Shopian, Indian administered Kashmir – As snow fell heavily on the village of Zirkan, deep in the forests of the Shopian district of Indian-administered Kashmir, Akhtar Jan struggled as his contractions grew more intense.
It was the fourth birth for the frail 32-year-old and as her labor progressed, she knew that travel to the nearby hospital would be nearly impossible for her.
Akhtar’s family frantically attempted to clear the village road, surrounded by tall pine trees and choked by piles of snow from the worst snowstorm of the season on January 4.
As desperation grew, the family, helped by neighbors, had to transport Akhtar on a makeshift stretcher on a nightmarish 12 km (7 mile) journey.
They had difficulty walking on the road, which was practically indistinguishable under the snow.
“I thought I was going to die,” Akhtar told Al Jazeera at her home last week. “I didn’t know if I would come back alive with the child or not.”
Akhtar was unable to get to the hospital on time and gave birth to a baby boy on the road.
“It felt like a long journey to life as I faded with pain in the biting cold,” she said, adding that the experience had haunted her ever since.
As it continued to snow and temperatures fell to freezing, Akhtar and her newborn baby, wrapped in a blanket, continued their journey on the makeshift stretcher until they reached the hospital.
“We are faced with such cases here and sometimes it is cursed why a woman is born in such a difficult situation,” she said.
While Akthar and his child – named Ishfaq which means kindness – were fortunate enough to survive, the hardships of living in this remote region of the Himalayas did not end for them.
Akhtar is a Gujjar, a member of a nomadic tribe of shepherds who live a precarious life with rudimentary access to health services.
After a six-day stay in the hospital, Akhtar’s family hired a vehicle which dropped them off nearly 5 km (3 miles) from their home, leaving her to walk uphill as the snow on the road did not was not yet cleared.
“I was not able to walk but had no other choice,” she says.
In winters, public transport is not available on village roads, forcing villagers to negotiate slippery roads and snow on their own.
“These hardships for women like us living in remote areas are still there and nobody cares. It is difficult to reach the hospital, ”said Zaytoona Begum, 28, Akhtar’s neighbor.
“If an elderly person gets sick or a child is not feeling well, it becomes really stressful for everyone.”
During Kashmir’s winters, heavy snowfall can cause roads to be cut off for weeks at a time.
There is also a single tertiary maternity hospital in the main town of Srinagar, 80 km from Akhtar’s home, which serves the entire region.
On average, the 700-bed Lal Ded hospital receives at least 35 referrals each day from across Indian-administered Kashmir by rural hospitals lacking advanced health facilities.
In a workforce audit in March 2018, the region’s health department said there was one doctor per 3,866 people, compared to a national average of one doctor per 2,000 people – one of the doctor ratios. lowest patient in the country.
The World Health Organization recommends one doctor per 1,000 people.
In rural hospitals, the shortage of doctors is more acute, forcing pregnant women to travel long distances, even for minor maternity issues.
Unlike Akhtar, Yasmeena Jan, from Sangarwani Village in Pulwama District, made it to the hospital in time for the birth of her child, but her journey was just as arduous.
Yasmeena was scheduled to deliver on January 14. A week earlier, it started to snow heavily in the Himalayan region, blocking roads.
As Yasmeena’s family worried about getting her to hospital on time, a snow removal vehicle arrived in the village. Since it was about transportation, Yasmeena and her husband Riyaz Ahmad Gorai asked the operator to drive them.
“The snow plow agreed to transport the two to a location where they could access public transportation,” said Zubaida Khatoon, 25, Yasmeena’s sister-in-law.
Once the couple arrived in town, they took a taxi to Srinagar where they rented a hotel room for a week so they could be near the hospital.
“The trip was like a holy pilgrimage. It was nothing less than the Hajj, ”Khatoon said.
A research article on maternal mortality in Kashmir, published in December 2018 in the International Journal of Scientific and Engineering Research, indicates that the deaths of women in childbirth “have become more alarming in Kashmir.”
Sobia Jan, one of the researchers who conducted the study, told Al Jazeera that 27 deaths occurred in transit between 2009 and 2018 in the region, while 52 women died in home births during the same period.
“Women in tribal and remote areas are suffering a lot,” she said, adding that the death rate in Indian-administered Kashmir would only improve if “the availability, accessibility and awareness of the Kashmiri people is ‘improve’.
“Health infrastructure is only built and remains closed in these remote areas. One of the main causes is complications during childbirth and pregnancy. In addition, access to maternal health in such places is difficult, ”said Jan.
Sameer Mattoo, director of health services in the region, told Al Jazeera that the government has made arrangements to facilitate access to maternity care for women in remote areas.
“We have created all the facilities for women in rural areas. Heavy snowfall therefore occurs in such situations, the district administration has a hash service for such cases or they [women] are transported to health facilities, ”he said.
However, the state of maternity health care throughout Indian administered Kashmir can be assessed from the burden facing Lal Ded Hospital in Srinagar, which sometimes receives patients from Rajouri district, 400 km away ( 248 miles).
Doctors at the hospital say they feel overwhelmed because peripheral health centers are not even able to handle normal deliveries at times.
“In cases where a lot of time is spent in transition, the risk of maternal mortality increases,” a doctor told Al Jazeera on condition of anonymity.
“You won’t find blood banks in rural hospitals, which is vital in most births. Better maternal health remains a dream for women in remote areas, ”she said.