Menstrual taboos and menstrual hygiene policy in Nepal
A multi-method scoping study to understand the barriers to good menstrual hygiene for adolescent girls.
Menstrual taboos are common in many low and middle income countries (LMICs), though the type and severity varies. Such taboos – which can include diktats on where a woman or girl sleeps, what she eats, and who she interacts with – have a direct negative effect on psychosocial and mental health.
Understanding the barriers
Taboos contribute to poor menstrual hygiene management (MHM), which in turn leads to further negative health outcomes. Despite this, and the importance of MHM in satisfying basic human rights and standards of dignity, it remains a neglected area of research and policy.
Our research will identify the barriers to good menstrual hygiene experienced by adolescent girls living in rural areas in the far-west of Nepal. The project comprises a programme of qualitative and quantitative data collection to understand the range of menstrual taboos and their impact. Supporting girls around menarche will help them to effectively manage their menstrual hygiene, which may, in turn, empower them to address other aspects of their sexual health.
Addressing the key issues
A particular concern in Nepal is the practice of Chhaupadi, which is a traditional practice in the far-western regions of Nepal where women are secluded in outbuildings during their menstrual period. Although the practice has been illegal since August 2018, it is unlikely this will have a significant impact. For comparison, abortion was legalised in 2002, but by 2016 only 41% of women were aware of this.
Previous research has shown that Chhaupadi is associated with poor reproductive and mental health. Furthermore, women and girls are frequently forced to change their sleeping arrangements even in regions not affected by Chhaupadi. One study found that 28% of schoolgirls surveyed slept separately during menstruation, and 89% experienced some form of restriction.
The project will comprise a programme of qualitative and quantitative data collection to understand the range of menstrual taboos and their effects. As well as in the far-western areas of the country, additional interviews will be taking place with Government officials and Non-Government Organisations (NGOs) in Kathmandu.
Our research team will collect data from girls aged between 14 to 19 and their families, for example their mothers and mothers in-law where appropriate. Focus group discussions, including participatory methods, will be used to identify themes, menstrual taboos and their psychosocial impact.
Our team will collect further data through a survey on behaviours, attitudes, practices and experiences of menstruation. Overall quality of life will also be measured along with a specific focus on psychosocial stressors and psychological distress, which may be related to issues surrounding menstruation. A key priority is identifying appropriate measures of psychosocial health among adolescent girls living in low and middle income.
The data collected will inform the development of an intervention. The effectiveness of the intervention will form a large-scale grant application, developed in partnership with a number of partners.
The long-term aim of the research is to:
- reduce menstrual taboos
- improve MHM
- reduce associated negative psychosocial and psychological outcomes
- advise NGO/government officials on the best ways this can be achieved through policy change
Longer term impacts rely on a better understanding of how menstrual taboos and MHM impact girls to enable the development of an effective, scalable intervention. This project will also provide methodological developments in the study of MHM, as well as a clearer sense of where MHM fits within UK and international development policy.