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Uterine Prolapse Alliance

The mission of the alliance – now composed of 42 members – is to work in a collaborative manner to reduce the prevalence of uterine prolapse amongst Nepalese women of all age groups and diversities, primarily by increasing coordination between various government and non-government stakeholders and by promoting a national consensus strategy on the prevention and treatment of the condition. The alliance hopes to achieve these objectives by raising awareness at the household and community level (through mass media, IEC materials, school curriculums, and professional trainings for health workers), lobbying national and international stakeholders to recognize the urgency of addressing this issue, and increasing access to treatment through surgery camps and a strengthened health care system.  



Uterine prolapse is a reproductive health condition burdening hundreds of thousands of women in Nepal (see the joint report by UNFPA and TU Teaching hospital, Kathmandu, for more on this and other reproductive morbidities in Nepal). A recent report by the UNFPA found that 600,000 women in Nepal suffered from prolapse, and that 200,000 of those needed immediate surgery.

Further academic research is emerging to chronicle the extent of the problem. A 2004 study conducted by Bonetti et al. found that one out of four women who had presented to a clinic with gynecological complaints received a diagnosis of uterine prolapse.  Of the women who were diagnosed, 37.5 percent of those reported having completed only one pregnancy before the onset of symptoms.

A study by Bodner-Adler et al. in 2007 examined the risk factors contributing to the high prevalence of uterine prolapse in Nepal. Many of those factors--such as the continued heavy work that women perform while pregnant and soon after delivery and lack of access to trained birth attendants--can be linked to conditions of rural life in Nepal.  

In August 2006, in response to the growing evidence of the problem of uterine prolapse and other reproductive health conditions in Nepal, the Second National Conference on Safe Motherhood brought diverse stakeholders together from across Nepal to address the situation. At the urging of the Women's Development and Unity Centre (RUWDUC), Centre for Eco-Agriculture Development (CAED), and COSAN (among other organizations), separate sessions were scheduled at the conference to discuss uterine prolapse. From these special sessions emerged the impetus for the Uterine Prolapse Alliance (UPA): a coalition of committed organizations, individuals and experts dedicated to improving the prevention and treatment of uterine prolapse in Nepal.

Since its founding in 2007, the UPA has continued to hold bi-annual coalition meetings to promote a unified plan forward for the prevention and treatment of uterine prolapse; additional trainings and workshops have been organized to advance the skills and increase the coordination of all members.  Delegates from the alliance have approached relevant authorities on the regional and national level to lobby for the cause of Nepali women affected by uterine prolapse, and a successful media campaign has helped saturate TV, radio and print media with information about the condition.  

The alliance has sponsored various educational activities to promote awareness about the condition, including trainings for community activists in the areas of Reproductive Health and Rights, Psycho-Social Counseling, etc. Because the UPA frames uterine prolapse as a product of the social environment and an issue of reproductive rights (not just a biomedical concern), they have also organized workshops for concerned NGOs on Gender and Sensitivity and the relationship between gender issues and uterine prolapse. 

To support victims of uterine prolapse and promote awareness of the condition among other women, the UPA has sponsored 41 groups for women suffering from prolapse. From these groups, 802 women have come together across Nepal to discuss their condition and conduct outreach activities for other women.

• Reports:

The CAED, a leading member of the alliance, has produced a Uterine Prolapse Study Report based on a survey carried out in two districts to map the prevalence and characteristics of uterine prolapse in the region.

• Advocacy Project News Bulletins:

Uterus Damage Condemns Women to Sickness and Stigma in Rural Nepal, August 2, 2007

• Blogs:

Collaborating NGOs:

Center for Agro-Ecology and Development (CAED) Women's Development and Unity Centre (RUWDUC) COSAN Safe Motherhood Network Federation ADRA-Nepal Britain Nepal Medical Trust (BNMT) Center for Research on Environment Health and Population Activities(CREHPA) Doctor’s Wives Association Family Planning Association-Nepal Forum for Women on Legal Development (FWLD) Helping Hands, Nepal HSSP-GTZ INF-Nepal Kirtipur Volunteer Society Merlin-Nepal Public Health Development Center (PHDC) Phect-Nepal/Kathmandu Model Hospital Rural Health Development Program (RHDP/SDC) RHEST

Rural Self-reliance Development Center (RSDC) Saathi Sahabhagi (Darchula District Hospital) Sancharika Samuha SOWD Women’s Rehabilitation Center (WOREC) NeSOG Samaj Sewa Samiti Dalit Mahil Sangh Everest Memorial Youth Club Samudayik Bikas Manch Watawataran Samrakchhan Kone Laligurans Watawataran Samrakchhan tatha Swastha Sewa Kendra Matighar Daiya Samuha Dalit Janjagaran Sewa Samiti Gaunle Jagaran Samaj Janchetana Dalit Sangam

Through couple-facilitated counseling sessions and other public education campaigns, motivators from the UPA have so far encouraged over one hundred women to go forward and seek hysterectomies for the treatment of uterine prolapse; a similar number of women with second degree prolapse have been provided with ring pessaries to prevent progression of the condition.  The couple-based facilitating method has proven to be effective in making uterine prolapse an issue that both men and women can discuss openly.

Campaigners have motivated an additional 250 women to report to health centers for reproductive health check-ups, suggesting that the work of the alliance has contributed to a healthier social environment in which women can take charge of their own reproductive health.  Activists have also noted the effect of educational efforts on men’s awareness and men’s attitudes, and have reported incidences of some husbands taking their wives to health posts for check-ups and diagnosis. 

Evidence of social change is apparent in the behavior of the UPA local motivators themselves, who are reporting greater ease in discussing sensitive issues of reproductive health and gender with both men and women, and who have built the confidence to approach politicians and figures of importance regarding the campaign

The alliance has also successfully lobbied regional health centers to allocate budgets to specifically address uterine prolapse, and the national government has committed to hosting 25 surgery camps throughout the country for the treatment of the condition.


Contact:
e-mail Samita

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