Mountain midwives deliver babies where hospitals cannot reach

Dawn breaks across the Pir Panjal mountains, and Fatima Deader feels the first labor pains. She's on horseback, a week from her due date, somewhere in the middle of a 215-kilometer trek through dense forest. There is no clinic nearby. No nurse. No doctor. Only her mother, a midwife named Saira Begum, and a canvas tent pitched on damp ground.

Hours later, after her son is born, Fatima is still bleeding and weak. But the caravan moves on. She rides again, her newborn carefully tied to the horse beside her, through terrain home to tigers and bears.

This isn't an isolated incident. Each year when snow melts across Kashmir, nearly a million nomadic Gujjar and Bakarwal herders set out on journeys lasting months, traveling ancient routes like the Mughal Road that winds through the 3,500-meter Pir Panjal pass. For the women among them who are pregnant, the migration continues regardless. Babies are born under trees, by riverbanks, in forest shelters. Some mothers haven't eaten properly in days.

The gap between data and reality

On paper, Jammu and Kashmir looks like it's doing well. The official maternal mortality ratio sits at 46 deaths per 100,000 live births—better than India's national average and far below the global figure of 224. But these numbers tell only part of the story. They come from hospital deliveries. Women on migration routes rarely reach clinics in time, so their deaths often go unrecorded. The data makes the problem invisible.

Fozia Choudhary was 16 when she gave birth in 2016. Married at 14—early marriage is common among these communities—she survived on a cup of milk and a single flatbread most days. By the time labor began, she was dangerously malnourished. At the hospital, doctors were shocked she had made it. She needed four blood transfusions before she could safely deliver. Recovery took months.

For women like Fatima and Fozia, survival depends on traditional midwives. Saira Begum, 63, has delivered dozens of babies along these mountain routes. She speaks plainly about what she cannot do. "Sometimes there is so much blood loss we can't save the mother," she says. She remembers a woman named Gulnaz, eight months pregnant and already sick with liver disease, who died in the hills in 2021. The nearest hospital was six miles away. They had no food or water left.

Begum carries only knowledge passed down through generations—no medicines, no formal training, no backup. When she asks who will help these women when she grows too old, the question hangs unanswered.

Solutions exist, but haven't reached these mountains

The barriers are real: terrain, staffing shortages, funding gaps, poverty, malnutrition, and early marriage all compound the problem. A senior Jammu and Kashmir health official acknowledged the difficulty. For decades, political leaders have promised mobile healthcare for nomadic women. The support has never materialized.

But elsewhere, models are working. Mongolia runs mobile clinics that bring preventive care and ultrasound scans to remote herders. Ethiopia's traveling health teams deliver antenatal care, immunizations, and nutrition services to pastoralist communities. Somalia has launched similar pilot projects. The solutions aren't theoretical—they're being tested and refined in places with similar terrain and populations.

What's missing is the decision to bring them here.

Back in the forest, after helping another young woman deliver, Saira Begum folds her cloths. "What else do you have in the jungles, except an old woman's hands?" she asks. The new mother, Fatima, rocks her newborn by firelight. "We survive by luck," she says. "But every year, another woman does not."