Ramesh Dahal

Uterine prolapse exists in 30% of the world’s older women. They represent women, especially from discriminated or poor sections of the population who have given birth to at least one child. Uterine prolapse is a hidden health issue for around 1.36 million Nepali women.

This can be seen high in numbers with the women from the age 30-70 years but women with uterine prolapse may have suffered from the age of above 18 which belongs to reproductive age.
It is taken as a prestigious issue in Nepal, so about 83% of the affected women hide the complication unless they need surgery. Around 53% of women are affected due to the negligence of themselves and their families. The ignorance multiplies the severity and increases untimely death too.

Weak Pelvis
Uterine prolapse occurs in women when their muscles and tissue in the pelvis weaken. This allows the uterus to drop into the vagina. Common symptoms include leakage of urine, fullness in the pelvis, bulging in the vagina, lower back pain and constipation.

A study shows that uterine prolapse is an outcome of poverty that limits women’s ability to get food, rest, and health treatment timely. The cause of silence includes social, financial and cultural disparities in Nepal.
Generally, the complication is caused by workload, lack of rest, and a balanced diet during pre and post-delivery. Nepali women face frequencies of early marriage, fewer gaps between pregnancies, improper delivery, poor health-seeking behaviour, multiple children birth and sometimes repeatedly abortion in the improper setting are generally. Even having a good educational background, women can be exposed to this complication due to social barriers.

A woman with uterine prolapse is taken as ‘dirty’ by her family, relatives and friends. The worrying full health situation of women related to sexuality makes husbands unhappy. Wife health in the male dominant society like ours where cases of domestic violence occur frequently multiplies the complication. Women do not feel comfortable talking among friends although they have had pain for years. Husbands keep a distance so ‘relations’ becomes ‘once in the blue moon’ and ends ‘unpleasant’, which makes women psychologically alone and frustrated.

Recent research undertaken by Nepali health workers and activists concluded that the causes of uterine prolapse include gender discrimination especially restricted choices of women’s sexuality and willingness for reproduction. Studies reveal that women’s health-seeking behaviour is influenced due to shame and fear of scolding, beatings or abandonment.
The gender disparity in Nepal reflects mostly in the allocation of societal roles, and household chores. Women are also taken as machines to produce multiple children either due to lack of contraceptive measures of husband’s negligence or ‘son’ preference. The suppression imposed in a patriarchal society like ours by generations harasses women if they talk to family. Such conditions prevail in different forms in Nepali families irrespective of the social hierarchy.

Development workers wishing to break the social taboo better implement different strategies. The short-term strategy gives immediate relief to women by preventing their worsening health conditions. It impacts by spreading the message to the population through health camps or awareness initiatives and mass media communication. Such programmes encourage women to convey the message to their mothers because mothers feel comfortable in exchanging health issues. Likewise, women in the village can also be sensitised through the locally trained community health workers is relevant to break the silence and take them up to the hospital for treatment. Similarly, making easy access to get health check-ups from specialists along with required medicines is free of cost or minimum cost shift behaviour.

Women being silent on their health issues further degraded their condition irreparably. However, ice-breaking through regular efforts can produce positive impacts. Local government if organizes an orientation programme for community health workers to extend support to affected women can also be meaningful because trained community health workers can work in a catalytic role in connecting them to the medical resources.
Some health complications can be better solved early if women’s accessibility to resources (money, doctors, medicine, information etc.) increased. Various programs like talk shows, debate, poetry and other forms of artistic extracurricular activities at school can be instrumental to spread the message to the family. The extracurricular activities of kids sensitise women and stimulate them for self-reflection.

The outcome of which will be that the schoolboys and girls become aware of themselves, talk about the issue at home and motivate their grandmothers, mothers, aunts or sisters to talk and seek health services. The students also learn the cause and consequences of uterine prolapse so that they became aware of the complication and feel easy to bring the case to light if found on them too.

Media increases public awareness and assist to collect views, information and attitudes. Media is a powerful communication tool of human phenomena so, without media, people would be isolated whose social issues will be abandoned. Television, FM/Radio, newspaper and social media like Facebook and Youtube have significant roles in mass communication. In the production and broadcasting of the materials related to health issues such as uterine prolapse, local FM/Radio have remarkable roles and encourage women to talk if they have symptoms. The mass media program let women know the availability of resources and shift their health-seeking behaviours.

Breaking Taboo
If we want to break the social taboo, we should expect our local government to establish equipped gyno departments at their hospital or health post with medicine free of cost. With this effort, uterine prolapse shall get space in discussion in each village, household and among family members. The message will go to the family that uterine prolapse is a ‘health issue’ and if kept, it brings additional complications up to life loss. It would be a great initiative if the local governments have provisions for allocating budget for the treatment of uterine prolapse. These activities include organizing/collaborating with external stakeholders for health camps and funding for needy once for surgery cases.

Although uterine prolapse exists globally in older women, it is a cause of the ruin of Nepali women from the reproductive age group. The cultural disparity that is also linked with poverty scales up the cases high in Nepal. The hidden health complication can be brought to light and treated by governments, private organizations or individuals step up the strategy to break the social taboo.

(Dahal is a development expert and lyricist)