Photos used in this piece are representational in nature.
The long-standing stereotypes, societal pressure and expectations have made women vulnerable to mental health issues in Kashmir. As fertility dips, emotional abuse continues to ascend.
By Muntaha Mehraj Hafiz
THROUGH the narrow-serpentine lanes of North Kashmir’s Kralpora area, a group of young men appear shouldering a coffin of a 32-year-old woman. The funeral is followed by women mourners gathered to protest against the death of Nahida: “Hamei insaaf chaiye” (We want justice).
On June 5, 2022, Nahida was found dead at her in-laws house. Inside her room, she was found frozen—her hands turned towards the back; face hanging in despair, mouth agape, her hair flowing loose.
The rope had left a callous impression on her long pale neck – deep and dark, like the harrowing details of her married life.
A decade ago, Nahida was married to Arshad Khan. Despite the difference in their social status, both liked each other and decided to tie nuptial knot. Arshad’s family—educated and elite—accepted the bride who was beautiful, kind and the first female to complete M.A, B.Ed., from her entire village.
But soon after her marriage, her in-laws started to trouble her. She would deflect the sneers and keep herself busy in her household chores. But as time passed by, a demand for a child increased.
“My daughter was tortured since the first month of her marriage,” says Rafiqa, in a regretful tone wiping the stream of tears with her Dupatta. “She endured all of that silently, without sharing her woes with anyone.”
Six years passed and as Nahida became more vulnerable to atrocities she decided to join a local private school to keep herself away from the troubles of her marital life.
“She would share all her earnings with her husband,” says Rifat, Nahida’s elder sister. “She would cook, clean and do all her duties expecting this would make her husband and in-laws happy. But nothing worked.”
The village often heard hues and cries in the middle of the night from their home as her husband beat her nastily. However, as the situation worsened, Nahida reported to Women’s Commission in Srinagar in a hope of proper reconciliation with her husband. However, after several deliberations the abuse returned.
Established in 1999 to investigate and deal with issues relating to crime against women in Jammu and Kashmir, the Women Commission was disbanded after the abrogation of Article 370—leaving women like Nahida abandoned and agonised.
“She always told us that her husband was short-tempered and abusive, but we counselled her that he will improve someday until one day he beat her like an animal fracturing her right arm and left her in bruises,” Rifat continues detailing her sibling’s distressed married life.
“He would beat her so much that she had to undergo leech therapy on her face to relieve off the blood clot.”
According to psychologists, the urge to harm another person is called Harm OCD – a common subtype of Obsessive Compulsive Disorder that causes intrusive thoughts, images or urges to harm oneself or others.
Any personality disorder, the mental healthcare specialists suggest, is a symptom of a disease left untreated since years and in many cases delineated to the time when the abuser was in the womb of his/her mother.
“In most of the domestic violence cases that come to us, we find either there has been a devastating history of violence in male’s family or in the family of the female,” says Dr. Waseem Kakroo, a noted clinical psychologist of Kashmir. “It’s a repetitive cycle of abuse: from parents it often translates into the children.”
People often say, Dr. Kakroo continues, “Get your son married, he will be fine. Is he a machine that you will have to switch him on and off? You’re dealing with a human being. If you find your children having temperamental issues and an inability to handle disagreements, get them counselled and treated before marrying them off. Save them from a torment of life time.”
Nahida’s family insisted her to return and take divorce from Arshad. But fearing that her “broken betrothal” will affect the health of her parents, as one of her sisters was recently divorced, she decided to stay.
“I don’t want to return,” she would often say. “What would Abba do? Be chas nakhe wesmich (I’ve been married off).”
The fear of society was so much that she suffered all alone, says Nahida’s close friend: “She needed help and a proper counselling to come out of self-guilt and mental trauma triggered by infertility and subsequent torment by her in-laws.”
Childless women often suffer silently. As per reports by National Family Health Survey (NFHC), more than 79.4 per cent of women admitted that they did not raise their voices against the cruelty of their husband in fear of their peers and social groups.
In fact, for a year or so, Nahida lived alone with her in-laws and took all her responsibility and cooked in a separate room. Her husband seldom returned home and she had no idea about his whereabouts. He would only visit her when she would receive her salary.
In the cycle of the entire trauma, Nahida was devastated when she found that Arshad lived nearby in rented quarters. Six months ago, he had married another woman from a Sikh community – a divorcee with a son.
The pain was overwhelming and the betrayal unforgivable.
Before Nahida was found dead, she had had a disagreement with her husband who had returned the night earlier. Gasping for breath, her mother recalls, “She was here with us for last four months but then she returned to her in-laws house saying ‘That’s my home forever’.”
Nahida was strong, the heartbroken mother says. “She didn’t commit suicide. She had bruises on her cheeks. All of them should be hanged like my daughter was hanged.”
She weeps inconsolably and looks at the sky as if looking at God, singing an elegy, ‘Be kemis wane panin museebat’. (Who should I tell about my misfortunes?)
Behind Nahida’s torment was her inability to conceive a child. Her infertile state not only made her target of taunts but also made her life troubling. But she wasn’t the only one living the fraught fate.
Infertility or low-fertility is a global issue known to disturb and disbalance the social and marital life of a couple.
In many developing countries this has been matter of concern as how infertile women are more exposed to an increased risk of domestic violence compared to fertile women, eventually having serious implications on their mental, physical and emotional wellbeing, as stated in a report published by World Health Organization.
“Women with 2 to 3 year history of infertility,” the report notes, “have significantly higher depression scores compared to women with infertility duration of less than 1 year.”
According to the latest survey by NFHS, the fertility rates have declined from 2.2 to 2.0 in India, while around 79 per cent of women revealed they were victims of domestic violence.
Another finding of the report is how Jammu and Kashmir’s fertility rate has declined from 2.0 to 1.4, which is alarming.
In fear of Isolation
Shahida calmly runs her calloused fingers through a diary to find the best match for her husband. The diary notes the list of widows and overaged women in Baramulla, the north-western district of Kashmir.
Her gaze is grim and her emotion intact, as she silently murmurs to the matchmaker: “Agar shur te aases keh chune parwayi” (It wouldn’t matter if she has a child), “magar mye seeth gasi asel peth rozin (but she should live courteously with me)”, gulping in her fear of separation from her husband.
Shahida, 36, completed her MSc in 2011 from Kashmir University and was soon recruited as a teacher at a government school in her district. In 2013, she was married to a family that had a good name and reputation in her hometown. Now after a decade of her marriage she has lost herself in a quagmire of physical and emotional trauma inflicted upon her by mother-in-law and sister-in-law.
“The first two years of my marriage were beautiful and everyone pampered me. I considered myself to be the luckiest woman on the earth. What else does a girl need except for love and respect?” says Shahida in a matter-of-fact tone.
By the third year of her marriage, the scenario changed. Her in-laws started to ask her unusual questions about her fertility. “All of a sudden,” Shahida continues, “my in-laws became suspicious of me being infertile, and they started tormenting me.”
At that point in time all her reports were promising—at least to some extent—but as stress intensified, there was a sudden fluctuation in her hormones which led to a delay in her menstrual cycles. The symptoms were not evident enough to aware her that something was wrong with her body until Shahida suffered Premature Ovarian Failure at the age of 35.
Premature Ovarian Failure (POF) – also known as primary ovarian insufficiency – is a loss of normal function of the ovaries before the age of 40. Studies have demonstrated that psychological stress, such as chronic anxiety, sadness, and fear can lead to POF by changing the functioning of the hypothalamic-pituitary-target-gland axis causing the emergence of the hypothalamic-pituitary-ovarian axis disorder.
“This news came across as a shock to me when doctor told me that my Anti-Mullerian Hormone levels had dropped considerably, and I can no longer conceive,” says Shahida.
The diagnosis shattered her to the point that she was put on anti-depressants for almost three months. This has been a matter of concern among gynaecologists who’ve depicted premature menopause to have reached an alarming proportion in Kashmir.
Dr. Rumana Masudi – Obstetrician and Gynaecologist – says: “The cause of POF goes undetermined in majority of cases; however lifestyle choices, thyroid, auto-immune diseases, poor nutrition, genital tuberculosis and high levels of stress are some of the reasons.”
She’s downcast as she says that patients come to clinics when it’s too late. “Pre-pregnancy counselling and evaluation is thus a must for the couple for early detection and prevention of infertility,” she says.
Despite knowing that she cannot conceive, Shahida consulted doctors in a hope of having a child until last month. But as all the treatments exhausted she decided to find a match for her husband.
However, through all this, Shahida would never forget how her in-laws treated her in her tough time and made her feel that violence was a part of her life and she deserves to be humiliated, and maltreated. She never questioned anyone and ended up being a victim of spiral of silence.
In her account of violence, her sister-in-law abused and exploited her for not having a child. The startling revelation is how this torture came from a woman who was educated like her and of her age.
“My sister-in-law assigned me work from dawn to dusk,” says Shahida. “I did all the household chores, fed her five children, cleaned and cooked. I was a servant to the family of 12 members.”
As she speaks it’s evident how the society has normalized abuse by terming it “Sabr”.
Sabr in Islam is often translated as patience and includes aspects of restraint, self-discipline, firmness, perseverance and determination- conveying a positive connotation. However in Kashmiri society, many reckon, this virtue has been misinterpreted and misused particularly for supressing womenfolk.
“It’s unfortunate how women are asked to overlook the mental and physical violence perpetrated upon them,” says Yaqeen al Haq Sikander, a Kashmiri-origin psychotherapist based in Istanbul.
“Sabr is an ibadah [act of worship] but that’s when a calamity falls – something that’s out of the control of a human being. Suffering abuse is not a part of that. Islam acknowledges individuality and people will be asked on the day of judgement about how they dealt with oppression.”
After an outrageous fight between Shahida and her sister-in-law, her husband decided to shift to the first floor of the house.
“We separated so that we could live a happy life but they still try to harass me in one way or another,” Shahida details her distress.
Now she feels distraught and left out specifically after the day when her sister-in-law hurled a heart-piercing taunt at her, ‘Cze chakh haant. Cze pazi marun’ (You’re infertile and you should die!)
“They want me to suffer and feel alone so I either run away from the house or commit suicide, but I’m not a coward,” she speaks with a resilient tone.
Despite being buoyant about her life, Shahida is upset that her husband barely took a stand for her basic human rights. She turns her gaze out of the window, squinting her eyes and says, “He could’ve confronted his family with dignity and tell them that what they were doing was wrong but all he expects from me is to do “Sabr!”
The Social Anxiety
The long-standing stereotypes, societal pressure and expectations have made women vulnerable to mental health issues in Kashmir. As fertility dips, emotional abuse continues to ascend.
Rabiya, a 29-year-old woman from Srinagar, faced a miscarriage four months ago. It was a 2-month old foetus, however she’s yet to overcome the loss and finds herself in an unrelieved psychological and emotional distress.
“For them it was a lump of meat, but for me it was my child,” says Rabiya in an agonizing tone, filled with pain and anger. “I can never forget the loss!”
Nobody pacified me, instead everyone expected me to be fine in a couple of days as if nothing had happened, she continues, referring to her extended relatives who she calls “toxic and insensitive.”
Rabiya had conceived after three years of her marriage. After being constantly demeaned, intimidated and questioned she was finally relieved that she had conceived, and wouldn’t have to face queries about not having a child.
“I felt an adrenaline rush when I was positive for pregnancy,” says Rabiya. “The moment was a blessing for me.”
In Rabiya’s case, her husband and in-laws supported her well throughout. But all the trouble started when she was questioned and interrogated by her husband’s aunts, cousins and other relatives. She reveals how those “questioning eyes” harmed her self-esteem and developed social anxiety in her.
“I’ve stopped attending marriages because they ask me unusual questions like: “Nothing has happened yet?” “Why’re you so lean?” “You don’t eat anything that’s why you’re not able to carry a child.” “Poor girl!”
Over the years, Rabiya has developed paranoia as she reveals how she feels scared to attend any social gathering. “I sense as if everybody is looking at me and thinking about me being infertile.”
She has become more apprehensive after the event when one of her relatives hid her child from her thinking that she will cast an evil eye on him. “Nobody is a fool,” says Rabiya with her eyes glistening with tears. “We all are humans. We have emotions. Her behaviour impacted me badly.”
In a society that runs on a conservative thought-process people trigger the stress for a young woman who’s yet to start a new journey of her life and hurl unsolicited advices like a professional doctor.
Gynaecologist Rumana Masudi says how her patients especially the educated ones trouble her by asking: Why’re you prescribing this medicine? Is this important? Most of them consult someone’s suggestion through a social group or research through internet,” she says. “In cases of miscarriage or other gynaecological problems a consultation with a trained gynaecologist or infertility specialist is recommended. Not Googling it!”
Rabia is perturbed by the question that society asks her: What will you do in old age? To which she says: “Aren’t there couples who’ve children but are living in old age homes?”
Treatments: Medical and Spiritual
In a rush to conceive after her marriage, Lyka, a 31-year-old MBA degree-holder, consulted every doctor despite being fertile. As her test reports suggest, she took all the types of medication that she was prescribed by the doctors.
In one and a half year of her marriage, she has visited more than 7 gynaecologists, done more than 30 hormonal profile tests, and recently done HSG – tube test.
“In a society like this,” says Lyka, “you’re expected to conceive in 7 days of your marriage. So you’re pushed to the wall to make it happen.”
But this approach is entirely disapproved by gynaecologists.
“There’re women who consult us just after a month of their marriage,” says Dr. Rumana Masoodi. “The fear is instilled in their minds because either they’ve someone in their immediate family who has been divorced, or has become a victim of domestic violence for not bearing a child.”
In a patriarchal society, the gynaecologist says, when a woman is unable to conceive, all the blame is put on her even if the reports show that it’s the male factor that’s responsible for infertility.
The other concern revealed by Dr. Rumana is—how in haste women end up going to untrained doctors and specialists who put them on treatments that should have been otherwise suggested to them after two years of marriage thereby exposing them to long term side-effects.
“After all my tests were satisfactory,” continues Lyka, “my doctor advised my husband to do a hormone analysis but he’s adamant to do one. My husband is not ready to understand that problem could be with anyone of us. And the only decent way is to work on it and get it resolved.”
But her husband refused to go for male hormone profile by telling her: how dare she question his masculinity? And after a nasty verbal spat sent Lyka to her paternal home for two months.
“The difference of opinion deteriorated our relationship,” Lyka says. “Sometimes the brawl gets so intense that our relatives have to reconcile us after months of separation.”
In such cases, psychologists suggest couples especially women to get trained in handling such situations.
“We counsel women and work on their emotional intelligence so that they can counsel their husbands at home, without them having to visit a psychologist,” says Waseem Kakroo. “But it’s unfortunate how in our society relatives are asked to settle the matters between a husband and wife when it’s a job of a professional who can counsel them.”
Lyka regrets as she reveals how different medication has harmed her health to the point where she’s planning for an In-Vitro Fertilization or IVF treatment. But going for an IVF or any other infertility treatment is also a taboo in Kashmir.
“My mother-in-law grumbled that what people would tell me,” says Lyka. “But tell me who will conceive in a stressful environment like that where I am always compared to my husband’s cousins who have children?”
After disapproving IVF, Lyka’s mother-in-law suggested her to seek help from faith-healers. The distressed woman then obtained an address of a faith-healer from her colleague. The spiritual guide vows to help infertile couples and after the successful delivery of the baby asks for a lump-sum amount of Rs.1 Lakh.
Many couples in Kashmir opt to go to faith-healers in order to heal themselves through prayers and counselling in the light of Qur’an and Sunnah. The choice for this alternative is primarily faith and expenditure. While faith keeps the couple firm enough to struggle further, the couple is comfortable to spend less money when compared to expenditure on medical doctors. In some cases, patients strike a balance between a medical doctor and a spiritual healer.
There are cases where the unresponsive behaviours of doctors have been a matter of concern for patients. Many women either complaint about the use of berating statements against them or doctors not giving them enough time to explain their symptoms.
“It was horrible when I had to remind my doctor of a medication that I was supposed to continue for another month,” says Urtiba, a 28-year-old woman from Srinagar. “My doctor gives an average of 30 seconds to each patient. Sometimes I’ve to implore her: Please listen to me!”
Urtiba has a horrible history of treatment. Since last 3 years she had been continuously getting Ovulation Induction treatment that has left her ovaries hyper-stimulated. It has had harmful effects on her health. A recent hormone profile shows decline in her egg reserve, and ultrasound has detected that she’s suffering from PCOS (Polycystic Ovarian Syndrome).
PCOS is a long-term, highly prevalent, complex endocrine disorder characterized by a multitude of metabolic and reproductive disorders.
As per NFHS, 60 per cent of married Kashmiri women report PCOS or more reproductive health problems which is higher than the national average of 40 per cent affecting the birth of a child.
“After prolonged treatments I’ve gained weight, and become hypersensitive,” says Urtiba. “I’ve become intolerant to things. Sometimes when someone asks me: Is there a good news? I lose my cool and tell them to mind their own business. As I say this, my eyes fill with tears. My heart throbs out of anxiety, and I stay upset for the days to come.”
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