For 2 billion women and girls worldwide, menstruation is a monthly reality yet according to the United Nations, 1 in 3 girls in South Asia know nothing about menstruation prior to beginning it.
In villages in Nepal’s far west region, menstruation takes on a different meaning. It means that women and girls are oftentimes banished to a shed, isolated from their families for the duration of their period.
This long-held practice, known as chaupadi, comes from ancient Hindu scriptures that consider secretions associated with menstruation and childbirth to be religiously “impure,” deeming women “untouchable.”
But despite the practice being outlawed by the Nepalese Supreme Court a decade ago, girls and women continue to stay, eat and sleep outside every month.
Until recently, nonprofit Wateraid was working with girls and women in western Nepal, not to end the tradition, but to help them manage it safely.
Not only have they lacked access to WASH facilities, but there have been multiple reports of women and girls being raped, or killed by wild animals, snakebites and disease.
In Nepal, more than half of the country’s population of around 17 million do not have access to adequate sanitation. More than 3 million don’t have access to safe water.
So how do you try to end an outlawed practice in a country with deep-rooted cultural beliefs?
Wateraid Nepal Country Director Tripti Rai, told Devex about the organization’s work on the issue.
“We and our partners focused on building and ensuring sanitation facilities for women and girls. We wanted [to make] sure they’re able to manage it safely and increase awareness,” she said.
“It’s difficult to just end a cultural practice. We’re an organization that doesn’t really focus on women’s rights per se, so I think it was a strategic way to look at what the needs are for women and girls in WASH and then really pick up on this issue, which is generally guided by equity inclusion.”
Rai stressed that while it was encouraging Nepal had outlawed the practice, many remained unaware of the policy around it.
“The policy needs to be followed up by measurable actions and monitoring,” she said.
Despite the practice of chaupadi being relatively confined to the far western region of Nepal, for thousands of women and girls, menstruation means missing school, not being able to enter the kitchen or temple, cook or touch someone.
Wateraid therefore decided to focus its work on menstrual hygiene management, aiming to look at the hygiene needs of women and girls across the country. The organization is working to link WASH more strongly with women’s rights in a holistic way, focusing on adolescent girls in schools in three districts where WASH facilities were lacking and teachers’ awareness was low.
“If you don’t have changing facilities in schools, if you don’t have water to wash, if you don’t have a proper place to dispose [the sanitary napkin], then that is creating an environment where you can be embarrassed,” Rai said, adding that girls often have to sit through an entire day without using a sanitary napkin.
“If there is better sanitation facilities for young girls to manage menstruation in school, together with raising awareness and creating sense of understanding of what it is, girls will be able to face taboos and stigma. And that whole process has started.”
Pema Lhaki, deputy executive director of Nepal Fertility Care Center, which partners with Wateraid, also focuses on the issue of menstrual hygiene as a whole.
“More than just working on chaupadi, we have to work on menstrual hygiene and menstrual restrictions that are in place,” she said. “This is the bigger picture. Menstrual restrictions are so entrenched in people that they don’t want to talk about it; they validate it in a lot of ways.”
At the national level, Wateraid has begun a campaign to try and change mindsets among policymakers and is working with the department of education to make toilets gender-friendly. But as Rai emphasized, this is not purely about separate toilets for boys and girls but rather looking at whether schools have the facilities to help girls manage menstruation.
Rai said schools provided an enabling environment where students could ask questions in a supportive environment.
“School has been a good entry point to help break the silence, because when you talk to students about change, they can go home and talk to their parents,” Rai explained. “At the policy level, it hasn’t been difficult to talk about it, but more difficult to really say what the measurable actions will be.”
Lhaki added that adolescents had been an easier entry point than parents. The organization has also been educating teachers to talk with students about menstrual hygiene and the issue of basic human rights.
To further facilitate dialogue around the issue, Wateraid has held workshops with partners and stakeholders to raise awareness. However, Rai stressed that because menstrual hygiene management didn’t stand as an issue on its own, the scope of their work could be limited.
“There are many opportunities to work on menstrual hygiene management, but without a broader analysis of women and girls’ conditions in societies and the barriers and challenges they face, maybe the work we do on menstrual hygiene could be quite limited,” she explained. “For us, it’s really about connecting with organizations that do good work on women and young girls and looking at how we can work together to address their WASH needs.”
Today, on World Toilet Day, 2.5 billion people worldwide still lack access to toilets and it’s clear that adequate menstrual hygiene management is a critical way to ensuring women and girls have not only the best chance at optimal health, but equal rights and opportunities for
But for Nepal, that’s still a long way off.
“For something as simple as cooking, women aren’t allowed to do that for four days of the month — many justify it as having four days off [which] justifies the other 26 days they’re working in the kitchen,” Lhaki said. “It comes down to rights and having a choice without feeling guilty — unfortunately it’s just not there in Nepal.”
Join our #WorldToiletDay Twitter chat today, Thursday, Nov. 19 at 10 a.m. Eastern Standard Time / 3 p.m. Greenwich Mean Time / 4 p.m. Central European Time titled "More than just toilets, how do we close the global sanitation gap?" Tweet questions to @Devex using #SanitationIs.
Sophie Cousins is a health writer based in India. She was previously based between Lebanon and Iraq focusing on refugee health and conflict. She is particularly interested in infectious diseases and rural health in South Asia. She writes for international medical journals, including The Lancet, and for international news websites such as Al-Jazeera English.
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