkar under the Sanjoy Ghose Rural Reporting Award (2015-16). The views expressed in the article are that of Mr. Tsering Dolkar.
