SRINAGAR, Kashmir – Ishrat Hussain says she locked herself in her room when she learned she could not conceive.
Two years after her wedding and still not pregnant, the 26-year-old visited a gynecologist, who diagnosed her with polycystic ovary syndrome, an endocrine disorder that can cause women to stop ovulating, gain unusual weight, develop irregular periods or skin problems and grow abnormal facial and body hair.
Hussain struggles to describe how people ridiculed her in her community in Kashmir, where infertility is taboo.
“An infertile woman is generally viewed as incomplete with a notion of having a curse bestowed for some misdeed,” she says tearfully.
Dr. Ashraf Ganaie, an endocrinologist at Sher-i-Kashmir Institute of Medical Sciences, says plenty of other women share Hussain’s problem amid the decades-old conflict and related uncertainties of life in the Kashmir Valley, a disputed territory between India and Pakistan.
He says an unpublished study that he supervised attributed 90 percent of infertility cases in the valley to polycystic ovary syndrome and related diseases, 5 percent to premature ovarian failure and another 5 percent to other stressors in life.
“In the last few years, we have received more than 150 women who suffer from premature ovarian failure,” he says.
Clinical psychologist Iram Nazir says that stress can negatively affect women’s hormonal levels.
“Due to the decreased insulin sensitivity after any bad experience, there is a rise in the glucose level in the body, which in turn stimulates increased insulin production and raises noradrenaline levels, a stress-related chemical released during emotional upsets,” Nazir says.
A Stress-Related Link
Nazir links these rises with polycystic ovary syndrome. He says that the syndrome is a major precursor of infertility in which ovaries develop multiple small cysts and fail to produce hormones that regulate the menstrual cycle.
“Women suffering this disorder don’t have regular periods due to the elevated insulin levels that stimulate excess androgen production by the ovaries, and thus they may be unable to ovulate and become pregnant,” Nazir says.
The stress of a decades-old conflict and political uncertainty in the Kashmir Valley has been linked to a general disruption of women’s reproductive health here.
A 2006 study by Doctors Without Borders, “Prevalence of PTSD in Conflict-Hit Kashmir,” attributed the high rate of miscarriages among women in the area to post-traumatic stress disorder, an anxiety disorder caused by a shocking and upsetting event.
The study also found that out of 63,000 patients who visited the Government Psychiatric Diseases Hospital, Kashmir’s lone mental health hospital, 15 to 20 percent were suffering from the disorder. Women constituted 60 percent of the overall study group.
According to Hussain’s medical reports, a traumatic incident during her childhood is still engraved in her mind. Her anxiety over conceiving a child likely increased these stress levels, which may have together triggered her polycystic ovary syndrome.
In 1992, several years after conflict broke out in Kashmir, Hussain was returning home around 1 a.m. with her father and uncle after attending a marriage ceremony in the valley’s Baramulla district, about 40 miles from Srinagar. She says that a group of nongovernmental soldiers stopped their vehicle and ruthlessly beat her father and uncle. When she tried to stop them, the army also attacked her until she lost consciousness and suffered multiple injuries.
“Those scars are still fresh in my mind,” she says. “On that night, I was lying unconscious on the road [un]til morning. Some villagers came to my rescue and dropped me at my home.”
Her father and uncle disappeared. Hussain says that for many years, she and her family searched police stations, but found neither one.
Doctors later diagnosed her with major depressive disorder due to the incident and prescribed her medication for several years, which she took until she got married.
The news of her infertility sucked her back into her earlier depression, Hussain says. Feelings of guilt and unworthiness came back.
After fertility treatments failed, she faced in-laws who blamed her for not being able to conceive.
“My husband was a lone son among four sisters,” she says. “Everyone in his family was demanding his second marriage without divorcing me. I was silent and said nothing because I was held responsible for no fault of mine. My in-laws made me so ashamed that I felt like killing myself.”
She says her family always supported her, and her husband did at first.
“Initially, my husband supported me,” she says. “But then due to the stigma of infertility, he slowly withdrew his support.”
She suggested in vitro fertilization or adoption, but she says he rejected both ideas.
“He was adamant about having a natural baby,” she says.
Hussain says she became so stressed about her in-laws’ demands for a second wife that she divorced her husband and returned to her parents’ home.
She is currently on medication to regulate her mental health as she struggles to cope with her inability to conceive and also grieves for her past losses.
Originally appeared in Women’s e-News