Silent Suffering

Thousands of illiterate and rural women silently suffer the miseries of uterine prolapse caused by sheer hard work coupled with lack of basic health services

By A CORRESPONDENT

Radha Maya, 45, comes from an impoverished family in Dhankuta. She has been suffering from uterine prolapse since the age of 28 years. She believes her uterus prolapsed as a result of lack of nutritious food, carrying heavy loads of fodder and water. First, she suffered vaginal bleeding, fever, loss of appetite, pain in the waist and lower abdomen. Several days later, she noted a lump of flesh protruding from her vagina. For five years she did not go for any medical check-up. When she did approach a health post, the nurse inserted a pessary ring. Although she has been informed that her illness can be cured with an operation, poor financial condition prevents her from undergoing the surgery.

Women : Silent suffering

Sani Maiya, 71, has similar story to tell. A mother of 4 sons and 7 daughters – of which four daughters died at a very young age, Maiya suffered from uterine prolapse at the age of 20 years. Even at this age, Sani Maiya wishes she could get an operation, but lacks fund to do so. Both Sani Maiya and Radha Maya had to undergo indifference and even outright negative attitude from their immediate family members after they suffered from the prolapse.

The stories of Radha Maya and Sani Maiya (names changed) mentioned in the study report on the situation of Uterine Prolapse conducted by Safe Motherhood Network (SMN) indicate the silent sufferings of the rural and poverty-stricken Nepalese women.

Uterine Prolapse is a specific type of pelvic organ prolapse that occurs when the uterus drops from the normal position in the pelvic cavity and descends into and sometimes outside the vagina in the most serious cases. The weakness in the muscles and ligaments of the pelvic floor can cause this condition- which is generally caused by multiple and unsafe pregnancy and childbirth; unhygienic lifestyle; and lack of basic health service.

Nepal is one of the countries with the highest Maternal Mortality Rate (MMR) with an estimated 539 women dying in every 100,000 live births. “For every maternal death it is estimated that between 6 to 15 women face morbidity or a debilitating illness for life as a consequence of unsafe pregnancy and childbirth,” states the study report by SMN.

According to the findings of this study titled “Uterus Prolapse: A key Maternal Morbidity Factor Amongst Nepali Women 2005”, women in mid-hill region account for 70 percent while women in Terai districts account for 30 percent. The study states that Nepalese women of all ages are suffering from this condition, which include 58 percent women from Brahmin/Chhetri community, 24 percent from other ethnic communities while 19 percent from Dalit community. In Nepal , 26,000 to 65,000 women suffer from uterine prolapse every year.

In course of the study, health camps were conducted where the action research found 9 percent of all the women who were checked up were suffering from various stages of uterine prolapse.

During the study, almost all the respondents who were approached believed carrying heavy loads, weakness and lack of nutritious food during different stages of pregnancy were responsible for their prolapsed uteruses. Lack of access of basic health services during pregnancy is another cause of this condition. A vast majority of Nepali women still deliver children in their homes and away from any medical supervision – one reason why this country has one of the highest MMR in the world.

Nepali rural society is still a primitive one where gender discrimination, superstition, illiteracy and ill-health prevail. Women are still regarded as second-class people and their rights – especially the reproductive health rights – are never respected and cared for. As a result, these women suffer from a number of easily preventable maladies that not only cause debilitating illnesses but also death.

In recent years, the case of uterine prolapse has been getting increasing attention from the NGOs that are active in promoting the women’s rights and health. SMN is one of them. “In addition to its traditional role of creating awareness and advocating at all levels on the issue of safe motherhood and newborn health, the Network has also endeavored to research into and promote important but comparatively invisible issues related to safe motherhood,” said Dr. Arzu Rana Deuba, chairperson of the Safe Motherhood Network Federation.

The SMN’s study has also provided a set of useful recommendations to overcome the problems related with uterine prolapse and subsequent maternal morbidity. “We would like to urge the government to include maternal morbidity as an issue to be addressed within the purview of the basic health services package provided at the grassroots,” said Dr. Deuba.

Its recommendations include treating uterine prolapse as a priority reproductive health issue; promotion of preventive as well as curative facilities; raising awareness; promoting better health care during pregnancy; regular organizations of targeted health camps with particular focus on hilly and rural areas; educating women; and eradicating violence against women.