Feature Stories
The Pain of Fallen Womb
By Trishna Kunwar and Anna Adhikari
Operation Theatre
She has been hiding her problem because going to a male doctor was too embarrassing.
Kapilbastu, November 2008 - The uterus in its normal size is not bigger than a match box. Its muscles stretch during pregnancy to accommodate a baby. In what condition would a womb that went through this process sixteen times be? Uma* who we met in Kapilvastu District Hospital during the uterine prolapse surgical camp had sixteen children. She had suffered from the fallen womb for the last ten years.
Early marriage, early pregnancy and inadequate spacing between pregnancies are some of the causes of the reproductive health problems among women in the district. Uma was not aware of her reproductive rights that included access to information about available contraceptives, nor did she know that by law in the country she was entitled to free contraceptives, free medical check-ups and medicine during pregnancy. Moreover she did not have idea about available treatment for uterine prolapse. Her primary obligation was to bear children- she has nine sons and seven daughters. We can only imagine how difficult it was for her to carry on with the usual household chores after developing the condition. All those years, it never occurred to her that it was a problem or a disease. As parts of one's body like the uterus or vagina, are not a topic of conversation, even among women, Uma simply assumed that it is common and natural.
Most of the women in her village have to deal with this trouble; nevertheless, they are ashamed to talk about it, said Bona, another woman who came for the uterine prolapse surgery. We were surprised to learn that she had not revealed the truth even to her daughter. Though in her 60s, she felt shy and hesitant to talk. More than that, she felt awkward to show her problem to a male doctor. Her daughter took her to hospital when walking had become difficult for her.
The fallen womb is a truly socially inclusive problem existing in every social, ethnic and geographic group in Nepal. The roots can be traced to malnourishment during pregnancy, lack of pre and postnatal care, carrying heavy loads during and immediately after pregnancy, giving birth to children too early and too often. According to a survey by UNFPA, WHO and Institute of Medicine, Tribhuvan University (2006) about six hundred thousand women are suffering from the condition, of which around two hundred thousand are in need of immediate surgical treatment. The ailment occurs as early as sixteen.
Thanks to the hard work and advocacy of various organizations for the third year running the government has provided funds for the free surgical uterine prolpase treatment for 12000 patients. Though this number is below the needs, the quota has been increased yearly. In support of this, surgical camps are organized periodically through the United Nations Population Fund/Government of Nepal Population and Reproductive Health Integrated Community Based Progamme (UNFPA/GoN PARHI CBP) in six districts: Dadeldhura, Dang, Kapilbastu, Mahottari, Spatari and Rautahat. During surgical camps patients previously identified by health facilities are sent to the designated hospital where a team of specialists conducts the operation. The surgery and medication is free of charge and each patient, with one attendant is provided with a stipend to cover their travel and food expenses. The commercial price of the uterine prolapse operation is around 25,000 Rupees (USD 325). From 2005 till the end of 2008 UNFPA has supported 3,500 surgical corrections of uterine prolapse in Nepal.
* All names have been changed.
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