Without access to necessary reproductive and maternal health services, approximately 1.4 million women in Nepal suffer from uterine prolapse. These women not only suffer physically from this painful and debilitating condition, but also emotionally. They are stigmatized and sometimes even cast out of their families and communities as a result.
The incidence of uterine prolapse in Nepal has hit epidemic levels, affecting one out of ten women, with higher incidence among poor and rural communities. Several factors contribute to this epidemic including malnutrition, early marriage and pregnancy, multiple births in rapid succession, and performing heavy labor during and after pregnancy. Additionally, Nepalese women lack access to reproductive health education and medical care.
At 17 years-old, Reena Pokharel gave birth without the assistance of a trained midwife or other medical professional due to her rural location. A soothsayer tried to facilitate the birth by putting pressure on her abdomen and instructing her to cough. She endured a painful and protracted labor that lasted four days and left her with a prolapsed uterus. Large numbers of women throughout Nepal have endured similar experiences.
When asked about her condition, Reena Pokharel, now 46 years-old, stated, “I became an outcast in my own family. They said I had brought bad luck and called me an evil omen. The community would not eat or work on farms with me. My husband beat me, saying I was lazy and unlucky.”
Most people in Nepalese society do not understand this medical condition. Consequently, women affected by uterine prolapse are often labelled as “lazy.” Husbands ridicule, beat or even leave their wives due to their inability to have sex or perform daily tasks. Due to social stigma, these women also avoid talking about their pain or getting help for their condition. Many have no idea what causes their symptoms and options available for treatment.
Uterine prolapse occurs when pelvic floor muscles and ligaments weaken, allowing the displacement of the reproductive organs. Without proper support, the uterus slips down into the vaginal canal, and in severe cases may even protrude out the vagina. This condition usually affects older, menopausal women but in Nepal there is a high incidence among women as young as their 20s.
Documented causes of uterine prolapse in Nepal include inappropriate birthing methods that include placing pressure on the abdomen, difficult and prolonged labor, giving birth at a young age, and having a large number of children in a small amount of time. Additionally, malnutrition stunts the development of pelvic muscles and hard physical labor strains the muscles.
Once uterine prolapse develops, women experience disabling symptoms including abdominal and back pain, trouble urinating and defecating, pain and difficulty when having sex, and a predisposition to infection. The resulting discomfort makes it difficult for affected women to sit, walk, or perform daily labor tasks.
“I started feeling back pain and stomach pain and I couldn’t stand straight or sit or do work. I feel pain in my lower abdomen and generally I have back pain when I work hard. When I sneeze my uterus comes out,” explained Kopila, a 30 year-old woman.
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