“I used the sanitary pad upside down for about a year because I was neither told by anyone how to use it properly, nor did I ask anyone due to the fear of humiliation. It leaked and I was so embarrassed. One day, I saw my friend using the pad in the restroom and I realized that I used it wrong.”
“When I had my first period, I used sanitary pads. My mom bought them. But she didn’t tell me about the cycle and I used the pad every day for about two months until I knew from my friend that periods have a cycle.”
These statements from girls in Nepal only three months ago show that open conversation about menstruation is still considered a “taboo” subject. Since my return from Brookings as an Echidna Global Scholar, I have visited multiple rural communities in Nepal, and found that adolescent girls are still suffering during menstruation.
My ongoing research, as well as research carried out by WaterAid, shows that menstruation-related taboos and restrictions prevent girls across South Asia from attaining educational success. For instance, nearly 90 percent of girls in Nepal are still forced to observe restrictions on mobility or face social exclusion during menstruation, and as a result, many girls miss school for about a week during first menstruation and about 3 to 4 days in subsequent menstrual periods. Every month, girls are faced with multiple discriminatory practices by their families and communities.
Restrictions and obstacles related to menstruation in Nepal:
a) Isolation from the family: usually, relegation to neighbor’s house during first menstruation and to a floor corner in their own house after that
b) No entry to the kitchen and prayer room
c) Limited or no access to family events and celebrations
d) No access to pills during excessive pain
e) Lack of access to sanitary pads: Commercial sanitary pads are expensive and parents–particularly in low-income families-are reluctant to spend money on pads
f) Issues of leakage and resulting embarrassment
g) Extra work to wash the clothes used during the first three days of menstruation and scrub the floor they slept on during the period
h) Non-menstruating females take responsibility of the kitchen for the entire family when their mothers and other members of the family are menstruating every month (males don’t cook in many of the families)
i) Lack of running water and trash bags to deposit the pads at school
j) Safety concerns when forced to stay in other people’s houses during first menstruation
k) Lack of access to the kitchen–and thus food and beverages–during menstruation when family members are away
This treatment and lack of information about proper menstrual hygiene can cause anxiety and can have serious health implications—resulting in rashes, infections, and illness. Additionally, girls miss school during their periods—and combined with not being able to catch up on missed lessons and increased household chores—many gradually drop out.
Menstruation restrictions are often tied with socio-cultural and religious traditions. Changing these practices is a challenging, long-term process that requires a multi-pronged approach including the strict enforcement of law, changing people’s mindsets, educating parents, and empowering girls. For example, Chhaupadi, the age-old tradition of isolating girls during menstruation, was outlawed in 2005 but still persists in about nine districts in western Nepal. It was criminalized due to the heavy pressure created not only in Nepal but also at the global level; however, in January 2018, news reports of the suffocation of a 23-year-old woman in Chhaupadi revealed that the practice endures. We learned from this case that mere regulations are not enough, and we need other simultaneous approaches to address this issue in the long-term. In addition to enforcing the implementation of policies that protect girls from discrimination, we need strategies to eliminate barriers to girls’ education related to menstrual health and hygiene.
Here are three interventions that I have seen work in Nepal and that should be pursued further:
- Empower girls with knowledge about menstrual health: My research as an Echidna Global Scholar found that girls can fight against cultural taboos if they know the biology behind menstruation, get proper information about menstruation hygiene and management, and understand their rights. Training also builds their confidence and increases their agency. Girls who received training on menstrual hygiene management (MHM) use clean, homemade pads and have educated other girls in maintaining MHM. Moreover, girls-centered empowerment programs, such as the one conducted by the organization Her Turn, include leadership development, girl lead community events, and information about how health, safety, rights, and resources contribute to the holistic development of girls. Such programs have prepared girls to fight taboos in the community and improve school sanitation for effective MHM.
- Increase parental support for menstruating girls: If parents support girls during menstruation, girls may face fewer obstacles to continue attending school. However, this is a big challenge in rural Nepal where most of the parents do not readily give up harmful traditional practices associated with menstruation. Overcoming these barriers requires an integrated approach of educating parents through literacy and gender awareness programs. These atypical approaches stem from prolonged discussions about the consequences of menstruation taboos in girls’ education and gender issues in families and communities, as well as a series of literacy programs linked with income generation. This kind of support from parents—especially fathers—encourages girls to continue their study. During my research, some girls mentioned that their fathers were very supportive during their period—buying sanitary pads and allowing them to sleep in their regular bed and attend school during menstruation.
- Ensure that there is a supportive school environment: Girls face many challenges in schools during menstruation. According to UNICEF Nepal, only about 50 percent of schools have separate toilets for girls but not all of those have basic facilities such as running water, soap, and trash bins to deposit sanitary pads. About half of adolescent girls miss school during menstruation due to the lack of gender-friendly MHM facilities. Two rural districts in Nepal show that strengthening WASH (water, sanitation, and hygiene) facilities in schools, which include separate toilets for girls and MHM facilities in school, has increased girls’ school attendance during menstruation, built their confidence to talk about menstruation, and created a girl-friendly environment in school. Additionally, only about 15 percent of teachers in secondary schools in Nepal are female. Recruiting more female teachers in each school could have a positive impact on girls’ education. A designated point of contact for girls to share menstruation issues with would help create a supportive environment for girls in school.