Fallen womb: the hardest burden for a woman to bear.

• Author: Amatya, Sushma

ONE IN TEN MARRIED WOMEN IN NEPAL is estimated to suffer from a fallen womb or prolapsed uterus. This condition occurs when the cervix, along with the uterus, moves down from its normal anatomical position, because the surrounding ligaments are unable to maintain support. A primary cause is unattended childbirth, accentuated by heavy manual labour too soon before or after giving birth. But rarely does a woman know what has happened and why, or that it can be treated. She is often too embarrassed to ask for help.

Nepalese women start carrying heavy loads and doing difficult labour at an early age. They marry young and usually have several childbirths at home without any help, which may stretch the pelvic muscles during long labour. Also manoeuvring by unskilled birth attendants and resuming heavy work immediately after delivery can cause further damage. "Our research shows that some 95 per cent of women in Nepal resume their household work within 45 days of delivery", says Dr. Rajendra Gurung, reproductive health specialist for the United Nations Population Fund (UNFPA). "That's just too soon, as the ligaments are still too soft. Even worse, more than 14 per cent are doing heavy work within seven days of delivery. This is just dangerous! The scale of the suffering is enormous--we are talking of 600,000 women and girls."

One solution has been to bring services through mobile reproductive health camps, where women can be fitted with a pessary ring, which holds back the uterus and prevents it from falling out. The ring, costing about 20 cents, is a practical alternative to surgical repair or uterus removal that cost anywhere between $150 and $250 and is out of reach of the poor rural women. Nirmala Khatri, 21 years old, kept the painful secret of her condition for six years before she gained courage to do something about it. Srimati Limbu, a grandmother, has been living with a hanging pouch-like thing for the past 42 years, and Jaya Maya Suwang, 72 years old, tolerated it for 40 years before finally seeking help. I met them at one such camp in August 2006 in Panchthar, a mountainous district on Nepal's eastern border with India. Their stories illustrate the very difficult life of rural women, whose prolapsed uterus becomes their hardest burden to bear.

Nirmala got married at 14 and gave birth to her first child at 16. "I could feel something coming out like a child's head when I went to the toilet the very day after my child was born", she told...