title: Living with pelvic organ prolapse: voices of women from Amhara region, Ethiopia.
abstract: BACKGROUND
  The objective of the study was to explore how women with symptomatic pelvic organ prolapse in a low-income setting explain, experience, and handle the potential practical and social consequences of the condition.
  
  
  METHODS
  An explorative qualitative design was employed using in-depth interviews in the data collection. A total of 24 women with different degrees of symptomatic pelvic organ prolapse were included; 18 were recruited at the hospital and 6 from the community. Fieldwork was carried out in the Amhara region of northwest Ethiopia in 2011 and 2015.
  
  
  RESULTS
  The informants held that the pelvic organ prolapse was caused by physical strain on their body, such as childbirth, food scarcity or hard physical work, particularly during pregnancy and shortly after delivery. Severe difficulties and pain while carrying out daily chores were common among the women. The informants used a variety of strategies to manage their work while striving to avoid disclosure of their condition. Disclosure was related to embarrassment and fear of discrimination from people living close to them, including the fear of being expelled from the household. Most of the informants, however, experienced substantial support from relatives, friends, and at times also from their husband, after disclosing their condition.
  
  
  CONCLUSIONS
  The study highlights how symptomatic pelvic organ prolapse may severely affect women's lives in a low-income setting. The condition is perceived to be both caused by and aggravated by the heavy physical burdens of daily work.
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway. Janne.Gjerde@uib.no.|Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway. Janne.Gjerde@uib.no.
authors.forename: Janne Lillelid
authors.identifier: http://orcid.org/0000-0003-1763-0263
authors.initials: JL
authors.lastname: Gjerde
authors.affiliation: Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.|Research Unit for General Practice, Uni Research Health, Bergen, Norway.
authors.forename: Guri
authors.initials: G
authors.lastname: Rortveit
authors.affiliation: Women and Health Alliance (WAHA) International/Gondar Fistula Center, Gondar University Hospital, Gondar, Ethiopia.
authors.forename: Mulu
authors.initials: M
authors.lastname: Muleta
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, University of Gondar, Gondar, Ethiopia.
authors.forename: Mulat
authors.initials: M
authors.lastname: Adefris
authors.affiliation: Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Astrid
authors.initials: A
authors.lastname: Blystad
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D030881:Disclosure; D005002:Ethiopia; D005260:Female; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000523:psychology; D056887:Pelvic Organ Prolapse / Q000209:etiology / Q000523:psychology*; D011203:Poverty; D011247:Pregnancy; D036301:Qualitative Research; D011788:Quality of Life; D012725:Sexual Behavior; D012944:Social Support; D018454:Spouses / Q000523:psychology; D013240:Stereotyping; D055815:Young Adult
keywords: Ethiopia; Experience; Low-income setting; Pelvic organ prolapse