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Uterus Damage Condemns Women to Sickness and Stigma in Rural Nepal, August 2, 2007

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AdvocacyNet
News Bulletin 115, August 2, 2007
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Kathmandu, Nepal: Throughout rural Nepal, impoverished women suffer from uterine prolapse - a painful and debilitating condition in which the uterus protrudes from the vagina, sometimes for years.

More than 600,000 Nepali women are thought to be affected - one of the highest incidences in the world. But the problem has been largely ignored by the government of Nepal and the international community, leaving local Nepalese organizations struggling to respond.

Uterine prolapse is widespread in Eastern Nepal, where an Advocacy Project Peace Fellow, Nicole Farkouh, is volunteering with the Collective Campaign for Peace (COCAP), a network of community groups. Ms Farkouh recently attended a meeting at the Community Development Forum (CDF), a COCAP member organization that has made uterine prolapse a top priority.

The meeting reviewed graphic pictures of women suffering from the condition, and according to Ms Farkouh's blogs, the biggest protrusion was the size of a "small cantaloupe." She writes: "The larger ones had sores on the sides where the delicate tissue of the hanging uterus had become chaffed by walking thighs that rubbed against it."

The presentation deeply affected Ms Farkouh: "I put the pictures down, stepped outside, sank down in the shade on the concrete porch and sobbed."

Like so many challenges to women's health, uterine prolapse is a product of poverty, social pressure and inadequate health services. According to some estimates, 200,000 women in Nepal with the most severe symptoms, are thought to need immediate medical treatment. But they are generally deterred from seeking help by their distance from medical centers and a sense of shame.

The problem starts with childbirth. Many women in rural Nepal are under pressure to marry young and produce sons before they can properly support, or even understand, childbirth. Many adolescent girls even believe that the first stages of prolapse are completely normal. Only 10 percent of births in rural areas are assisted by trained birth attendants.

Women are then forced by poverty to return to work before their muscles are strong enough to support the womb. One UN study found that more than 14 percent of Nepali women are doing heavy labor within a week of childbirth. In another study, one woman was reported to be living with a fully prolapsed uterus for 42 years after she lifted a water vessel shortly after giving birth. She was forced to continue working because she needed to feed her family.

The problem requires surgery in its later stages, but can be corrected if dealt with quickly. This, however, requires community support - yet many victims often suffer from social ostracism and are even divorced by their husbands.

Ms Farkouh was told that divorce adds immeasurably to the stigma: "If (they) are cast out by their husbands, their parents often won't take them back due to economic hardship. This leaves such destitute women no other choice than to work as a servant in a home that will provide them food and shelter in exchange for their work - often becoming a servant to their husband and his new wife."

Contacted by The Advocacy Project, Dr Gillian Greer, Director General of the International Planned Parenthood Federation (IPPF) in London, said she was not at all surprised by Ms Farkouh's report. "Poor women in the poorest countries of the world bear a disproportionate burden of ill-health. Sexual and reproductive ill-health for women of child-bearing age represents one of the greatest health inequities between rich and poor, and between the developed and developing world.

"Until women's rights are seen as a priority, health issues that affect only women will never be a priority for most governments or societies, and health spending will continue to be allocated elsewhere," said Dr Greer.

But at least other reproductive conditions, such as fistula, have aroused outrage and provoked a concerted response. Uterine prolapse, in contrast, has attracted little attention or funds, from the government of Nepal or the international community. This has generated something close to desperation among local advocates like CDF.

When Ms Farkouh asked for an explanation, she was told by CDF members that uterine prolapse is "an issue which only affects women" and that women are not encouraged to advocate on their own behalf. According to CDF, even the Nepalese director of women's affairs is a man.

Dr Greer, from IPPF, agreed that uterine prolapse needs more attention. "We join in the call to publicize this neglected issue," she said. "More needs to be done to support national organizations working at the local level to address the pressing health needs associated with uterine prolapse. This is not something that anyone should have to live with, nor needs to live with."

• Read Ms Farkouh's blog.
• Email Ms Farkouh.

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