The accessibility of health services can be broken into three components: availability, affordability, and acceptability. Each of these components can make a treatable, mild to moderate case of uterine prolapse progress to the most severe stage. Overall, accessibility of health services for rural Nepalese is decidedly inadequate.

Availability – The availability of health services in Nepal is extremely limited. Health posts are usually far away from small villages, farms and those who need medical treatment most. According to the government of Nepal, 85 percent of the country’s population lives in the rural areas of Nepal. The people who need the health services the most are often those located the farthest away.

The poor infrastructure of Nepal makes getting to these health services very difficult. The limited options for transport to and from health posts are walking or bicycling. Even making a trip to the health post can be futile, as there are not always treatment options available. Inadequate equipment, supplies, and treatment options force women to have to travel even further to hospitals unless the Nepali government or a NGO is sponsoring a health camp nearby.

The Maoist insurgency in Nepal further limited the availability of health services by targeting health centers, disrupting the already constrained provision of health services. There is a lack of skilled, qualified health workers to staff these health centers. During the insurgency, many were afraid to work at rural health posts, and there are still many who are afraid to return.

Affordability – Rural Nepalese live off of agriculture. Subsistence farmers cannot afford to take time away from fields and labor to travel. The cost of travel alone can sometimes be too much for women suffering from uterine prolapse. The high price of treatment and services effectively limits treatment options. Only the wealthier families can afford skilled birthing attendants or delivery in a health center or hospital.

Surgery for a prolapsed uterus costs about $200, which is out of the question for the majority of women suffering from the condition. Until there are more funded or free surgeries, one-third of women experiencing prolapse who need surgery will not be helped.

Acceptability – Women’s health care, especially reproductive health care, is not a high priority in a society that values males over females. Women are reluctant to discuss reproductive problems due to the stigma and societal taboo of being open about such issues.  When they do discuss such issues, women can be discouraged from seeking out and receiving treatment by husbands, family, and neighbors.

	Bishna Maya Bandari
	Chandmati Pasi