Uterine Prolapse: The “Neglected Tragedy” of Nepal

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KATHMANDU, Nepal — Shame, fear and stigma surround a debilitating affliction that plagues 10 percent of Nepal’s 13 million women.

Known as uterine prolapse (UP) — a condition in which a woman’s uterus slips down into her vagina — it leaves women in severe pain and often marks them as outcasts from society.

While UP affects women around the world, researchers have found its prevalence and severity among Nepali women to be particularly high. In comparison to American women who experience UP at the median age of 61 post-menopause, Nepali women increasingly experience it in their 20s and 30s — a result of socio-cultural factors stemming from gender inequality.

UP, or the “neglected tragedy,” typically occurs when a woman has had several vaginal births, especially at an early age, and resumes a heavy workload during post-natal recovery. Under these conditions, the muscles, ligaments and other structures that hold the uterus in the pelvis wear down until they are no longer able to support it.

According to a report conducted by the United Nations, UP is the leading cause of morbidity in women of remote areas of Nepal. Lack of education and extreme poverty, as well as limited access to trained birth attendants, contribute to UP’s prevalence.

Symptoms include incontinence, vaginal bleeding, risk of infection and difficulty when undertaking common tasks like sitting or walking. For Nepali women, these effects can prove disastrous for their personal lives since much of their societal worth derives from their ability to successfully reproduce, maintain households and contribute an income.

In addition to physical effects, sufferers may also endure low self esteem, ridicule, abuse, lack of economic support and domestic violence, states a 2007 study conducted by the Women’s Reproductive Rights Program. Nepali desire for sons equates to limited contraceptives and continuous pregnancies for women, which in turn leads to UP.

However, those with UP are considered impure by husbands, families and society. Additionally, UP renders intercourse painful or impossible, consequently causing husbands to leave their wives and children for women currently unaffected.

There are several stages of UP, the least severe of which may be counteracted by a minimally invasive ring pessary, which holds the uterus in place. If left untreated, UP may degrade to the point where surgery becomes necessary.

Adequate medical centers are few and far between, with many villagers affected with UP unable to take the time and money to seek out treatment. Furthermore, the services provided by the government of Nepal’s 2008 women’s health initiative are considered to be inadequate, with many women walking as far as 7 hours home immediately following surgery and no post-operative care provided.

Researchers suggest preemptive health care as the best option for treating UP: increasing education on its causes, improving working conditions for women and mitigating the stigma surrounding the condition.

Despite the fact that women of all ages and social groups suffer from UP, the stigma surrounding it forces women to keep silent. Until these underlying issues are addressed, women will remain mute until their health degrades to the point where no other option, even surgery, is possible.

Sources: Al Jazeera, WRRP Nepal, The Lancet, United Nations 1, United Nations 2, World Health Organization, NCBI, Irin News
Photo: Baltimore Sun

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