Archives of Obstetrics and Gynaecology Mini Review

Studies in Social Justice

Discriminatory practices related to menstruation affect the social, mental and physical wellbeing of girls in many low-and middle-income countries. We conducted mixed methods research in five districts of Nepal to explore how menstruation affected girls’ ability to fully participate in school and community life. We conducted 860 structured interviews, 26 group interviews and 10 focus group discussions with schoolgirls in rural areas,14 semi-structured interviews with girls’ mothers, and 10 interviews with health teachers. Girls in all districts experienced social, material and information barriers to confident menstrual management. Menstrual blood was believed to carry diseases, and girls’ movement was restricted to contain ritual pollution and protect them from illness, spirit possession, and sexual experiences. Taboos prevented girls from worshipping in temples or in their home, and some girls were not allowed to enter the kitchen, or sleep in their home while menstruating. Teache...

Global Public Health, 2019

Menstruation is a natural, physiological process, but it can be a challenging experience for millions of women around the world. In Nepal, a geographically small yet diverse country of 125 caste/ethnic groups, understanding how caste/ethnicity impacts menstrual health is critical for developing context-specific interventions to improve women’s health. A community-based, cross-sectional survey was conducted with 679 women and girls between the ages of 13–51 from the country’s most populous castes/ethnic groups. Forty eight percent had high menstrual knowledge, 60% had positive menstrual attitudes, and 59% had positive menstrual practices. Caste/ethnicity was a significant predictor of menstrual knowledge and practices. The caste/ethnic groups Tarai/Madhesi/Other, Newar, Janajati, and Muslim all had statistically significant fewer odds of positive menstrual practices compared to Brahman/Chhetri (high caste groups), with Janajati (indigenous ethnic groups) having the poorest outcomes. Despite Nepal making impressive advances in health, certain caste/ethnic groups have fallen behind in terms of menstrual health outcomes. Consequently, blanket menstrual health programs may not be sufficient for improving menstrual knowledge and practices for all. Future programming should consider the use of local languages and context-specific content that incorporates indigenous beliefs, as well as cultivate partnerships with indigenous health organizations, and develop outcome indicators disaggregated by caste/ethnicity to ensure improved menstrual health for all.

2018

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.

This book examines the complexities of menstrual beliefs and practices in Nepal. Taking an interdisciplinary and intersectional approach, it explores and promotes the rights of women, girls, and people who menstruate to a dignified and healthy menstruation. The volume • collates current research in Nepal from local academics, early career researchers, and the Dignity Without Danger research project; • provides a more nuanced understanding of the complex stigmas and taboos that surround menstruation; • highlights the importance of rethinking ideas of religion, gender, menstruation, stigma and taboos, cultural practises, and discrimination; • proposes a counter-narrative that places sociological studies at the heart of the discussion surrounding menstruation; and • calls for more collaborative action research to strengthen the links between academia and activism across disciplines. An authoritative contribution, the book will be of interest to scholars and researchers of gender studies, public health, sociology, human rights, South Asian studies, medical sociology, cultural studies, and social medicine, particularly for those concerned with Nepal.

Dhaulagiri Journal of Sociology and Anthropology

There is a long history of menstrual restrictions, stigmas and taboos across nearly all religions, regions and cultures. The origins of myths and misconceptions have often been linked to various religious texts and women were prohibited from participating in normal life while menstruating. Culturally, in many parts of the world, menstruation is still considered ‘dirty’ and ‘impure’, although this is not true. Menstruation is often associated with feelings of shame, horror, danger, disgust, and sin. There have been initiatives to change the perception that menstruating women are not polluted, thus bringing an end to traditional customs such as not being allowed to sleep in their own home or touch male relatives to more extreme forms of isolation such as being confined to the ‘cow shed’. This paper draws on research conducted between 2019 and 2021 under a British Academy-funded Global Challenge Research Fund project entitled ‘Dignity Without Danger’. The study employed qualitative met...

BMC Women's Health, 2021

Background During their menstrual period, women are generally considered impure in Nepal; in the rural areas of the western part of the country, they are even banished to stay in sheds (called chhaupadi) during this time, which increases their vulnerability to a variety of health consequences. There is lack of clarity regarding the effectiveness of interventions that have been implemented to address menstrual taboo and improve menstrual hygiene and practices in Nepal (e.g., public awareness, community sensitization and legislation). In this paper, we discuss why menstruation management interventions, particularly those implemented to change the menstrual taboo might not work, and the opinions and experiences regarding the implementation of such interventions. Main text Anecdotal reports from the field and empirical studies suggest that interventions to address menstrual taboos have only been effective for short durations of time due to several reasons. First, local community stakeho...

BIBECHANA, 2018

Introduction: Menstruation, a normal physiological process in reproductive life of female still has many misconceptions. Knowledge of menstrual hygiene and menstrual sanitation practices affects the health of female. Lack of awareness on menstrual care practice is a challenge for community health. Objective: The objective of this study was to find knowledge and practice on menstrual hygiene; and perspective of Chaupadi (menstrual shed) among the reproductive age group female. Methodology: A community based mixed method study having cross sectional study as quantitative domain and phenomenological study as qualitative domain was conducted in Maranthana community of Pyuthan district of mid-western Nepal from April 2016-September 2016. Using convenient sampling techniques, 109 participants were included for cross sectional study and five of them who experienced Chaupadi were enrolled for phenomenological study. One eligible participant form each household was taken after getting informed voluntary consent. Collected data was entered in Microsoft excel and analysed by SPSS and NVivo software. Results: Regarding knowledge, 73.7% were aware on the right age of menarche. Almost 93% were aware on possible pregnancy after initiation of menstruation. Many of them (34.9%) were informed on menstruation by friends. Almost half (45.9%) had negative belief of use of old clean cloth during menstrual flow. Regarding practice, only 40.4% used sanitary pad during their menstrual flow. Most (65.1%) of them did not dispose,16.5% bury in nearby ground and 18.4% burn. More than half (60.6%) used soap-water to clean genitalia. Remedial measures adopted during menstruation were taking adequate rest (44%), seeking medical advice (22.9%) and drinking plenty of fluid (13.8%). Different traditional practice followed were use of separate utensils (64.2%), not allowed to see sun (75.8%), restriction to- go outside (71.6%), cook food (56%), usual food intake (56.9%), worship (74.3%), eat with others (27.5%), sleep in usual bedroom (27.5%) and touch male members (28.4%). Most (94.5%) of them experienced Chaupadi (Menstrual Shed) during their menarche. The phenomenological approach found that Chaupadi was common. They had various infections and ill health. Mother groups were advocating to eliminate Chaupadi in their locality. Conclusion: The know-do gap on menstruation was evident. Despite increasing awareness, people were still following traditional cultural practices. BIBECHANA 16 (2019) 228-235

Reproductive Health

Background Menstruation, a natural biologic process is associated with restrictions and superstitious beliefs in Nepal. However, factual data on women’s perspectives on menstrual practices and restrictions are scarce. This study aimed to assess socio-cultural perceptions of menstrual restrictions among urban Nepalese women in the Kathmandu valley. Methods Using a clustered random sampling, 1342 adolescent girls and women of menstruating age (≥15 years) from three urban districts in the Kathmandu valley completed a survey related to menstrual practices and restriction. This was a cross-sectional survey study using a customized program allowing pull-down, multiple choice and open-ended questions in the Nepali language. The self-administered questionnaire consisted of 13 demographic questions and 22 questions related to menstruation, menstrual hygiene, socio-cultural taboos, beliefs and practices. Univariate descriptive statistics were reported. Unadjusted associations of socio-cultura...

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Culture, Health & Sexuality, 2014

Menstrual stigma has been demonstrated in many societies. However, there is little research on menstrual attitudes in South Asia, despite religiously-based menstrual restrictions imposed on women. To understand menstrual stigma in this context, we conducted qualitative research with women in Nepal. Nepali Hinduism forbids menstruating women to enter a temple or kitchen, share a bed with a husband or touch a male relative. During menstruation, women are 'untouchable'. There has been virtually no research on how Nepali women make meaning of these practices. The current study employed focus groups and individual interviews to understand how some Nepali women experience menarche and menstrual stigma. We explored how women describe their experiences and the strategies they adopt to manage age-old stigma in a rapidly modernising society where they have multiple roles as workers, wives and mothers. Participants reported they experienced menarche with little preparation, which caused distress, and were subjected to ongoing stigmatisation as menstruating women. They described coping strategies to reduce the effects of this stigma. This study provides a unique perspective on coping with menstrual stigma in South Asia.