Falling wombs – a maternal health crisis in Nepal

By Sanhita Ambast, Amnesty Campaigner

The summer in Nepal’s Kailali district is scorching. The pre-monsoon lands are dry, cracked and dusty, and temperatures soar above 45°C. Schools even change their hours, running from 6-10am  to avoid the worst of the heat.

I’m in Nepal with a team from Amnesty International, researching the prevention of uterine prolapse, a treatable medical condition in which the pelvic muscles are unable to support the uterus, causing the uterus to “fall”. Over the past three weeks, our team has been researching the gender discrimination that underlies this condition across different regions in Nepal, and what the government has been doing to prevent and treat it. We began our research in Kailali, in the Terai region.

Modern day slavery

At 11:00 am on one hot day, our team was outside a community centre in Lal Bhoji, Kailali district. We were waiting to speak to school-aged girls about reproductive health and discrimination. Nearby, a green signboard announced: “Muktha Kamaiya Sahakaari Sanstha”. Loosely translated, it means “Freed Kamaiya Cooperative Society”. Many of the girls we were meeting came from the Tharu (Indigenous) community in Nepal’s south-west known as Kamaiyas, or bonded labourers.

Kamaiya, often described as modern day slavery, is a system of bonded labour prevalent in southern and south-western Nepal. Landless Tharu families, particularly young girls, are forced to work in the houses of wealthier landlords as bonded or indentured labourers to pay off familial debts. Young girls, known as kamlaris, are sold into this system by their families. They are made to work long and hard hours, and are often trafficked and sexually exploited.

In 2002, the government of Nepal passed  the Kamaiya Labour (Abolition) Act, officially “freeing” many kamlaris. Despite its official abolition, many young girls continue this work, and vestiges of the practice remain.

Hard labour

Our team met with 12 girls that afternoon, many of whom were freed kamlaris attending the government school. “When we have no work at home, we go to work at other people’s houses,” one girl told us, describing these homes as belonging to “farmers who have land and are richer”.

The work they do includes  cutting and threshing rice, mixing and carrying cement, and working in construction. They are now paid 150 Nepali rupees (a little over £1) for a day’s work.

What about school work, we asked? “We do homework for three to four hours a day,” they told us, “but we don’t go out to work on the days we have school.”

The girls were consistently cheerful, giggling as they told us about their friends who had eloped and got married young, and curiously thumbing through the health-related information we distributed to them.

According to government data, anywhere between 7% and 37% of Nepali women suffer from uterine prolapse.

Discriminatory social practices, such as early marriage and early pregnancy, heavy work loads (particularly immediately after the birth of a child) and domestic violence, including marital rape, increase the risk of the condition.

Our discussion with the girls gave us valuable insights into the role that schools have in spreading awareness and information about reproductive health – perhaps a first step towards preventing this preventable condition.

This work is supported by the Swedish Postcode Lottery (Svenska Postkod Lotteriet).


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Read our team’s second post from their trip to Nepal.