In the high Himalayas of  Kashmir, winter does not arrive quietly. It rolls in across mountain ridges in dense sheets of snow, swallowing roads, sealing off valleys and transforming steep passes into walls of white. 

Entire communities become temporarily cut off from the outside world. In some villages, the only link to the nearest hospital disappears for weeks.

For most residents, winter is a season of endurance. But for pregnant women, it can become a countdown measured not in weeks, but in weather forecasts.

Officially, the region of Jammu and Kashmir records one of India’s lowest maternal mortality ratios: 47 deaths per 100,000 live births, nearly half the national average. 

Public health indicators suggest improvement over the past decade, with institutional deliveries increasing and antenatal coverage expanding. But statistics do not climb mountains.

Across remote districts near the Line of Control, the de facto border dividing India and Pakistan, childbirth is shaped as much by geography as by policy. Villages sit at high altitudes. Roads are narrow and vulnerable to landslides. Within hours, snowfall can block the only route linking a community to a district hospital.

When that happens, ambulances stop running. Helicopter evacuations depend on clear skies and administrative clearance. Primary health centres, already short of specialists and equipment, become the only point of care.

Every autumn, families in snowbound belts quietly begin preparing for a decision that has become routine: relocate pregnant women to lower-altitude towns before the snow closes in or remain behind and hope there are no complications.

For those who can afford to move, childbirth becomes an economic burden. For those who cannot, it remains a medical gamble.

Leaving before the snow seals the valley

In Machil, a remote Himalayan border village in north Kashmir, the nearest district hospital lies more than 60 kilometres away in Kupwara.

In summer, the drive can take several hours along winding mountain roads carved into steep slopes. In winter, heavy snowfall can render the route impassable for days and sometimes weeks. 

For 67-year-old Abida Khan, winter no longer brings beauty: “I have seen women suffer because they couldn’t reach a hospital in time,” she told Health Policy Watch.

Her daughters and daughters-in-law now leave the village weeks before their due dates. The family arranges temporary accommodation in Kupwara or Srinagar, absorbing the costs as best they can.

“If complications happen at night during heavy snowfall, what can we do?” she asked. 

In previous winters, residents say they waited days for helicopter evacuations that were delayed due to poor visibility. In such conditions, childbirth becomes dependent on timing and luck rather than medical preparedness. 

Local health workers say they routinely advise families to shift pregnant women out of Machil before peak winter. But relocation requires savings, something many households that are reliant on small-scale farming or daily wages struggle to accumulate.

Migration for childbirth

Nearly 200 kilometres away, in Kangan market in central Kashmir’s Ganderbal district, Faqir Mohammad stands outside an electrical shop, weighing whether to buy a room heater he cannot afford. 

The heater is intended for a rented room where his pregnant wife, Rasheeda Begum, now lives with their two children, far from their home in Buglinder village in the remote Tulail Valley of Gurez. 

Tulail lies in a high-altitude belt that remains snowbound for months. Once heavy snowfall begins, roads close and air evacuations become uncertain.

“We have no choice,” Rasheeda told Health Policy Watch from the cramped rented room. “Every winter, doctors tell our husbands to shift the pregnant women out of Gurez. It is out of compulsion, not comfort.”

She is expecting her third child. Her first two deliveries, both at home, were uncomplicated. But this time, early snowfall warnings pushed the family to leave in November.

 “Our monthly expense is nearly ₹20,000 [$220],” Faqir said. “The rent alone is ₹4,000 [$40]. I don’t earn that much.” 

To manage costs, he borrowed ₹1 lakh [$1,100] from his brother-in-law, a sum that will take months, perhaps years, to repay.

“I am mentally disturbed with all this financial burden and the harsh cold,” said a woman twho asked not to be named. “But staying back would be more dangerous.”

She recalled a tragedy in her village nearly a decade ago when a woman died because the helicopter couldn’t travel for three days during a snowstorm. 

“They kept her in the medical room until she lost her breath. That memory scares all of us.”

Structural gaps in care

Even outside winter, maternal healthcare in remote belts faces systemic constraints.

There is no ultrasound facility in the entire Gurez–Tulail region.  Rasheeda must travel around 120km for a single scan, and pay about ₹1,000 [$10]  excluding transport.

“We don’t have specialists, tests, transport, nothing,” she told Health Policy Watch.

Such limitations reflect wider staffing shortages. Reporting by Kashmir Times found that hundreds of consultant posts are vacant across Jammu and Kashmir’s health department, leaving tertiary hospitals overstretched and peripheral centres understaffed.

Previous coverage by Health Policy Watch reported that dozens of primary health centres and hundreds of sub-centres in the region lack reliable electricity, a critical requirement for conducting safe deliveries and emergency procedures.

A doctor in north Kashmir, speaking on condition of anonymity, said terrain magnifies existing shortages: “There are areas we simply cannot reach in winter. Even in summer, these terrains are difficult. During snowfall, ambulances get stuck. If a woman develops complications at night, response time becomes critical.”

He added that while referral systems exist on paper, implementation falters when roads close or communication lines fail.

Conflict and climate pressures

In frontier towns near the Line of Control, residents say periodic cross-border shelling adds another layer of unpredictability to maternal care.

In villages near Uri, families described how an escalation in shelling has forced temporary evacuations in the past. Pregnant women were shifted to safer areas with limited facilities, disrupting routine check-ups and antenatal monitoring.

“When there is firing or roads close, where do we go?” asked Nadeem from Buzgaow. “We cannot abandon our homes for months. But we cannot reach hospitals either.”

Weather patterns, too, have grown less predictable. Residents report sudden heavy snowfall arriving earlier in the season, complicating planning. In high-altitude regions already vulnerable to isolation, even minor shifts in snowfall timing can determine whether a woman delivers near a fully equipped hospital or in a basic facility without specialist support.

Choice between debt and danger

For women in Kashmir’s snowbound valleys, childbirth often becomes a negotiation between financial survival and physical safety. Temporary migration means rent, heating, food and transport costs in unfamiliar towns. Many families depend on livestock or seasonal agricultural income. Months away from home disrupt livelihoods.

“We left our home, borrowed money and separated our family just to survive childbirth,” Shazada Akhter from Kupwara told Health Policy Watch. “What else can a mother do?”

Back in Machil, as the first snow settles across the mountains, Abida Khan watches the road disappear beneath fresh drifts.

“We pray the winter passes without emergency,” she said.

The region’s maternal mortality statistics suggest progress. But in villages perched along fragile mountain routes, safe delivery still depends on clear skies, open roads and borrowed funds.

For pregnant women in Kashmir’s high Himalayas, winter remains the single most decisive factor in whether childbirth is routine or perilous.

Image Credits: Rutpratheep Nilpechr/ Unsplash, Welt Hunder Hilfe, Safina Nabi.