Historically, women of Nepal have many children and during these births usually no skilled healthcare workers are in attendance. Traditionally women carry out heavy physical labour throughout their lives with no concession made during pregnancy; they are also expected to return to such work within days of giving birth.
Women often return to this dangerous work out of fear. The culture of moving to the home of your husband’s family after marriage means that brides can often be treated as servants and punished for misbehaviour. Heavy lifting, farming, cleaning and fetching water are all common causes of prolapse.
Nepal is currently experiencing somewhat of an epidemic with hundreds of thousands of women experiencing genitourinary prolapse and with nearly half of these cases occurring in women under the age of 30 years.
Prolapse of the uterus is where the organ begins to drop into the vagina. At its most severe the womb can even slide outside of the body. It is a condition which most commonly occurs in older, post-menopausal women. It can be classified by four stages of prolapse with four being the most serious.
Unskilled birth attendants can increase the chances of prolapse occurring as they do not recognise tears which can occur in labour, neither do they know how to repair such complications should they be spotted.
Women who experience uterine prolapse are embarrassed as there is a stigma attached to the condition. They can be excluded from their community and even cast aside by their husbands. The condition is extremely painful, can lead to urinal incontinence and severe bleeding. Another side effect is that sexual intercourse cannot occur in severe cases and even in less serious cases it is incredibly painful for the women. Some husbands of course do not accept this. A huge number of women are having to deal with these symptoms for the rest of their lives with no hope of reparative surgery although it has been reported that some husbands are preventing their wives from undergoing surgery as this will further reduce their ability to have intercourse.
Women are terrified to speak out and feel there is no one to help them anyway. We are seeing a dangerous increase in women trying to manually re-insert their wombs or even forcibly remove organs themselves in makeshift operations.
It has been suggested by the Nepalese government that somewhere around 600, 000 have been affected but the government itself admits to not knowing the true extent of the problem. With other studies placing the figure much higher.
Amnesty International have agreed that this is indeed a human rights issue at its core and the organisation, Pro Public even took the issue to the supreme court where this idea was upheld and the government were held responsible for not doing enough to reduce the occurrence of prolapse.
Many women’s groups have further criticised the government’s solution to the issue. They have attempted to set up “clinics” which are more a sort of camp where women can undergo free hysterectomies for uterine prolapse. These camps have so far served something like 50, 000 women. Their substandard treatment and care however has led the government to shut down these so-called clinics having been criticised for poor-quality, sub-standard and rushed operations. These procedures are now taking place in registered medical facilities.
It should be noted that in the Western medical community the treatment for uterine prolapse is rarely hysterectomy these days, especially in cases where women are still of child bearing age. Advocacy groups for women’s rights have further criticised the Nepalese government for failing to employ preventative measures to help these women before any such event occurs.
The solution remains the same: trained midwives and doctors attending births and available family planning advice are the key to prevention.