Women's experiences and health care-seeking practices in relation to uterine prolapse in a hill district of Nepal.
BACKGROUND
Although uterine prolapse (UP) occurs commonly in Nepal, little is known about the physical health and care-seeking practices of women with UP. This study aimed to explore women's experiences of UP and its effect on daily life, its perceived causes, and health care-seeking practices.


METHODS
Using a convenience sampling method, we conducted 115 semi-structured and 16 in-depth interviews with UP-affected women during September-December 2012. All interviews occurred in outreach clinics in villages of the Dhading district.


RESULTS
Study participants were 23-82 years of age. Twenty-four percent were literate, 47.2% had experienced a teenage pregnancy, and 29% had autonomy to make healthcare decisions. Most participants (>85%) described the major physical discomforts of UP as difficulty with walking, standing, working, sitting, and lifting. They also reported urinary incontinence (68%) bowel symptoms (42%), and difficulty with sexual activity (73.9%). Due to inability to perform household chores or fulfill their husband's sexual desires, participants endured humiliation, harassment, and torture by their husbands and other family members, causing severe emotional stress. Following disclosure of UP, 24% of spouses remarried and 6% separated from the marital relationship. Women perceived the causes of UP as unsafe childbirth, heavy work during the postpartum period, and gender discrimination. Prior to visiting these camps some women (42%) hid UP for more than 10 years. Almost half (48%) of participants sought no health care; 42% ingested a herb and ate nutritious food. Perceived barriers to accessing health care included shame (48%) and feeling that care was unnecessary (12.5%). Multiple responses (29%) included shame, inability to share, male service provider, fear of stigma and discrimination, and perceiving UP as normal for childbearing women.


CONCLUSIONS
UP adversely affects women's daily life and negatively influences their physical, mental, and social well-being. The results of our study are useful to generate information on UP symptoms and female health care seeking practices. Our findings can be helpful for effective development of UP awareness programs to increase service utilization at early stages of UP and thereby might contribute to both primary and secondary prevention of UP.
Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal. binjwala.shrestha@gu.se.
Binjwala
B
Shrestha
Sharad
S
Onta
Bishnu
B
Choulagai
Amod
A
Poudyal
Durga Prasad
DP
Pahari
Aruna
A
Uprety
Max
M
Petzold
Alexandra
A
Krettek
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008393:Marriage; D008875:Middle Aged; D009390:Nepal; D010342:Patient Acceptance of Health Care; D026684:Personal Autonomy; D012380:Role; D012735:Sexual Dysfunction, Physiological / Q000209:etiology / Q000523:psychology*; D012752:Shame; D057545:Social Stigma; D018454:Spouses; D014549:Urinary Incontinence / Q000209:etiology / Q000523:psychology; D014596:Uterine Prolapse / Q000150:complications / Q000523:psychology*; D055815:Young Adult