By Leslie Pariseau
4 February 2009 [MEDIAGLOBAL]: In Nepal, where fertility rates are high and manual labor is a fact of life, an increasingly common and often socially degrading condition has presented a growing threat to the country’s hard-working women.
Often called a “fallen womb,” uterine prolapse is a condition in which a woman’s supportive pelvic muscles, tissues and ligaments break away from the body’s internal structure and the uterus, rectum, or bladder drops into or out of the vagina. The incapacitating affliction is usually prompted by poor nutrition, heavy lifting and prolonged or difficult labor. Symptoms and prevention can be further complicated with poor maternity care, poorly spaced pregnancies, unequal gender relationships, and sexual intercourse soon after childbirth. In the case of most prolapses, mobility becomes limited, ongoing back pain and urinary incontinence occurs, and many women are deserted by their husbands and excluded from their communities as social outcasts.
Denise Barrett, the International Rescue Committee’s (IRC) Country Director for Nepal explained to MediaGlobal the difficulties of treating uterine prolapse in an undeveloped and rural nation: “While you can advise women about the causes, ask them to reduce their physical labor or eat better, poor women in rural Nepal cannot afford not to work and do not have the means to eat better.”
The IRC reports one in three rural Nepalese women is affected with uterine prolapse while the United Nations Population Fund (UNFPA) states one in ten Nepalese women overall is a victim. Presently, 600,000 suffer from the disease and 200,000 are in need of immediate care. Due to the difficult and mountainous terrain and lack of infrastructure, high rates of women do not have access to adequate healthcare.
Though it is a common phenomenon around the world where years of lifting and childbearing are prevalent, uterine prolapse is a condition occurring in greater numbers of young Nepalese women than the global average. It is becoming clear the disease is a symptom of a larger problem concerning reproductive rights and access to education and information. For the most part, Nepal adheres to traditional gender roles where women are not always able to make independent decisions about their reproductive health. According to the UNFPA 20 percent of adolescent girls are either pregnant or have at least one child. Furthermore, half of these females do not receive proper medical care and 19 percent eventually die.
Many maternal mortality cases and disabilities can be attributed to obstetric fistula, a hole in the vagina or rectum caused by untreated and elongated labor. Like uterine prolapse, this condition is avoidable, but without access to medical treatment it is simply a failure of resources.
Furthermore, where Nepal was once a country with a low rate of HIV/AIDS, there are now more than 70,000 inhabitants infected, which qualify the country as having entered a “concentrated” epidemic phase, according to a 2005 UNFPA study. As with uterine prolapse, the lack of proper information and education has put young people most at risk, especially young women in West and Far West Tibet whose migrant husbands have returned from India HIV positive.
Barrett described specific physical measures taught by educational camps and programs, such as Kegel exercises (the contracting and relaxing of the pelvic floor muscles), which help to strengthen the pelvic structure during and after pregnancy. They can also aid women that have a minor form of the disease to prevent worsening of the condition.
However, Ms. Barrett stressed that in order to prevent the incidence of disease, accessible knowledge is key. “Programs that can address the multiple root causes of uterine prolapse are well suited to make a bigger impact on the problem as a whole,” said Barrett. “In the meantime, IRC is doing its best on the health prevention and treatment side.” IRC supports operations for women with stage three uterine prolapse and often enables them to make the long journey to a hospital for medical procedures they might not be able to afford otherwise. Barrett also reported that along with the UNFPA and IRC’s existing programs, several others have begun to mushroom and are slowly gaining momentum.
Another advocacy group, the Safe Motherhood Network Federation (SMNF) has launched a campaign specifically to target women at risk of uterine prolapse in Nepal. The Uterine Prolapse Alliance raises awareness of the condition through mainstream government health programming and works in stride with several other committees on related gender-based violence education, clean delivery, and postpartum care.
Though a handful of ministries and NGOs have taken the initiative to begin the treatment and education of Nepal’s female population, there are many more countries in need of the same. The only factor preventing at-risk women from receiving prevention treatment and immediate care is money, “If we had more funding, we could begin to address the social and economic issues related to UP,” said Barrett. The next step to a solution is raising awareness among developed nations to take the issue to governments and policy-makers for immediate attention and support on behalf of those women who need it most.