May 28th marks Menstrual Hygiene Day, an opportunity to create more visibility and actions to sensitize people to a normal biological process that is rendered a problem for roughly half the world’s population. Because menstruation is associated with shame, silence, myths and stigma, the needs of many menstruating women remain unmet. They lack the information and support needed to understand this natural process and care for their bodies with ease and dignity. The theme for MH Day 2019, It’s Time for Action, stresses the urgency of concrete actions and transformative changes to improve this public health issue.
The challenge that menstruating women and girls face in Nepal (more prominently in the hills of mid-western Nepal) is rooted deeply in harmful social norms, strongly held religious beliefs and discriminatory practices. Chhaupadi, the practice of banishing menstruating girls and women to huts and animal sheds, is still widespread despite being criminalized in 2017. Penalties for enforcing chhaupadi include a Rs. 3, 000 fine and imprisonment for three months, or both. This seclusion is to contain the menstrual pollution, keeping the house pure and auspicious for the gods that are worshipped inside the home. Along with the seclusion, other exclusions include eating restrictions, cooking restrictions, abstaining from religious activities, not touching men in the family, and not going to school - among many others.
As part of Water Resource Management Program (WARM-P), Helvetas adopts an integrated approach to water, sanitation and hygiene (WASH), within which menstrual hygiene management (MHM) is a key component. Through “blue schools”- a concept of WASH and environment-friendly schools, we engage directly with both girl and boy students as well as teachers, exploring conversations around menstruation and increased access to menstrual health products/services, and creating a safe and enabling learning environment within schools. An earlier blog documents what school girls have to say about this. At the community level, we train government Female Community Health Volunteers (FCHVs) and other interested women as Hygiene Literacy Community Facilitators (HLCF). The training focuses on menstrual hygiene management and ways to break the taboos.
A few weeks ago, I was in Tiyadisthan, Dailekh talking to a group of local women, HLCFs and some young girls about the changes around the observance of chhaupadi in their village. In the past few months, many chhau goth (chhaupadi huts and makeshift shelters) have been destroyed. Although this is positive, it is not a very significant change, as the women now instead move to a small room attached to the outside of their house during their periods. The restrictions remain broadly the same and, in some cases, the myths around menstruation have been further strengthened.
With regular encouragement from a previous Helvetas staff member, Rubika Shrestha, Kamala Karki left her chhaupadi hut to stay inside her house and live a “normal” life during her periods, as described here. This was a huge step for Kamala, but the experience was short-lived. She started having body pains and upon consultation with the jhankri (local shaman), she was told that the pain was inflicted by the gods who were angry at her polluting the house during her periods. Although Kamala didn’t go back to the chhaupadi hut, she now takes to the seclusion of her veranda when menstruating. Like Kamala, other older women have had their belief in the risk of angering the gods reinforced.
Although the older generation seem to be satisfied with what they have achieved in terms of staying closer to their house, the younger generation is not happy. Asmita Bhandari’s family have constructed a small room adjoining the house in which she is expected to stay during her periods.
Asmita Bhandari, Dailekh
Asmita and other younger girls had many questions to ask. Menstruation is a confusing experience for them, shrouded with ambiguity. They know all the restrictions by heart but have no understanding of why they menstruate, or why they feel pain. They have been taught about maintaining hygiene when bleeding and given pads in schools, but they have no idea about the biology of menstruation.
Undoubtedly, the availability of appropriate infrastructure (girls/women friendly toilets, incinerators), products (pads), and services (adequate water facilities) are key to menstrual hygiene management, but this would only be seeing the tip of the iceberg. The main challenge faced by women and girls is less tangible than simple access to these products/services: it is the stigma of being “polluting”. Menstruation-related challenges need to be seen holistically. If we are to leverage the recent focus on menstruation by government as well as non-government actors in Nepal, we need to integrate provisions for hygiene and sanitation with educational initiatives, information and support to understand bodies and functions - an approach that talks about health, behavior change and stigma all together.