Thanks to a number of activist, organization and leaders, the Government of Nepal has constructively moved to address the specific culture and traditions around menstruation.  In Nepal and in other countries where the Swiss Red Cross is working, Menstrual Hygiene Management (MHM) has become an issue.

“Death in a menstruation hut” – this sad news from Nepal was published by BBC on 4 February 2019: 21 year old Bagmati, who was confined by her family to sleep in the menstruation hut, suffocated from lack of oxygen while lighting a fire to keep her warm during sleep. This is not a single case; many more tragic stories around menstruation have appeared in the national and international news in the past.

Despite being declared illegal in 2005 and criminalized in 2017, the tradition of “Chaupadi”, mainly exercised in the Mid-West and Far West regions of Nepal, still exists including different cultural beliefs and traditional practices. In the Chaupadi, menstruating girls and women, and women after child birth are perceived as “impure” and have to follow certain rites and traditions. When girls have their period for the first time, they are not allowed to look into the sun and at male family members. In all cases, menstruating girls and women are excluded from the daily family life in various manners: they are not permitted into the kitchen, not allowed to cook and touch dishes, and are restricted from certain food items, such as cow milk and some vegetables.

They sit separately at meal times and are confined to sleep in a separate shed (so called menstruation hut) or have to sleep separately until the bleeding is over. After five days, they are allowed to take a bath for the first time, and again participate in family life. For girls, the Chaupadi often results in non-attendance at school due to lack of separate toilets for girls, lack of facilities for proper menstrual hygiene management; lack of sanitary pads and proper disposal of menstruation waste.

Traditions such as the Chaupadi, based on religious norms, are fostering exclusion, shame and a certain stigma. However, following the Chaupadi has one advantage: this is the only time for hard-working girls and women in rural Nepal to do less household chores than normal. While at a normal day they work from 4 a.m. to 10 p.m. feeding cattle, sweeping the floors, preparing meals, washing, agriculture etc. they are working mainly outside the main family house and are excused from all duties which involve touching people and food items.

The fact that a women is menstruating is quite obvious in Nepal, all household members know. But dealing with menstruation and menstruation hygiene management is less visible and not addressed openly. Menstruation “pads” are produced in all secret from old sari cloth. The cloths are washed only by the women and are hung in a dark place, not to be seen by other household members or neighbors. Cloths often dry poorly without sunshine and are prone to develop fungus and are contaminated by flies causing chlamydia and vaginal infections. Lack of cloth or pads at school and lack of adequate water, sanitation and hygiene (WASH) facilities force girls to leave school suddenly and staying at home for a few days.

The Nepal Red Cross Society supported by the Swiss Red Cross, implements several Water, sanitation and hygiene projects in two provinces, Karnali province and Province 5 of Nepal. During project implementation in the communities and at school, the issue of menstruation management became more and more pertinent. Results from an assessment done in 2015 in 5 districts of these provinces showed that 21% of schools did not have a separate toilet for girls, 23% had no water in the toilet and almost 30% had no facility to dispose menstruation pads. But how do girls and women deal with menstruation at all? What if it starts at school? Where do pads come from? The project staff was confronted with lots of questions …and decided to embark on the implementation of a menstrual hygiene management component.

“When the Red Cross team came to our school, I volunteered to be part of a youth Red Cross group”, says the 14 year old Kamala. “I did not know what I was getting myself into”, she giggles. The Red Cross team asked us about menstruation, what we do, where we get pads from, where our problems and challenges are. First I was a bit embarrassed, but then I realized, that this is a burning issue.

Only us girls talk among each other, but we get no outside help or ideas. Nobody in our family is interested, how we deal with our periods and if we agree to the traditions and rites. We just do it, as our mothers teach us. I got a lot of information from the Red Cross team. They showed us, and also some boys, how to sew re-usable menstruation pads, how to change them, wash and dry them correctly. And we also discussed the Chaupadi practices. I thought about them, but it is difficult to change traditions all at once, which our elders follow and introduce. One day, something very funny happened. My mother and myself had the period at the same time.

My father works abroad and sends money regularly. I have three much younger brothers. Now, both my mother and myself were not allowed in the kitchen. Nobody could cook for us. My brothers were very hungry and begged us to prepare a meal from them. So I took this opportunity to talk to my mother about the traditions. We decided to take a risk: one of us just has to get into the kitchen and cook. It was me, because my mother thought this will make the Gods less angry. All night we were both awake praying that nothing evil will happen to our family.

The next morning, we realized that all was as it is: no punishments from the Gods. We were both very relieved. Now we are very relaxed during our periods. We both cook and do our household chores. We were even able to convince my father about it. My father also allowed us to keep sleeping in our rooms. During my period, I sleep now in my room on the floor, which is already a big change”.

The Nepal Red Cross team ensures that boys and girls are participating in the classroom sessions on Menstrual Hygiene Management. They learn about menstruation and all what goes with it. The school management and teachers are involved in the teaching on how to sew menstrual hygiene pad. This is a sustainable and ecological solution, made from local material. The school also provides disposable napkins to girls, who start bleeding at school. One of the teachers is in charge of the programme, and she ensures that the disposable sanitary pads are regularly replenished. In order to ensure a safe waste management, the project team constructs gender-friendly toilets with attached incinerators, so that the disposable sanitary pads can be burnt regularly by the school caretaker. Discussions with the Government of Nepal are ongoing on how to make the sanitary pad disposal more environmentally friendly.

Besides the impact in the girls’ personal lives, the project has helped to increase attention and coordination between different partners and key ministries regarding MHM. A national network, the so-called Menstrual Health Management Partner Alliance was founded in 2017 with involvement of all relevant organization working in the areas of MHM. The alliance is active on awareness/advocacy, research and upholding the importance of the topic. The Alliance is considered an advisory network for the Government of Nepal to facilitate and support knowledge management and promoting and improving issues on MHM. The alliance regularly holds exchange meetings, where new initiatives and learnings are discussed. The alliance’s effort culminated in a consultative workshop which brought organizations, policymaker; researcher; public health professional; women and reproductive right activist; adolescent/youth and media together. National and international delegates shared scientific evidence as well as regional and country specific experiences with current strategies and intervention and local initiatives for MHM. The workshop has prepared recommendations on different areas of MHM; learning and education, water sanitation and health, innovation and sustainability, policy and advocacy, research and analysis for future consideration by the stakeholder as well as concerned Ministries in their plan of action for 2019/2020.

The Government of Nepal and the MHM partner alliance hosted the International Menstrual Hygiene day on 28 May 2018 with involvement of different key ministries; Health, Water and Sanitation, Women and Children and Education which expressed a commitment to eliminate and prohibit detrimental and discriminatory practices around menstruation, to support MHM friendly institutions and integrating MHM activities across all sectors.

The Government of Nepal has drafted the National Policy on Dignified Menstruation and an MHM Master Plan (2018-2020) which is in the process of endorsement by the cabinet. Furthermore, the Department of Education with involvement of the MHM expert has reviewed the school curriculum. The MHM Alliance gave their feedback and included age specific content on menstruation.

“We are very happy with these developments” says Raj Kumar Kshetri, Deputy Programme Director, Nepal Red Cross Society Community Empowerment for Health Promotion Programme. We have almost reached 10’000 girls and boys reached so far, and constructed 23 female friendly toilets in schools. Most important, we vested great interest and commitment at ministerial and policy level. Having Government policies on our side, as well as working with the young generation may eliminate discrimination, stigma and traditional practices, such as Chaupadi, forever.”

………………..

Contribution by the Swiss Red Cross, a member of Medicus Mundi Switzerland, to the 2018 Annual Report of the MMI Network

Authors

Monika Christofori-Khadka, Swiss Red Cross, Wabern, Switzerland, Tulasa Bharati, Swiss Red Cross, Kathmandu, Nepal and Anju Gautam, Nepal Red Cross Society, Nepalgunj, Nepal

References and further information