Rafeeqa Zargar is 43 and her hope of becoming a mother has faded.
Yet, whenever she hears of any gynecologist treating couples to successfully conceive their children anywhere in Kashmir, her faded hopes get rekindled.
During the eight years of her marriage, Zargar, a resident of north Kashmir’s Kupwara district, has consulted about twenty doctors to find a way to conceive or at least establish a reason for her infertility.
“I see other women with their babies and it breaks my heart,” she said.
Zargar had taken responsibility for her family at a young age and looked after her ill parents and a younger sister, while she totally sidelined the “urgency” to get married as had been recommended by a doctor who she had visited when she started to get extremely painful periods and continuous breast discharge.
At 35, Zargar was married to her cousin who is nine years younger than her, and soon began their struggle to conceive a child. “My husband has accepted the fact that I cannot give him a child but I cannot,” said Zargar. “I always wanted to have a child.”
The late marriages, which have become extremely common in Kashmir, are believed to be a major reason for growing infertility issues in the region.
Rumana Masudi, a gynecologist at the SKIMS hospital Bemina, said late marriages are the “biggest cause” for delayed pregnancy as well as infertility amongst couples.
The concept of late marriages has become common in Kashmir as the criteria of eligibility have changed in Kashmir, said Masudi. “Parents of a girl spend a lot of time looking for a groom who is well settled … till then the girl often reaches her late thirties and has problems in conceiving start,” she said
Masudi said the best age to get married “is the early twenties, when (a woman) has a good ovulation reserve when the number of eggs in the ovaries is higher”. “At that time, there is a high chance of conceiving,” Masudi said.
With each passing year, the body of a woman ages too and with time a woman not only lacks the eggs needed to conceive but also the physical and mental energy of bearing a child, she said. “It is a nine-month-long process and it takes a lot of energy,” said Masudi.
The last major survey conducted to ascertain the prevalence of primary infertility in Kashmir was done in 1997 by doctors of Sher-e-Kashmir Institute of Medical Sciences Soura who had interviewed 10,063 married couples and found 15 percent of the couples had primary infertility.
The National Family Health Survey published in 2019 had found that 39.7 percent of women currently aged 25-29 were not married, while 7.7 percent of women currently aged 30-34 were not married and 1.7 percent of women in the age group 35-39 were not married.
Babloo, a 45-year-old transwoman from Srinagar who has been matchmaking for the last 25 years, said she has definitely observed a change in the marriage age of women.
“Nowadays, marriage is not the first priority for most women. They want to get educated and make a career before they get married, so most of the women go for late marriages,” said Babloo.
In the decades when she began matchmaking, Babloo said, most women would hardly study till class 12th and would be married off at a young age. “(Now) women usually get married between 28 to 36 and in some cases after that as well. And men get married even around 40 years of age,” she said.
During her eight years of working as a gynecologist, Masudi said she has noticed an evident change in the age of pregnant women and believes that cesarean sections or C-Sections have become more common because of the same reason.
“When a woman is young, she has a threshold for labor pain as well,” she said. “Earlier, pregnancy was treated as a physiology, now it is treated as a pathology.”
Often, when a couple is unable to conceive, the woman is blamed, said Masudi, while the man can be equally responsible but the “male factors” are ignored. “I have often seen cases where a couple was unable to conceive because of the man but despite the medical reports confirming that, the woman goes through treatment for conceiving,” said Masudi.
The male factors, said Masudi, often include erectile dysfunction, retrograde ejaculation, and other hormonal and metabolic problems like diabetes or hypertension and even some local infections. “Sometimes there are internal problems in the reproductive parts of the male and even azoospermia,” she said.
Masudi said if a couple who have married at a late age are unable to conceive within a year, they should immediately seek professional help. “The more they delay, the lesser are their chances of conceiving,” she said.
This is the first part of the series ‘Kashmir’s infertility issues’ in Kashmir.