Shopian, Indian-administered Kashmir – As snow fell thickly on Zirkan village, deep in the forests of Indian-administered Kashmir’s Shopian district, Akhtar Jan struggled as her contractions became more intense.
It was the frail 32-year-old woman’s fourth birth and as her labour progressed, she knew the journey to the nearby hospital would be nearly impossible for her.
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Akhtar’s family tried frantically to clear the snow off the village road, surrounded by tall pine trees and muffled by piles of snow from the season’s worst snowstorm on January 4.
As desperation grew, the family, helped by neighbours, had to carry Akhtar on a makeshift stretcher on a nightmarish 12-km (7-mile) journey.
They struggled to walk on the road, which was practically indiscernible under the snow.
“I thought I would die,” Akhtar told Al Jazeera at her home last week. “I was unsure whether I will come back alive with the child or not.”
Akhtar could not make it to the hospital on time and delivered a baby boy on the road.
“It seemed a long journey to life as I withered in pain in the biting cold,” she said, adding that the experience has haunted her since.
As it continued to snow and temperatures fell to freezing, Akhtar and her newborn, wrapped in a blanket, continued their journey on the makeshift stretcher till they reached the hospital.
“We face such instances here and at times one curses why a woman is born in such a difficult situation,” she said.
While Akthar and her child – named Ishfaq which means kindness – were fortunate to survive, the hardships of living in this remote Himalayan region did not end for them.
Akhtar is a Gujjar, one of a nomadic tribe of herders who live a precarious life with rudimentary access to healthcare services.
After a six-day stay in the hospital, Akhtar’s family rented a vehicle that dropped them nearly 5km (3 miles) away from their home, leaving her to walk uphill as the snow on the road was not yet cleared.
“I was not in a condition to walk but I had no other option,” she said.
In winters, public transport is not available on village roads, forcing the villagers to negotiate slippery roads and snow on their own.
“These difficulties for women like us living in far-flung areas are always there and no one cares about it. It’s difficult to reach the hospital,” said 28-year-old Zaytoona Begum, Akhtar’s neighbour.
“If any elder person falls sick or a child is unwell, it becomes really stressful for everyone.”
In Kashmir’s winters, the heavy snowfall can result in roads being cut off for weeks at a time.
There is also just one tertiary maternity care hospital in the main city of Srinagar – 80km (50 miles) away from Akhtar’s home – serving the entire region.
On average, the 700-bed Lal Ded hospital receives at least 35 cases every day referred from all around Indian-administered Kashmir by rural hospitals that lack advanced healthcare facilities.
In a manpower audit conducted in March 2018, the region’s health department said there was one doctor for every 3,866 people compared with a national average of one doctor for 2,000 people – one of the lowest doctor-to-patient ratios in the country.
The World Health Organization recommends one doctor for every 1,000 people.
In rural hospitals, the lack of doctors is more acute, forcing expecting women to travel long distances even for minor maternity issues.
Unlike Akhtar, Yasmeena Jan, from Sangarwani village in Pulwama district, made it to a hospital in time for her child’s birth, but her journey was equally arduous.
Yasmeena was due to deliver on January 14. A week before that, it started to snow heavily in the Himalayan region, blocking the roads.
As Yasmeena’s family grew anxious about getting her to a hospital on time, a snow-clearing vehicle arrived in the village. Since it was the transport around, Yasmeena and her husband Riyaz Ahmad Gorai asked the operator to give them a ride.
“The snow-clearer agreed to carry the two to a place where they could access some public transport,” said Zubaida Khatoon, 25, Yasmeena’s sister-in-law.
Once the couple reached the town, they took a taxi to Srinagar where they rented a hotel room for a week so they could be near the hospital.
“The journey was like a holy pilgrimage. It was no less than Hajj,” said Khatoon.
A research paper on maternal mortality in Kashmir, published in December 2018 in the International Journal of Scientific and Engineering Research, says 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 across the region, while 52 women died during home births in the same period.
“The women in tribal and far-flung areas suffer a lot,” she said, adding that the mortality rate in Indian-administered Kashmir would not improve unless the “availability, accessibility and awareness of Kashmiri people improves”.
“The healthcare infrastructure is only constructed and remains closed in these far-off areas. Complications during childbirth and pregnancy is one of the main causes. Also, access to maternity health in such places is difficult,” said Jan.
Sameer Mattoo, director of health services in the region, told Al Jazeera the government had made arrangements to facilitate access to maternity care for women in remote areas.
“We have created all the facilities for women in the rural areas. Heavy snowfall happens so in such situations the district administration has chopper service for such cases or they [women] are being carried to the health facilities,” he said.
However, the state of maternity healthcare across Indian-administered Kashmir can be gauged from the burden faced by Srinagar’s Lal Ded Hospital, which sometimes receives patients from Rajouri district, 400km (248 miles) away
Doctors at the hospital say they feel burdened as the peripheral heath centres are not even able to cater to normal childbirths at times.
“In instances when 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 during most childbirth cases. Better maternity health is still a dream for women in far-flung areas,” she said.