Consequences of heavy carrying and uterine prolapse prevention - support and behavior change for women's health in Nepal

©Akina Shrestha

Project description

In most of the countries of the Global South, women in particular spend a lot of time and energy every day to get water and food for their families and animals. This is also the case in Nepal. The frequent physical stress of carrying heavy loads (water, animal feed, stones, wood) implies a risk for musculoskeletal disorders and reproductive health. According to the United Nations Population Fund (UNFPA), one in ten women in Nepal is affected by pelvic organ prolapse. Organs sink into the vagina and emerge from it in an advanced stage.
In a pilot study (2019), our research group, together with researchers from Kathmandu University Hospital and Eawag, found that Nepalese women carry an average of 19 kg of water and 35 kg of other loads (wood, animal feed) per time and that lifting and putting loads down when carrying are not very ergonomic.
We identified low self-efficacy (belief that behavior cannot be organized and carried out with one's own resources) and lack of social support as reasons for unsafe carrying behavior.

Enabling hypothesis:

The prerequisite for being able to carry out a health behavior is that it is subject to your own decision-making power. Especially in socially disadvantaged populations, socio-structural barriers such as gender-specific social expectations reduce the effective and perceived control over health behavior. According to the enabling hypothesis, one possibility of overcoming barriers is to be found in social support. Social support therefore helps to cope with environmental requirements and additionally strengthens the self-efficacy of the supported person.

©Valérie Bösch

Women lift safely - An intervention study to reduce the risks of heavy lifting

In the Women Lift Safely! Intervention study (2021-2022, n = 300) we aim to increase safe carrying behavior to reduce health risks of heavy lifting (i.e. reducing weight and using safe lifting techniques).

We want to test whether greater self-efficacy in women leads to safer carrying behavior. Furthermore, the enabling hypothesis is to be tested for the first time in this context.

Three villages in Nepal affected by the problem are randomly assigned to one of three intervention groups in a parallel group design: individual self-efficacy promotion, self-efficacy promotion + social support from a social partner, information only control group.Self-efficacy is induced by the sources of self-efficacy promotion: experience of success, vicarious experience (model learning), verbal persuasion and positive emotional state during behavioral performance. The intervention groups receive behavior change techniques to increase self-confidence and model learning. 


Kavre and Sindhupalanchowk District, Nepal


Suzanne and Hans Biäsch Foundation for Applied Psychology

Eawag: The Water Research Institute of the ETH Domain

University of Bern

Research team:

Dr Akina Shrestha (Kathmandu University Hospital; Kathmandu University School of Medical Sciences), Vica Tomberge (University of Bern), Regula Meierhofer (Eawag), Prof. Dr Jennifer Inauen (University of Bern), and Janine Bischof & Melanie Bamert (University of Bern)


Dr Helena Luginbühl (Physiotherapy, BFH), Dr Anjana Singh Dangol (Obstetrics & Gynaecology, Kathmandu University Hospital), and Dr Richa Amatya (Psychiatry, Kathmandu University Hospital)


Tomberge, V. M. J., Shrestha, A., Meierhofer, R., & Inauen, J. (2021). Understanding safe water‐carrying practices during pregnancy and postpartum: A mixed‐methods study in Nepal. Applied Psychology: Health and Well-Being, aphw.12325.

Tomberge*, V. M. J., Bischof*, J. S., Meierhofer, R., Shrestha, A., & Inauen, J. (2021). The Physical Burden of Water Carrying and Women’s Psychosocial Well-Being: Evidence from Rural Nepal. International Journal of Environmental Research and Public Health18(15), 7908. (* shared first authorship)