30-year old Kopila from western Nepal, had her first child at age 18. Her main plight is that she has lived with uterine prolapse since the birth of her fourth child when she was 24.
She has been prevented from seeking healthcare by her husband, and forced to do hard physical labour during and after pregnancy.
"(When I first developed uterine prolapse) I started feeling back pain and stomach pain and I couldn't stand straight or sit or do work. I feel pain in my lower abdomen and generally I have back pain when I work hard. When I sneeze my uterus comes out," Kopila said while unveiling a report, 'Unnecessary Burden: Gender Discrimination and Uterine Prolapse in Nepal', prepared by London-based Amnesty International.
There are many causes for uterine prolapse, including giving birth at a young age, having many children within a short space of time, inadequate nutrition, lack of access to skilled health workers during labour and being forced to do physical work during or soon after pregnancy.
But at the heart of the problem is persistent discrimination against women and girls that has gone unaddressed by successive Nepali governments.
Amnesty International has concluded that widespread and systemic gender discrimination in Nepal has led to hundreds of thousands of women suffering from a reproductive health condition that leaves them in great pain, unable to carry out daily tasks and often ostracised from their families and communities.
The new report, unveiled Thursday in Kathmandu, stated that uterine prolapse -- a debilitating condition where the uterus descends from its normal position into the vagina -- is rooted in discrimination that has severely limited the ability of women and girls to make decisions about their sexual and reproductive lives.
Harsh working environments, early marriages and having too many children all contribute to the condition, Amnesty International said in its report painting a very gloomy picture of reproductive health condition of Nepali women.
The report is based on extensive field research in Nepal, including interviews with women, girls and men, women's rights activists, medical experts and government officials, the rights body claimed.
Uterine prolapse is a global health problem but particularly prevalent in countries like Nepal where gender discrimination is high and access to healthcare is limited. one estimate suggests that 10 percent of Nepal's 13.6 million women are affected by this condition, and this figure could be much higher in some regions.
Unlike in the rest of the world where uterine prolapse is most common among older women, many Nepali women develop the condition in their 20s.
"This is an urgent human rights issue. Widespread uterine prolapse in Nepal goes back to the ingrained discrimination against women and girls that successive governments have failed to tackle adequately," said Madhu Malhotra, director of Amnesty International's gender, sexuality and identity programme.
There is a complete lack of an overall strategy to prevent uterine prolapse. A draft strategy, which included some elements of prevention, has been pending adoption by the government since 2008 -- an indication of an appalling lack of official attention.
This delay and lack of urgency reflects a lack of coordination and political will amongst relevant ministries in Nepal, who were all unwilling to take full responsibility for uterine prolapse prevention in interviews with Amnesty International.
The government's efforts have mostly focused on providing surgery (predominantly hysterectomies) for late stage cases -- a limited approach that does not do what is required to prevent the condition, Amnesty International said.