Nepal is one of the poorest countries in the world. There are slightly more females than males in Nepal. I am a public health professional and frequently travel in the countryside. During a trip to the site of my project in Lamjung, one of the rural districts of Nepal, I heard a very painful story about a Nepalese woman who suffered from a prolapsed uterus and it really touched my heart.
The story I am writing about is a representative story of the majority of Nepalese women.
Kamali Maya Tiwari lives in the Lamjung district, which lies in the western region of Nepal. She lost her mother when she was very young and, at the age of 11, she got married. She gave birth to her first child when she was 18 years old and in total she gave birth to nine children, five of whom are still alive. She is now 78 years old. All the deliveries were performed at home, which made each birth unsafe as each could have led to complications for both mother and baby, not to mention the higher risk of maternal and infant mortality.
In her late 40s, she was working in the fields near her village when she suddenly felt as if her insides were dropping out. At the time she experienced great pain.
She was confused about what had actually happened to her and told nobody, not even her children and husband, hoping that the problem would go away.
Tiwari is one of the many women who regularly go to hospitals in Nepal, seeking treatment for a prolapsed uterus, which is the main cause of ill health among women of reproductive and post-menopausal age in Nepal.
Prolapsed uteri are a major health issue in the rural areas of Nepal. There are simply no hospitals to treat the condition as it has to be treated at a more technologically advanced health facility. Rural women do not have access to these kinds of treatment facilities.
Experts have estimated that more than 500,000 women in Nepal (with a population of 30 million) suffer from a prolapsed uterus. It is one of the major causes of death among lower caste rural women. Lower caste women are considered to be the untouchable women. They are not allowed to enter the houses of higher caste people. In particular these marginalised women and underprivileged women do not have access to quality health care services.
The occurrence of prolapsed uteri is widespread In Nepal. It affects rural women of mountains, hills, plains and valleys of Nepal. Uterine prolapse occurs when pelvic floor muscles stretch and weaken and no longer provide enough support for the uterus which, as a result, slips down into or protrudes out of the vagina.
The major risk factors of uterine prolapse are age and a large number of pregnancies – however, although it can occur at any age, it often affects post-menopausal women who have one or more vaginal deliveries.
The female population of Nepal makes up slightly more than 50% of the total population of Nepal. In Nepal, sons are preferred over daughters. This is reflected in the social indicators of literacy, child mortality, maternal mortality and female mortality. Uterine prolapse is a very complex problem because, as mentioned earlier, it is often kept secret by Nepalese women because of the shame they feel about having a medical condition which affects the most imtimate and sensitive parts of a woman’s body.
I strongly believe that the prevention of uterine prolapse is essential in Nepalese communities. The major preventive measure could be to limit the number of pregnancies among Nepalese women. Health education during pregnancy is also essential as are adequate antenatal checkups and the proper nutrition of women.
Postnatal care is considered to be very poor in Nepal and it has to be improved in order to minimise the number of uterine prolapse cases. Equal opportunities for education are also essential as the school drop-out rate of Nepalese girls is very high. When the health condition of women improves, the result is a healthier family, community, nation and entire world.
|Pain of Nepalese women
|CC BY-SA 4.0