Women's Reproductive Rights Program (WRRP)

Empowering women to demand respect for their sexual and reproductive rights & tackling the root causes of uterine prolapse in eastern and western Nepal 

Approach

The Women’s Reproductive Rights Program (WRRP) addresses uterine prolapse as a reproductive rights concern, beyond a mere medical problem. In so doing, it tackles the root causes of the problem—prevailing patriarchal attitudes and the subordination of women—to effectively diminish the number of future cases and to enable women already living with the conditions to manage it with dignity. 

As part of its overarching human rights-based and preventive approach, WRRP engages in a number of activities to empower women to obtain preventive and curative treatment, and to advocate for the formulation and implementation of comprehensive policies for managing uterine prolapse. The program is built on two decades of experience in tackling uterine prolapse, making CAED one of the pioneering Nepali NGOs to work on the issue. CAED is widely considered to be a leading authority in this area, both among domestic as well as international partners, and has collaborated with organisations such as Amnesty International and Al Jazeera to bring the issue to light and call for action to eradicate it. 

What is Uterine Prolapse?

Uterine prolapse occurs when the muscles of the pelvis no longer support the uterus, which descends from its natural position until it eventually comes out of the vagina. The condition is painful and debilitating, and women who experience it are stigmatized and often considered unworthy. This is largely because it makes it impossible for them to continue to perform the heavy physical labour that is expected of them around the house and on the family farm—demands which, ironically, are a major cause of the problem in the first place.  Since it is commonly believed that women may not refuse to have sex with their husbands in more remote areas of Nepal, the fact that the condition makes sexual intercourse very uncomfortable or difficult further contributes to the view that women who have developed it are unworthy. 

Uterine prolapse occurs at alarming rates within Nepal. Although it is difficult to measure its prevalence, the majority of studies indicate that at least 10% of Nepali women suffer from the condition. A study conducted by CAED in 2007, however, showed that up to 42% of women may be living with the affliction in more remote districts of the country.  

The causes of uterine prolapse include:

  • Premature pregnancies
  • Too many births
  • Short time periods between births
  • Malnutrition / denial of access to nutritious foods
  • Harmful birthing practices (in particular, excessive downward pressure on the abdomen)
  • Strain on the pelvic muscles caused by heavy physical labour, which women are also expected to carry out soon after birth

When considering the factors that contribute to the condition, it becomes clear that the root causes of uterine prolapse are the subordination of women and prevailing patriarchal structures. For example, many of the causes are the result of a denial of women’s rights to make family planning decisions, or of harmful traditional practices that discriminate on the basis of gender, such as the dietary restrictions that are imposed on women during their menstruation or the social expectation for mothers to serve their husbands and children first before eating themselves. CAED has deliberately adopted a strategy to tackle these root causes of the problem with a view to putting in place the most sustainable solutions. 

Activities

WRRP comprehensively addresses the challenges posed by uterine prolapse through a multi-pronged strategy of advocacy, capacity-building and empowering activities. 

Firstly, a number of WRRP’s efforts are aimed at empowering women already affected by the condition and those at risk of developing it to assert their own rights. One of the program’s core activities is the training of local women’s health rights activists, to give them the tools to educate primary stakeholders on the causes, consequences and prevention of uterine prolapse. These trainings are mainly aimed at mothers and pregnant women, but also include married couples, husbands and adolescents, to ensure that entire communities are sensitised to the underlying causes of the condition. CAED further supports the establishment of local Reproductive Rights Forums, which create an opportunity for women to take charge of their own advocacy measures at the community level. 

In addition, WRRP takes a number of measures to ensure that women have access to quality treatment and healthcare services, so that individual cases of uterine prolapse can be treated or worsening of the condition prevented. This is primarily achieved through the training of government healthcare workers in preventive and basic curative aspects. Support (financial and other) is equally given to women with advanced stages of uterine prolapse to obtain surgical treatment. For such women, surgery is often the last remaining treatment option that can restore their basic functionality and dignity. 

Finally, WRROP advocates for the rights of women who have already been affected and those at risk of developing uterine prolapse at the local, district, provincial and national level. This helps to create accountability for the formulation and implementation of effective policies to tackle uterine prolapse. 

Principles Underpinning WRRP Activities

  • A sustainable solution to uterine prolapse can only be found if the underlying subordination of women and prevailing patriarchal mind-sets can effectively be addressed
  • Grassroots solutions need to be developed by empowering activists and role-models at the community-level
  • There needs to be close collaboration with government officials and public healthcare providers, in order to institutionalise reproductive rights
  • Boys and men, as well as other influential members of local communities, should be involved in efforts to understand and develop solutions to the problem, including the mainstreaming of principles of gender equality
  • Efforts to tackle uterine prolapse should be redoubled by joining forces with community-based, national and international partners.

Location

Province 1

Province 2

Province 6 – Karnali

Videos

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