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D<\/span>awn had just broken across the trail through the Pir Panjal mountains when Fatima Deader felt the first labour pains. She and her family had almost reached the midway point of their 134 mile (215km) trek from Rajouri in Jammu to Kashmir\u2019s higher pastures. Mist clung to the forest, and the ground was slick beneath the feet of the caravan of about 70 pastoralists who had stopped to camp together the previous night.<\/p>\n A week from her due date, she had been travelling on horseback and assumed the discomfort she felt was fatigue \u2013 until pain tore through her body.<\/p>\n \u201cThere was no clinic, no nurse, no doctor,\u201d Deader, 23, says. Only her mother and a midwife, Saira Begum, were with her in a damp canvas tent, whispering prayers. Hours after her son was born, and still weak and bleeding, Fatima had to ride again, her baby carefully tied to the horse with her, as the group\u2019s journey continued through dense forest, home to tigers and bears.<\/p>\n The 3,500-metre-high Pir Panjal pass, also called Peer Ki Gali, connects the Jammu region to the Kashmir valley via the centuries-old Mughal Road, and each year when the snow melts, nearly a million nomadic Gujjar and Bakarwal herders set out with their goats, sheep and horses on journeys that can last months.<\/p>\n <\/span>Fatima Deader with her children in her tent in Baramulla, months after giving birth and then riding a horse through dense forest during their seasonal migration. <\/span> Photograph: Arsalan Bukhari<\/p>\n For those who are pregnant during the migration, heavy loads still have to be carried, and rest found in tents pitched on wet ground. Babies are born under trees, by riverbanks or in forest shelters.<\/p>\n Some women give birth after days without a proper meal. Those who make it to district hospitals often arrive exhausted, anaemic or suffering from an infection.<\/p>\n Fozia Choudhary was 16 when she gave birth in 2016. \u201cI was still a child myself,\u201d she says. Married to her cousin at 14 \u2013 early marriage is common among tribal families \u2013 she often had nothing to eat but a cup of milk and a single roti<\/em> flatbread each day. By the time she went into labour, she was dangerously weak.<\/p>\n We have only the knowledge passed down to us \u2013 no medicines, no doctor. If I fall sick, who will help these women?Saira Begum, midwife<\/p>\n Choudhary was one of the lucky ones who made it to hospital, but doctors were shocked at her condition. \u201cThey shouted at my husband, asking how I had even survived this long,\u201d she says.<\/p>\n The teenager required a blood transfusion \u2013 \u201cfour bottles\u201d \u2013 before she could safely deliver the baby. Recovery was slow and painful.<\/p>\n For such women, survival often depends on traditional midwives. At 63, Begum has helped deliver dozens of babies along the mountain routes. \u201cSometimes there is so much blood loss we can\u2019t save the mother,\u201d she says.<\/p>\n \u201cI remember [a woman called] Gulnaz. We were in Doodhpathri, high in the hills, in 2021. The nearest hospital was six miles away and we had no food or water left. She was eight months pregnant, already sick with a liver problem. She died there, before we could get her any help.<\/p>\n <\/span>Children of Deader\u2019s nomadic group by their tents in Baramulla. <\/span> Photograph: Arsalan Bukhari<\/p>\n \u201cWe have only the knowledge passed down to us \u2013 no medicines, no doctor,\u201d she adds. \u201cIf I fall sick or grow too old, who will help these women?\u201d<\/p>\n A 2022 government study estimated Jammu and Kashmir\u2019s maternal mortality ratio (MMR) \u2013 the number of women dying from pregnancy-related causes per 100,000 live births \u2013 to be 46, better than India\u2019s national figure and well below the global average of 224 deaths. But these numbers obscure the experiences of nomadic women, whose lives largely go undocumented in official health data.<\/p>\n Dr Mushtaq Wani, a public health researcher in Srinagar who works with nomadic communities, says: \u201cThe state\u2019s MMR figures come from hospital deliveries. Women on migration routes rarely reach clinics in time, so preventable deaths go unrecorded.\u201d<\/p>\n Kashmiri political leader Yasin Malik says that for decades, successive administrations in the territory have promised mobile healthcare for Gujjar and Bakarwal women, but support has never materialised.<\/p>\n skip past newsletter promotion<\/p>\n Hear directly from incredible women from around the world on the issues that matter most to them \u2013 from the climate crisis to the arts to sport<\/p>\n Privacy Notice: <\/strong>Newsletters may contain information about charities, online ads, and content funded by outside parties. If you do not have an account, we will create a guest account for you on theguardian.com to send you this newsletter. You can complete full registration at any time. For more information about how we use your data see our Privacy Policy. We use Google reCaptcha to protect our website and the Google Privacy Policy and Terms of Service apply.<\/span><\/p>\n after newsletter promotion<\/p>\n <\/span>Deader\u2019s nephew with a kid in the Baramulla campsite during their summer migration in Kashmir.<\/span> Photograph: Arsalan Bukhari<\/p>\n A senior Jammu and Kashmir government health official, who wanted to remain anonymous, admitted that staffing, funding and the terrain made medical support difficult.<\/p>\n District hospital doctors confirm the consequences. \u201cMany women arrive after walking or riding 10-15km in labour,\u201d says a doctor in Baramulla, who also requested anonymity. \u201cBy the time they reach us, it is often too late to prevent complications, or even to save the mother. Severe anaemia, infections and obstructed labour are common.\u201d<\/p>\n The gap in healthcare is compounded by poverty, early marriage and malnutrition. Many women, particularly girls who married young, enter pregnancy undernourished and physically underdeveloped, which increases the risk of maternal and neonatal complications.<\/p>\n International organisations say this is not unique to the region. The UN Population Fund (UNFPA) notes similar patterns among pastoralist women in other countries where migration routes leave those facing childbirth out of reach of conventional healthcare. Pilot projects in Mongolia, Ethiopia and Somalia have attempted to address the lack of resources for nomadic women.<\/p>\n In Mongolia, an outreach initiative using mobile clinics \u2013 part of a broader health programme supported by the World Health Organization (WHO) targeting remote communities \u2013 provide preventive care and ultrasound scans to herders in <\/strong>areas many hours from clinics.<\/p>\n Ethiopia\u2019s mobile health programme in the Afar and Somali regions delivers antenatal, immunisation and nutrition services to hard-to-reach pastoralist communities through travelling health teams.<\/p>\n <\/span>Saira Begum, the midwife, makes tea outside her tent in Baramulla. She travels is often the only help for the women in labour. <\/span> Photograph: Arsalan Bukhari<\/p>\n Back in the forest, Begum folds her cloths after helping another young woman deliver her baby. \u201cWhat else do you have in the jungles, except an old woman\u2019s hands?\u201d she asks.<\/p>\n The new mother, Fatima, rocks her newborn by the glow of a fire, echoing her sentiment. \u201cWe survive by luck,\u201d she says. \u201cBut every year, another woman does not.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":" Dawn had just broken across the trail through the Pir Panjal mountains when Fatima Deader felt the first labour pains. She and her family had almost reached the midway point of their 134 mile (215km) trek from Rajouri in Jammu to Kashmir\u2019s higher pastures. Mist clung to the forest, and the ground was slick beneath<\/p>\n","protected":false},"author":1,"featured_media":33460,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[51],"tags":[5189,5173,1721,1718,37,19161,7396,6932,418],"class_list":{"0":"post-33459","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health","8":"tag-birth","9":"tag-born","10":"tag-forest","11":"tag-giving","12":"tag-health","13":"tag-kashmiri","14":"tag-maternal","15":"tag-mountains","16":"tag-women"},"_links":{"self":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts\/33459","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=33459"}],"version-history":[{"count":0,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts\/33459\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/media\/33460"}],"wp:attachment":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=33459"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=33459"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=33459"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}