Clad in a chaubandi cholo, a blue pote around her neck, a woman holds a sickle over her head and carries a huge pile of grass. This is an acrylic painting inspired by a woman from Rukum by Miriam E Krantz, an American nutritionist who has been working in Nepal for about 50 years. If not grass, women are seen carrying firewood, a gagri of water, a doko or a sack of grain. Sometimes, there is even a small child bound tightly to their bosom. These are only the most visible of all the loads, both literal and metaphorical, that Nepali women carry. Though such burdens highlight both the strength and subjugation of Nepali women, the latter far outweighs the former. The consequences of carrying heavy loads often manifest in viscerally real ways; one of which is pelvic organ prolapse or uterine prolapse, a condition in which the muscles of the pelvis are strained to the point where they can no longer support the uterus, which begins to slide downwards, eventually falling out of the vagina.

A UN estimate suggests that 10 percent of Nepal’s 13.6 million women suffer from uterine prolapse.  Most Nepalis develop the condition in their 20s unlike in other countries where the problem is more common among older women. A 2013 study by the Ministry of Health and Population and the UNFPA found that Nepali women rested for an average of 20.4 days—half the government’s recommended six week period—following the birth of a child, after which they noticed signs of prolapse. In the hills and mountains, women resume heavy physical week two or three weeks after giving birth. In the Tarai, 34 percent of women resume heavy work after just a week of birth. Uterine prolapse has, thus, been directly linked to women “carrying heavy loads” and “not taking rest”. These women are not in positions to protest; their socio-economic conditions often demand that work be resumed as soon as possible.

While the Health Ministry’s programme to provide uterine prolapse surgery free of charge is commendable, it is not without flaws. Health workers have been found violating protocol and performing over five uterine prolapse operations a day. Operations are also performed on women under 40 years, who should not have their uterus removed unless critical to health. Most important of all, there is a complete absence of initiatives to prevent prolapse in the first place. The problem of a fallen womb is not merely a health issue; it is one of persistent discrimination against women. Special programmes must be devised to encourage family members to share household responsibilities. A draft strategy to prevent uterus prolapse, pending in the government since 2008, must be finalised and implemented. In the long run, initiatives concerning reproductive health must target husbands, male members and children of the family.