Uterine Prolapse, Mobile Camp Approach and Body Politics in Nepal

Topics: Childbirth, Health care, Health Pages: 10 (6924 words) Published: May 29, 2014
Dhaulagiri Journal of Sociology and Anthropology Vol. 4, 2010

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22 | Madhusudan Subedi
1. Introduction

Uterine Prolapse, Mobile Camp
Approach and Body Politics in Nepal
Madhusudan Subedi
Various studies show that more than 600,000 women in Nepal are suffering from prolapsed uterus and that 200,000 of those needed immediate surgery. Many of the women with prolapse could recall the exact moment they first felt the prolapse and found difficulty to share the problems due to fear of stigma. Stories ranged from seven days immediately after the first delivery to after the birth of the fifth or sixth child; during cooking rice to sneezing and long coughing; fetching water in a big bucket to working in the field. If detected at an early stage, uterine prolapse (UP) can be controlled by pelvic exercises. For severe cases, the remedy is to insert a ring pessary to stop it from descending which has to be changed every four months. In extreme cases, uterine tissue protrudes from the vagina causing extreme discomfort. The only remedy is

hysterectomy in which the uterus is surgically removed. The
operation costs are about NRs 20,000. The Government of Nepal and other donor organizations have allocated funds to provide services to about 10,000 to 12,000 women suffering from uterine prolapse as humanitarian support each year and services are likely to be expanded in future. Women suffering from UP have not been able to get benefit from such assistance due to deep rooted sociocultural perceptions and practices. The number of suffering women, on the other hand, would not decrease from existing

curative management policy without hammering the root causes of UP. Moreover, a clear vision and strategy is needed to shift from humanitarian aid to a more sustainable public health intervention. Keywords: Camp Approach, Humanitarian Aid, Socio-cultural

Practices, Sustainable Policy, Uterine Prolapse

Although the women’s health agenda has been largely defined by biomedicine and public health, anthropology has much to offer in terms of defining and understanding women’s health from the perspective of women themselves (Inhorn, 2006). And the health problems, be it among men or women, cannot be separated from the larger social, cultural, economic, and political forces that shape and constraint human life. This paper examines the prolapsed uterus, one of the major reproductive health problems of women in Nepal, and the short term camp approach, perception of UP and different body part of women in the local context. Furthermore, it also tries to offer some policy issues for sustainable public health intervention.

UP is a condition in which a woman’s supportive pelvic muscles, tissues and ligaments break away from the body’s internal structure and the uterus, rectum, or bladder drops into or out of the vagina. The condition is mainly due to insufficiency of the pelvic floor and consists of herniation of an adjacent pelvic organ into the vagina. UP is usually classified into 4 anatomical stages, corresponding to the severity of the condition. For the first stage, the uterus leaves its place but is still inside the vagina. In the second stage, the uterus leaves its place and comes up to the opening of the vagina. For two lower stages (I and II), conservative management

including pelvic floor muscle training or ring pessary insertion are considered the best options (UNFPA and Sancharika Samuha,
2007). A ring pessary is a plastic or rubber device that is inserted into the vagina, which holds the uterus. After a health worker inserts this into the vagina, there is no need to do anything for three months. Every three months, it has to be taken out, cleaned

properly and inserted back after boiling in hot water. If a woman becomes pregnant while the pessary is inserted then it must be taken out in a health institution. The ring pessary cannot hold the uterus in a situation where the uterus is fully out.

When the uterus comes out...

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