It wasn't until I actually met rural Nepali women that I understood just how difficult life often is for mothers in that country. Not only are they expected to do all of the housework and most of the farming, they're expected to do it all while pregnant -- and to start their work again sometimes just one week after giving birth. This often leads many women to develop a painful condition where the womb falls into the vagina and, eventually, out of the body. It's called uterine prolapse and it affects at least 600,000 women in Nepal.
Last spring my partner Ian Bickis and I travelled to Siraha district in southeastern Nepal to document this widespread health problem, which is usually surrounded by stigma and secrecy.
One of the women we met was Kalasi Devi, 28, a mother of three whose uterus has been protruding from her body for more than a decade. "During my pregnancy I did a lot of heavy work, like carrying water and wood," she says. "I started working again 10 days after giving birth." Devi told us she feels ashamed to talk to her family about her problem. Despite her physical discomfort, she continues to do strenuous work because that's what is expected of her. "I feel severe pain in my lower abdomen, and it's very difficult to stand, to sit, to do work, but I still do it."
While uterine prolapse affects women everywhere, it's most common in older women who have hit menopause. But, according to the United Nations, in Nepal 44 percent of women with the condition developed it before they were 30.
"We have quite a considerable number of young women with uterine prolapse," says Dr. Kiran Regmi, head of family health at Nepal's health ministry. Dr. Regmi says the major causes are having several children in a short period of time, giving birth without a skilled birth attendant and doing heavy work soon after delivery.
But a recent report from Amnesty International says the high incidence of uterine prolapse in young Nepali women is a reflection of the country's severe gender discrimination.
Local women's rights activists agree. "They [women] don't have any rights here: when to marry, with whom to marry, at what age, if they want to have children or not and how many children. It all depends on husbands or family-in-law's decisions," says Samita Pradhan, executive director of Women's Reproductive Rights Program. Pradhan is calling on the government to focus more on prevention. "Just giving medical services will not control or solve the problem," she says.
The government says it is dealing with the issue. But as one of the poorest countries in the world (it has a per capita GDP of $1,500), resources are limited. Over the next year, the government will provide 10,000 women with pessary rings that can be inserted to support the uterus. Another 5,000 women will get surgical treatment. But hundreds of thousands of women will be left to suffer with their wombs hanging from their bodies. And these measures do nothing to help women like Kalasi Devi, whose husband won't let her get help even though she qualifies for free surgery. "We already have one son, but he wants one more, so no operation. He says: 'After having more babies, you can have the operation.'"