Sita Pariyar had barely recovered from childbirth when her uterus slipped out of her body, making her one of hundreds of thousands of Nepalese women struck by a debilitating reproductive condition.
Sleep-deprived and unsteady on her feet, Pariyar was carrying firewood home to her village in the hilly district of Dhading on the outskirts of the capital, Kathmandu, when she felt her uterus collapse.
“It was painful and terrifying. I had no idea what was happening,” the 25-year-old mother of four said.
Uterine prolapse, in which the uterus or womb descends into and protrudes out of the vagina, usually afflicts post-menopausal women, but 44 percent of cases in Nepal involve women in their 20s, UN data show.
An Amnesty International report blames widespread gender discrimination in the predominantly rural Himalayan nation for the unusually high incidence of uterine prolapse among young women.
“It’s high time it is seen as a human rights issue, not just a women’s health issue,” said Madhu Malhotra, director of Amnesty’s Gender, Sexuality and Identity Programme.
A 2011 Nepalese Ministry of Health survey said uterine prolapse was the “most frequently reported cause of poor health among women of reproductive age,” affecting about one in 10 Nepalese women.
Pariyar, whose impoverished Dalit family lies at the bottom of Nepal’s caste system, had little rest during or after her pregnancies, as she is expected to do everything from cutting wood and feeding cattle, to farming and housework.
By the time she was 20, Pariyar had three girls and faced unrelenting pressure from her husband and his family to give birth to a son.
“My husband would get drunk, beat me and threaten to marry again, all because I couldn’t give him a son,” she said.
When she finally gave birth to a boy four years ago, her relief was short-lived, as two weeks later, she experienced heavy bleeding and her uterus prolapsed shortly after.
As the organ descended into her vagina — often leaking fluid, — sexual intercourse became increasingly painful. When she told her husband about her condition, he hit her and called her “a dirty woman,” magnifying her anxieties.
Deep-rooted social stigma around the condition makes many women hesitant to seek help.
Binda Dhamala suffered uterine prolapse in her 20s. Since then the 49-year-old villager’s condition has worsened to the point where her uterus protrudes so much that it is impossible for her to work, walk or even sit comfortably.
A decade ago, her daughter, Madhuri Thakuri, also had her uterus prolapse.
“Every time I cough, urine seeps out. I am always worried it is going to fall out. It hurts so much and I feel dirty and embarrassed all the time,” said Thakuri, now 28.
Such stories are familiar to Aruna Uprety, a Kathmandu-based expert on Nepalese public health who has spent more than two decades working with uterine prolapse patients.
“It strikes younger women because they are malnourished, married off early and have babies at an age when their bodies can’t handle it. Most of them deliver at home, where traditional birthing practices can also damage the uterus,” she said.
Many women in Nepal do not have easy access to healthcare and rarely get time to recover from childbirth before being expected to work in the fields.
In 2008, Nepal’s Supreme Court called the high incidence of uterine prolapse a violation of reproductive rights and ordered the government to act quickly. The state responded by promoting and funding hysterectomies.
Yet campaigners say surgeries should only be suggested in advanced cases and that a surgery-focused drive may make younger women who are hoping to get pregnant more reluctant to seek help.
Inexpensive alternatives — such as a silicone ring pessary, a device that supports the uterus — or preventive measures are not given their due, Uprety said.
“It is Nepal’s shame that in the 21st century, so many young women are suffering so much,” she said. “And we still don’t have extensive national data so we may only have hit the tip of the iceberg.”