Being able to manage menstruation safely and without stigma is a basic human right which many women and girls in Nepal are denied. Unhygienic and ineffective menstrual hygiene practices have been linked to negative consequences for women and girls, in terms of both reproductive health and social factors such as school attendance. Negative cultural attitudes and taboos around menstruation are widespread in Nepal and basic knowledge of menstruation and menstrual hygiene, especially in rural areas, is limited. The chapter begins to explore the barriers to menstrual health and right and how menstrual Hygiene Management Projects providing education on menstruation and the provision of reusable sanitary pads, are widely used by Non-Governmental Organisations (NGOs) in Nepal to address these problems, with a stated goal of improving girls' reproductive health, educational performance, employment, reducing gender based violence and other psycho-social outcomes.
TopIntroduction
Menstruation is a natural and regular occurrence experienced by nearly all women of reproductive age. The average woman will have about 450 menstrual cycles over approximately 38 years of her life; this translates to managing menstruation for roughly 6.25 years. However, cultural taboos and stigmatisation of menstruation is almost universal (Crawford et al 2014). Being able to manage menstruation safely and without stigma is a basic human right which many women and girls are denied.
Menstrual Hygiene Management Programmes (MHMP) provide education on menstruation and are designed and implemented by a range of actors, Governmental Organisations (GOs), Non-Government Organisations (NGOs) at both the international (INGO) and national level, and smaller grassroots organisations. Organisations focus on health, gender and/or education and therefore an interdisciplinary approach is needed to review and evaluate the key issues surrounding this topic.
Water Sanitation and Hygiene (WASH) programmes are also an important factor when considering girls and women’s’ rights to menstrual health. Until recent years menstruation was neglected in WASH programmes in South Asia (Bharadwaj & Patker, 2004 cited in Mahon & Fernades, 2010).
Menstrual hygiene needs are often not considered in the design of toilets or waste disposal, or in education manuals or guidelines for health workers and gender mainstreaming. Similarly, whilst affordable production and supplies of soap and toilet construction materials have been promoted by Non-Governmental Organisations (NGOs) for poor communities, the supply of affordable and reusable sanitary pads has not been routinely part of WASH programmes. However, recently there have been reports of organizations such as Oxfam and WaterAid providing case studies and teaching resources focused on the issues of menstrual hygiene using Pakistan and Afghanistan as examples (Shafi 2011; House & Mahon 2014). This chapter will focus on the experiences of menstrual health in Nepal based on our research their working with a number of NGOs and educationalist given our longitudinal connection to Nepal1.
In Nepal, unhygienic menstrual hygiene practices have been linked to negative outcomes for women and girls in relation to reproductive health and social factors such as school attendance (Hennegan & Montgomery, 2016; IRIN, 2010). Taboos around menstruation are widespread while basic understanding of menstrual hygiene is limited, especially in rural areas (Adhikari, 2007; Sapkota, 2013). Menstrual taboos and stigmatisation exist across many countries (WHO 1981) but there is little research on this in the South Asian context. This chapter outlines the current situation in Nepal in terms of attitudes, education and approaches to menstrual health in Nepal and begins to explore the barriers to menstrual health and menstrual rights, the negative impact these barriers can have on women and girls’ everyday lives. Further the chapter presents initial findings from a pilot project evaluating the distribution of reusable sanitary pads in Nepal.