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Unheeded Agonies Women's Reproductive Rights Program (WRRP)

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Unheeded Agonies Women's Reproductive Rights Program (WRRP) 1 2 Please purchase 'e-PDF Converter and Creator' on http://www.e-pdfconverter.com to remove this message. Published by Unheeded Agonies Women's Reproductive Rights Program (WRRP) A Study of Uterine Prolapse Prevalence and it's Causes in Centre for Agro-Ecology and Development (CAED) Siraha and Saptari Districts, Nepal Post Box 4555, Kathmandu, Nepal Phone: 0977 1 6632942 Email: [email protected] September, 2007 Citation: Pradhan, S. 2007. Unheeded Agonies - A Study on Uterine Prolapse Prevalence and it's Causes in Siraha and Saptari Districts. Women's Reproductive Rights Program (WRRP), Centre for Agro-Ecology and Development (CAED), Kathmandu, Nepal. Supported by Fastenopfer-The Swiss Catholic Lenten Fund Luzern, Switzerland. www.fastenopfer.ch Photoes by Women's Reproductive Rights Program (WRRP) WRRP/CAED Center for Agro-Ecology and Development (CAED) Kathmandu Cover Design by 2007 Pramod Dahal with friends Cover Sketch by Anonymous Layout Design by Bimal Bogati 3 4 Please purchase 'e-PDF Converter and Creator' on http://www.e-pdfconverter.com to remove this message. Acknowledgement Executive Summary On behalf of WRRP/CAED, I would like to thank the respondents, who, despite their busy time, provided hours of their valuable time to Reproductive morbidity is one of the major problems faced by Nepali tell us about their problem to make us understand their situation women. Uterine Prolapse (falling of womb) is one of the poignant issues better. This research is dedicated to them. Special thanks go to the of reproductive health. It is a consequence of multiple pregnancies intertwined with abject poverty and discriminatory practices against enumerators Ambika Devi Chaudhary, Bhikni Devi Chaudhary, women in the society. Based on two districts of eastern terai, this Sapeta Urau, Eklas Mahara, Devanti Devi Bhagat, Amkula Yadav, research seeks to understand the relationship and its intensity amongst Asha Kumari Chaudhary, Sabita Kumari Singh, Bina Devi these components. Chaudhary, Chanita Chaudhary, Meenadevi Koirala, Gita Devi Ram, Ranjita Chaudhary, Nirmala Chaudhary, Shanti Devi Ram, Arhul With a total population of some 53,000 and 60,000 in Siraha and Saptari Devi Mandal, Tirtha Maya Mandal, Safala Neupane, Beli Devi Ram districts respectively, a total of 24 VDCs in Siraha and Saptari districts and Bhola Bishwakarma, who went door to door collecting were selected for the study area. It is inhabited by Dalits, Tharus, information facing a variety of situations - not always pleasant, using Muslims, Brahmins and Chhetris. Survery areas were chosen based on local languages, knowledge and contacts. the density of dalits and indigenous peoples. A little more than 60% of Tharus and 40% of dalits of their total population were incorporated in I appreciate the contribution of my colleagues at WRRP - Moti Rai, the study. Enumerators could speak Maithili and Tharu that are the Ram Kumari Chaudhary and Chhatra Tembe without whom the most widely spoken languages of the area. The economy is whole idea would not have gone into action. Special thanks go to predominantly agricultural with significant number of agricultural the partner organizations from Siraha and Saptari districts for their laborers. The districts score low in human development and gender every efforts including logistical support during the survey period indices. (names in Annex III for lack of space here). The survey covered a total of some 2,300 households, (that is just We are very much thankful to Tej Adhikari, who helped in under 10% of districts total population), where married women were processing and analyzing the data using SPSS package and Teeka respondent from the age group of 16 to 60 years representing different Bhattarai, who constantly encouraged and supported us by social groups, including dalits, indigenous groups (janajati), Brahmins providing his comments and suggestions during research and report and Chettris. The c lustered stratified sampling method was used to writing. ensure representation of different ethnic groups. We wish to thank Cherry Bird and Nicole Farkouh for editing English Uterus (or uterine) Prolapse (UP) is widespread chronic problem as well as for their comments and suggestions on the report. amongst women - an ignored major public health issue in Nepal. UP is defined as falling of the womb, when the muscles of the pelvis are We like to thank the all the audience who took interest and gave strained to a point where they can no longer support the positioning of input on the report during the presentations of findings of the the uterus. The uterus drops from its normal position in the pelvic cavity, research at various occasions. descending into and eventually, in extreme stages, out of the vagina. It Finally, we would like to thank Rene Wuest of Fastenopfer - The is a progressive condition that typically occurs in post menopausal women in most countries. However, it can also occur in younger women Swiss Catholic Lenten Fund, who helped making this research (SMNF, 2005) which happen frequently in Nepal. possible and gave WRRP/CAED an opportunity to bring out the findings on uterine prolapse on the discourse of gender issues and For women living with uterus prolapse, life’s basic activities are a the public health. challenge. Urinating, defecating, walking, standing and sitting are Samita Pradhan difficult and painful. Despite the occurrences being alarmingly common, Principal Investigator the women who suffer are awfully (kept) silent. Many women believe (Member-Secretary of the Board) (or made to believe) that reproductive health problems are women’s fate September 2007 and falling of uterus is part of being a woman. It is not known what portion of country's women exactly is suffering from what level of uterus prolapse in what geographical settings. Literature 5 6 Please purchase 'e-PDF Converter and Creator' on http://www.e-pdfconverter.com to remove this message. indicates in the range of 9% to 35% at varying degrees are suffering from it. It used to be believed that women in the western hills of Nepal Apparently, the role of education has been found to be quite strong in suffer from prolapsed uterus more than the women in other parts of the the study: almost all the women who were illiterate were suffering from country. One of the objectives of this study was to enumerate the UP. Women who do not have access to education are more prone to intensity and map the distribution of prevalence of uterine prolapse in prolapsed uterus. the study area. The specific objectives of the study were: 95% of the women gave birth without trained assistance. Although some To find out the prevalence, characteristics and factors causing of the women reported being subjected to pressure for expelling uterine prolapse in Siraha and Saptari districts. placenta and being affected by UP afterwards, no clear conclusion if this To test the following assumptions regarding UP, for a better is an important cause of UP could be drawn. Available national and understanding: international studies albeit limited state one major cause of uterus • Prevalence of UP is lower in more accessible areas. prolapse is intra-abdominal pressure during child delivery. • Patriarchy is a root cause of UP. • Poverty and ethnic background affect UP prevalence Just over 75% of the women with UP reported occurrence while lifting or • Frequent child bearing is an important factor of UP. carrying heavy loads, collecting water, chopping firewood, husking and pounding rice. They also mentioned its occurrence immediately after The nature of the research is exploratory and descriptive. The study childbirth. Heavy workload appears to be the most direct cause of UP, was carried out through mainly qualitative and few quantitative which points to a need for information and gender education within questions. Since uterine prolapse is a socially sensitive issue, local families. This indicates that lack of attention to women’s health needs, bilingual women were mobilized in support of local organizations. aggravated by discriminatory practices is a root cause of UP. Findings Over a half of the women first discovered (realized to have come out) An average prevalence of uterine prolapse in Siraha and Saptari was UP when squatting although there is no enough evidence that squatting found to be 37%, Saptari with an astonishing figure of 42%, higher than attributes to UP. It does nonetheless suggest that working in squatting any other district studied by CAED. The findings of this study therefore position is not good for women. challenge the widely held 'belief' that UP is not highly prevalent in the terai, compared to western hills. It strongly indicates a high prevalence It is not that women do not speak out about their problem. Over half of of UP in all parts of Nepal whether it is hills or terai, or the west or the the women said they did tell their husbands about their prolapsed east. The study shows that women from all social groups suffer from uterus. A 57% of their husbands did not show any reaction to this prolapsed uterus, with those from dalit communities having the highest information. This strongly suggests the lack of concern for a “women’s prevalence in comparison to the terai indigenous groups (mostly Tharu) problem” and the need for a rights based approach to UP, enabling and other terai groups such as Brahmin, Chhetris, Thakurs, Telis and more women to speak and obliging men to listen and support. Halwais etc. Women of all ages including relatively young were found to be affected. Recommendations Uterine prolapse should be considered an important public health issue The hypothesis of multiple and frequent child birth as the major cause of and dealt accordingly. It must be taken as a part of Safe Motherhood UP is not supported by the findings of this study, as a large number of and Reproductive Health.
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