Menstrual Health in Nepal: Challenges and Steps to Eradicate the Issue

This paper reviews the existing issues of menstruation in Nepal, focusing on all the existing causes, sexual and reproductive health problems, challenges, and its overall impact on the health & wellbeing of women. It identifies the gap areas and all the challenges related to policies and programs. The paper concludes that effective interferences must be made into context, design, and employed in order to generate awareness and transform people’s understanding of menstruation and the activities adjoining menstruation.

Abstract: Menstrual health in women is still one of the crucial issues in Nepal. The women
of rural areas still practise old tradition and methods to deal with this issue by going extreme
inhuman conditions. This paper will discuss all the challenges and problems that women in
Nepal face and steps or actions to eradicate this issue.
Objective: The objective of this paper is to review the existing issues of menstruation in
Nepal. It will focus on all the exiting causes, sexual and reproductive health problems,
challenges and its overall impact over the health & wellbeing of the women. It will also
identify the gap areas and all the challenges related to policies and programs.
Methods: The review was prepared by researching all the relevant research paper,
newspaper, websites published between 2013 to 2018.
Key search: Issues, menstrual health, Nepal, chhaupadi, awareness, affects, impact
Study tool: A pre- published research paper and secondary data were taken for analysis.
Results: The results were concluded out of 8 articles. Although 25 paper were selected at the
start of the review but 17 of them were excluded. The practise of chhaupadi is although
outlawed by the Supreme court of Nepal in 2005 but it is still practised in certain parts of the
country. Women blame their society and tradition for continuing this life-threatening practise.
Lack of proper education, government practises, poor knowledge on hygiene health are some
of the reasons of poor menstrual health of women in Nepal.
Introduction:
Nepal is a country in southeast Asia. It has diverse ethnic, cultural and linguistic population.
It is a landlocked country positioned between India and China. Nepal naturally has a very
diverse geography which comprises of mountainous, hilly, and plain terrain. The regions with
difficult terrain lag behind in terms of easy connectivity with other part of the countries.
Education, Economic disparity, Proper hygiene, gender equality etc. are poor in these regions
which further makes people in these regions superstitious. Even though the extent of problem
fluctuates amongst different communities, the standing of women in these rural regions
makes the women second-class people of the social order with less independence, control,
and liberty compared to men. Moreover, shortage of general awareness and education about
their legal and societal rights results them in being oppressed in the name of formal societal
procedure, customs, and traditions.
Practices in relation to Menstruation in Nepal
Chhaupadi is a traditional practice which exists in the remote hilly western part of Nepal in
which women are banished from their home for the duration of their menstrual flow. This
practice is derivative of a tradition that is related to discharges related to giving birth and
menstruation (Aro & Kadariya, 2015). The word Chhaupadi is a derivative of a local word
belonging to the Raute language of Achham district in the western part of Nepal where
Chhau stands for menstruation and padi stands for a woman. Women are thought not to be
pure throughout their periods and are for that reason required to abstain from taking part in
typical everyday activities (Gettleman, sharma, & Bhadra, 2018). It is almost mandatory for
the women to cut off themselves from the family and community then sleep inside a small hut
prepared up of stones and mud devoid of windows and locks, generally known as goth
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(Sapkota, Sharma, Budhathoki, khanal, & Pokharel, 2013). These huts particularly exist 20–
25 meters away from their own residence. The huts measurements are nearby 1×2 m. These
huts are narrow, congested and devoid of doors, which further makes the hut dim, with cold
unclean floors, where women sleep and sit down.
Chhau is seen as being of two types i.e. major and minor chhau. Minor Chhau i.e monthly
mensuration, women live in those huts for around 5 days and in major chhau they live around
11 days. This happens generally after giving birth or menarche. The women bathe, wash-
down their wears, bedcovers, blankets and return to their family (Pokharel & Gurung, 2017).
But, even on the concluding day, women are not permitted to immerse themselves in
community water sources like river and ponds. For that reason, the women involved in
Chhaupadi, wash their wears and bathe in an isolated well or natural water sprouts nearby the
village (Lamsal, 2017).
Chhaupadi is predominantly driven by a superstitious conviction amongst the people that
menstruating phase is impure, untouchable and if women during their mensuration reside
with their family in home, it would enrage the Deities and as a result their rage will adversely
affect the entire family (Parker & Standing, 2018). It is widely believed that if the
menstruating women come in physical contact with livestock, they would die, if they pass by
a source of water for the community it would dry, if they would come in contact with a fruit
tree, the fruits would fall of the tree before it could ripen et cetera. Therefore, they are
expelled from their residence to live in confined huts (Galli, 2017). The women are not
allowed to come in physical contact of their family members, fruit tree, crops and plants. If
the menstruating women accidentally come in contact with something that is forbidden for
her, that which had come in her contact must be purified by holy water (Nelson, 2017). The
women are prohibited from walking in or nearby the premise of worship places, or be present
at any religious rituals, even marriage ceremony, with conviction that they are not religiously
pure during this period. Women are not fed healthy green vegetables, milk, meat, eggs et
cetera rather they are fed rice, salt, along with some cereals or dry foods (ALDAMA, 2018).
The Government of Nepal has recognized youngsters as an underserved, significant
population important in realizing nationwide health and development objectives. In the
previous two decades, there has been a greater than before inter-sectoral cooperative effort to
make and implement schemes to rally adolescent health, stressing on reproductive and sexual
wellbeing (Subedi, 2017). These are echoed through numerous state policies, campaigns, and
strategies. In 2011, the national government, made a program built on the learnings of
previous campaigns to encourage the reproductive and sexual wellbeing of adolescents. The
parliament’s 2005 prohibition of Chhaupadi too indicates the shift of political pledge and
outlooks to improve menstrual cleanliness (Sharma, et al., 2018). The 2015 draft national
policy on adolescent reproductive and social wellbeing appeals for greater than before
participation of the private sector to meet adolescent health requirements. The approach
specially called for incorporating menstrual hygiene and wellbeing mechanisms with
reproductive and sexual education, information on healthy menstrual practices, menarches
and accompanying health benefits along with greater than before availability of menstrual
utilities for instance sanitary napkins, and addressal of menstrual ailments (Sedhai &
Rasheed, 2018).
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What motivated this review: Although there are various research articles on menstruation
issue in Nepal, the was not any systematic review which could contribute in getting clear
picture of current scenario & steps to eradicate it.
Inclusion & Exclusion: Only the recent articles between 2013 to 2018 were selected.
The articles chosen were from authentic source & were published in English. Articles which
mentioned women health issue other than menstruation were excluded. The selected articles
were specifically chosen which discussed the issue of menstruation in Nepal.
Figure: Articles selected for review
Conclusion:
Current evidence discloses that the majority of adolescent women and girls lack
understanding of menstrual physiology. Many of them have mistaken belief on the subject of
menstruation and are forced to follow mentally and physically perilous traditional practices,
for instance not drying reusable sanitary pads in direct sunlight and living out of the house far
away from family in poor surroundings for the duration of menstruation. These ethnic and
traditional practices fluctuate in the context of Nepal. Therefore, adolescent girls, women and
their separate stories ought to be at the pole position of this research. On the basis of the
discoveries, effective interferences must be made into context, design, and employed in order
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to generate alertness and transform people’s understanding of menstruation and the activities
adjoining menstruation. Menstrual Hygiene and Health management also calls for change in
behavior and the progress in an empowering environment. School teaching remains important
to communicate information and expertise on Menstrual Health and Hygiene management to
young women and adolescent women, but present core curriculum and writings deliver
inadequate information on menstruation. Additionally, thwarted by traditional and societal
shames, tutors are unwilling to provide information to students. Therefore, there must be a
combined effort across interested parties to review and bring up to date school core
curriculum to be more complete and address Menstrual Hygiene and Health adequately.
Proper teacher trainings, combined with a consistent and strong monitoring structure, should
be placed to impart education on regarding the issue and to see whether educators are
covering the issue satisfactorily. Proofs put forward that a majority of women and adolescent
girls struggle to access proper sanitary pads either due to not being available or high prices.
Therefore, a concrete and reasonable plan to provide reasonably priced pads or cloths on a
regular basis to women and adolescent girls must be established. This may be of specific
interest to the private organizations working in social marketing, but additional study is
necessary to conclude potential commercial options.
References
ALDAMA, Z. (2018, February 23). Period shaming in Nepal: new law may finally end practice of
banishing menstruating women. Retrieved from South China Morning Post:
https://www.scmp.com/magazines/post-magazine/long-reads/article/2134278/period-
shaming-nepal-new-law-may-finally-end
Aro, A. R., & Kadariya, S. (2015). Chhaupadi practice in Nepal – analysis of ethical aspects. Dovepress,
53-58.
Galli, K. (2017). Menstrual Health and Hygiene Management in Nepal. Lalitpur: Maverick Collective.
Gettleman, J., sharma, & Bhadra. (2018, January 10). In the Rural Nepal, Menstruation Taboo claims
Another VIctim . Retrieved from The New York Times:
https://www.nytimes.com/2018/01/10/world/asia/nepal-woman-menstruation.html
Lamsal, P. (2017, May 24). In Nepal, women are still banished to 'menstrual huts' during their
periods. It's time to end this dangerous tradition. Retrieved from INDEPENDENT:
https://www.independent.co.uk/voices/world-menstrual-hygiene-day-first-hand-account-
nepal-menstrual-huts-death-confinement-a7752951.html
Nelson, N. (2017, June 13). Is a Period a Curse for Girls in Nepal? Retrieved from NAMLO
INTERNATIONAL: https://www.namlo.org/2017/06/is-a-period-a-curse-for-girls-in-nepal/
Parker, D. S., & Standing, D. K. (2018, March 8). Tackling the taboo around menstruation in Nepal.
Retrieved from BRITISH ACADEMY: https://www.britac.ac.uk/blog/tackling-taboo-around-
menstruation-nepal
Pokharel, S., & Gurung, K. D. (2017, August 28). Nepal outlaws menstruation huts, but what will take
their place? Retrieved from CNN: https://edition.cnn.com/2017/08/25/health/nepal-
menstruation-huts-chhaupadi-ban/index.html
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Sapkota, D., Sharma, D., Budhathoki, S. S., khanal, V. K., & Pokharel, H. P. (2013). Knowledge and
practices regarding menstruation among school going adolescents of rural Nepal. Journal of
Kathmandu Medical College, 122-127.
Sedhai, R., & Rasheed, Z. (2018, January 17). Why menstrual stigma continues to claim lives in Nepal.
Retrieved from Aljazeera: https://www.aljazeera.com/news/2018/01/menstrual-stigma-
continues-claim-lives-nepal-180111125347290.html
Sharma, G., Rai, P., Rayamajhi, R. B., Sagtani, R. A., Bhattachan, M., Sánchez, E. C., & Budhathoki, S.
(2018). Menstrual hygiene management among women and adolescent girls in the
aftermath of the earthquake in Nepal. BMC Women's Health .
Subedi, B. (2017, July 17). Menstrual Taboos in Nepal and Its Effect on Girls’ Education and
Empowerment. Retrieved from WorldPulse:
https://www.worldpulse.com/en/community/users/bidya-subedi/posts/78790
Flow chart:
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