Having spent the last few weeks in WRRP’s office, reading over reports, editing WRRP’s brand new web site, and working on a grant proposal, I’ve had a chance to consider the finer details of WRRP’s approach and the issue of uterine prolapse.

Since learning I would spend the summer working with WRRP, and suddenly finding myself bringing up uterine prolapse in everyday conversation, I ended up meeting two women, both over 60, – one from the US and one from the UK – who had suffered with a prolapsed uterus. This was a good lesson for me in the global prevalence of this condition. However, while uterine prolapse occurs predominantly in post-menopausal women in developed countries, in Nepal, it happens from adolescence onwards. Why?

Walking around Nepali villages, talking to local women, and seeing the work these women do, has made the answer quite clear. Women in Nepal are generally responsible for  vast majority of the household duties; food preparation, childcare, and field work are all in their domain. It is very common here to see women carrying huge loads of grass or other goods on their heads. I often see girls moving huge rocks. And women, especially in villages, marry well before adulthood. 47% of women in Nepal are married by age 17. Also, access to health care in villages is very limited – either by finances or by geography. When women give birth, 92% of them do so at home and 90% of the births take place without a trained assistant.

In addition to all of this, women in Nepal are often the last to eat in their family. One woman I interviewed in Lahan said, “Why should I lie? My mother-in-law was so rude. She would give me 20 kilograms of rice grains to grind and very little to eat… She would only give me a small portion of the broken rice grains to eat. And then she would ask me to go work in the fields and harvest the rice. And do all other things.  She would give to her own sons and daughters good food to eat. I would only get the discarded water from the boiled rice…. In this way, I got weak.” One out of every four women in Nepal does not get enough food to eat.

These are all practices deeply rooted in Nepal’s patriarchal society. And they are also the practices that lead to the very high rates of uterine prolapse in Nepal.

The huge challenge WRRP faces is how to address an issue whose causes are inherent in the daily life people have been living and passing on to their children for generations? Fittingly, WRRP’s brochure states that it “addresses fallen womb as an issue of reproductive rights, rather than a mere medical problem. This problem is the consequence of the sub-ordination of women and is rooted in prevalent patriarchal structures”.

My coworkers have described WRRP’s approach to me as multi-pronged – tackling the short-term, medium-term, and long-term solutions necessary to address the problem of uterine prolapse in Nepal. For example, WRRP provides women in dire need of help with free access to treatment services. This often entails bussing groups of women from villages to mobile surgical treatment camps, battling road strikes, blockages, and unpredictable treatment camp schedules. For great accounts of these surgical treatment camps, check out past fellow, Nicole Farkouh’s, blog. To tackle uterine prolapse over the longer term, WRRP has a very strong advocacy and education programs. They have groups of campaigners in the fields who literally go door-to-door in villages, talking to families about how to prevent uterine prolapse. And these campaigners help to organize networks of women sufferers (pidit mahila manch) to run advocacy campaigns. In one such campaign, women sufferers chained themselves to the door of a district headquarters, demanding a change in reproductive rights policy. And they were successful! More details on this are described in WRRP’s recent video production, Saving the Womb on YouTube.

All of these activities are further challenged by the cultural context in which they’re taking place. In this context, women’s health needs are often not a priority and topics surrounding uterine prolapse are uncomfortable subjects.

It certainly is not an easy challenge WRRP has taken on – which makes it all the more impressive that they are achieving many impressive results which make a big difference to women across Nepal.

Source for statistics:

Earth, Barbara and Sabitri Sthapit. “Uterine Prolapse in Rural Nepal: Gender and Human Rights Implications. A Mandate for Development” Culture, Health & Sexuality, 2002, Vol. 4, No. 3, 281-296.