Katie Baczewski

Katie Baczewski (Care Women Nepal): Originally from the Seattle area, Katie earned a BA from Scripps College in Claremont, California. Prior to her fellowship she worked in the Dominican Republic and South Africa and served as a Peace Corps volunteer in Burkina Faso, where she developed a deep interest in family planning and maternal health. Katie was studying for an MA in law and development at the Fletcher School, Tufts University, when she was deployed to Nepal. After her fellowship she wrote: “.I got to be at the ministry of health, talk to the Prime Minister, speak with UNFPA, leading gynecologists, watch the surgeries take place, tour the hospital, talk to journalists in Dhankuta, attend the health camp, and speak to rural women in their home villages. This really gave me a complete picture. This fellowship (also) built on some of the skills that I had already built during Peace Corps - flexibility, adaptability, and learning how to change directions. I also gained some valuable practice writing grant proposals and developing program outlines.” kbaczewsiki@advocacynet.org



What is uterine prolapse?

15 Jun

This summer I am working with Care Women Nepal, an NGO which is currently organizing health camps to treat women with uterine prolapse. It seems a good place to start in talking about our work to start with the question, What is uterine prolapse? 

This is a more complex question than it may seem, as this is a medical condition which has, at its root, all kinds of societal causes. I will start by explaining the condition itself and the situation in Nepal. Throughout the summer and this blog I will continue to reflect upon and explore the socio-cultural roots of prolapse. 

Uterine prolapse is a condition in which the pelvic muscles are so severely weakened or damaged that the uterus of a woman slips. There are three degrees of prolapse, with the first stage being the initial shifting of the uterus, the second being the point at which the cervix protrudes into the vulva, and the third stage occurring once the cervix extends beyond the vaginal canal (in this stage it is even possible for the uterus to completely leave the vagina).

The first stage of prolapse can be treated with exercises of the pelvic muscles, the second stage can be treated with insertion of a ring pessary, and the most severe cases can only be treated with surgical intervention – often a hysterectomy. The physical effects of prolapse vary from woman to woman and with the severity from of the condition – from general discomfort and cramping to trouble lifting, sitting, walking, urinary problems, pain during sex, and odorous discharge. These symptoms not only cause physical suffering to the women who experience them, they also can lead to them being rejected by their husbands, families, and communities.

The most commonly cited causes of prolapse include the lifting of heavy loads (which is normal day-to-day work for many Nepalese women – especially in the rural areas), as well as the continuation of work during pregnancy and the return to it shortly after giving birth. Other identified causes include delivery at home either without any attendant or with an unskilled attendant. These unskilled attendants often apply pressure on the abdomen inappropriately during labor. Further factors include malnutrition, high birth rates and giving birth for the first time at a young age. 

Though uterine prolapse does occur in women all over the world, it is seen in much greater numbers and in much younger woman than is average in Nepal. Although the treatment for prolapse is relatively easy and inexpensive, many Nepalese women do not seek treatment due to the stigma and embarrassment associated with the condition, or because they simply don’t know that their condition can be treated.     

Estimates have ranged on how many women suffer from this condition in Nepal – a government report suggested that 6% of women of reproductive age were affected, but one study in an eastern province found 42% of women to be affected. One of the most commonly cited statistics comes from UNFPA’s 2006 study which found that 10% of women in the kingdom of Nepal suffer from uterine prolapse. A calculation estimated the number of women thus afflicted at 600,000, with 200,000 urgently in need of surgery. 

According to UNFPA’s 2006 Reproductive Morbidity study in Nepal, the mean number of years women with prolapse had been suffering from the condition was found to be 7.89 years, although some had been suffering for 20-30 years. 14% of women had experienced prolapse before the age of 20, and 44% before 30. By comparison, this disorder is most commonly associated with post-menopausal women in the West. Importantly, because of the stigma associated with this disorder and thus lack of reporting, it is suspected that the picture may be even worse than the one painted by these numbers. 

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This summer I am working with Care Women Nepal, an NGO which is currently organizing health camps to treat women with uterine prolapse. It seems a good place to start in talking about our work to start with the question, What is uterine prolapse? <\/span><\/p>\n\n

This is a more complex question than it may seem, as this is a medical condition which has, at its root, all kinds of societal causes. I will start by explaining the condition itself and the situation in Nepal. Throughout the summer and this blog I will continue to reflect upon and explore the socio-cultural roots of prolapse. <\/span><\/p>\n\n

Uterine prolapse is a condition in which the pelvic muscles are so severely weakened or damaged that the uterus of a woman slips. There are three degrees of prolapse, with the first stage being the initial shifting of the uterus, the second being the point at which the cervix protrudes into the vulva, and the third stage occurring once the cervix extends beyond the vaginal canal (in this stage it is even possible for the uterus to completely leave the vagina).<\/span><\/p>\n\n

The first stage of prolapse can be treated with exercises of the pelvic muscles, the second stage can be treated with insertion of a ring pessary, and the most severe cases can only be treated with surgical intervention \u2013 often a hysterectomy. The physical effects of prolapse vary from woman to woman and with the severity from of the condition – from general discomfort and cramping to trouble lifting, sitting, walking, urinary problems, pain during sex, and odorous discharge. These symptoms not only cause physical suffering to the women who experience them, they also can lead to them being rejected by their husbands, families, and communities.<\/span><\/p>\n\n

The most commonly cited causes of prolapse include the lifting of heavy loads (which is normal day-to-day work for many Nepalese women – especially in the rural areas), as well as the continuation of work during pregnancy and the return to it shortly after giving birth. Other identified causes include delivery at home either without any attendant or with an unskilled attendant. These unskilled attendants often apply pressure on the abdomen inappropriately during labor. Further factors include malnutrition, high birth rates and giving birth for the first time at a young age. <\/span><\/p>\n\n

Though uterine prolapse does occur in women all over the world, it is seen in much greater numbers and in much younger woman than is average in Nepal. Although the treatment for prolapse is relatively easy and inexpensive, many Nepalese women do not seek treatment due to the stigma and embarrassment associated with the condition, or because they simply don’t know that their condition can be treated.     <\/span><\/p>\n\n

Estimates have ranged on how many women suffer from this condition in Nepal \u2013 a government report suggested that 6% of women of reproductive age were affected, but one study in an eastern province found 42% of women to be affected. One of the most commonly cited statistics comes from UNFPA\u2019s 2006 study which found that 10% of women in the kingdom of Nepal suffer from uterine prolapse. A calculation estimated the number of women thus afflicted at 600,000, with 200,000 urgently in need of surgery. <\/span><\/p>\n\n

According to UNFPA\u2019s 2006 Reproductive Morbidity study in Nepal, the mean number of years women with prolapse had been suffering from the condition was found to be 7.89 years, although some had been suffering for 20-30 years. 14% of women had experienced prolapse before the age of 20, and 44% before 30. By comparison, this disorder is most commonly associated with post-menopausal women in the West. Importantly, because of the stigma associated with this disorder and thus lack of reporting, it is suspected that the picture may be even worse than the one painted by these numbers. <\/span><\/p>“,”class”:””}]}[/content-builder]

Posted By Katie Baczewski

Posted Jun 15th, 2014