In Nepal, where around 81% of the population adheres to Hinduism, menstrual customs and restrictions are deeply rooted in religious beliefs and cultural norms. These practices are reinforced by orthodox Hindu views that perceive menstruation as impure. This perception results in significant restrictions on women’s daily lives and their participation in various activities during their menstrual cycle.

Menstruation is traditionally viewed as a period of impurity, known as ashaucha, within Hinduism. During this time, women are considered ritually unclean, a belief rooted in ancient scriptures and practices emphasising purity and cleanliness for participation in religious activities. Menstrual blood is seen as carrying impurities that could disrupt the sanctity of religious rituals and spaces, leading to prohibitions on menstruating women entering temples, participating in pujas (prayer rituals), or engaging in other religious activities.

Behaviourally, many orthodox Hindu families in Nepal expect menstruating women to isolate themselves. They stay away from kitchens, shared living spaces, and religious areas, often sleeping on separate bedding to avoid physical contact with family members and maintain ritual purity. Women may also be restricted from cooking, touching food, or performing household chores to prevent the perceived impurity from spreading and ensure the household remains ritually clean.
These menstrual taboos reinforce traditional gender roles, positioning women primarily in domestic and subordinate roles and underscoring their secondary status within the family and community during their menstrual period. The stigmatisation associated with menstruation can have significant psychological and social impacts on women, contributing to feelings of shame, embarrassment, and isolation, affecting their self-esteem and social interactions.

While these orthodox practices are still prevalent in many rural and conservative communities, there is a growing movement among modern and urban Hindu women to challenge and change these restrictive norms. Educational campaigns and feminist activism are reshaping attitudes towards menstruation, advocating for more inclusive and respectful practices. Additionally, legal measures have been introduced in some regions to reduce menstrual stigma and promote menstrual hygiene management as part of a broader movement to ensure women’s rights and health are respected.

For further reading and detailed analysis, see:
Government of Nepal National Statistics Office. (2021). Caste/ethnicity | National Population Census. National Statistics Office. https://censusnepal.cbs.gov.np/results/cast-ethnicity
Hembroff, N. (2010). Orthodox Hindu attitudes to menstruation / Nicole Hembroff. https://opus.uleth.ca/handle/10133/2600
Thapa, S. & Aro, A. R. (2021). ‘Menstruation means impurity’: multilevel interventions are needed to break the menstrual taboo in Nepal. BMC Women’s Health, 21(1). https://doi.org/10.1186/s12905-021-01231-6
The Women’s Foundation Nepal | Challenges of Menstruation. (o. D.). https://www.womenepal.org/womens-and-childrens-issues-2/chhaupadi/

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Maintaining menstrual hygiene is a significant challenge for many women in Nepal, particularly in environments with limited water supply and privacy. They often use reusable cloths made from old saris, dhotis, or other fabrics as menstrual absorbents due to the limited availability and high cost of disposable sanitary products. These cloths are washed and reused, but the lack of clean water and privacy makes maintaining hygiene difficult.

The primary problem is the lack of privacy. In many rural and communal living environments, women do not have private spaces where they can discreetly dry their menstrual cloths. Cultural taboos surrounding menstruation often stigmatise the drying process, compelling women to hide their cloths. As a result, these cloths are often dried indoors, in dark or poorly ventilated areas, such as under beds, on top or inside clay barrels or in cupboards. This lack of proper sunlight and airflow prevents the cloths from drying thoroughly, creating an environment conducive to bacterial and fungal growth, which can lead to infections.

Another major issue is the limited availability of clean water. Washing reusable menstrual materials properly requires access to sufficient quantities of clean water to ensure that all blood and bacteria are thoroughly removed. However, in many parts of Nepal, water scarcity is a persistent problem, and available water sources are often shared and public, making it difficult for women to wash their menstrual cloths discreetly and hygienically. Inadequate washing due to water shortages or poor water quality can leave residues that foster the growth of harmful microorganisms, further increasing the risk of infections.

Weather conditions also play a significant role. During the monsoon season or in colder months, the high humidity and lack of sunshine can make it even more challenging to dry menstrual cloths properly. The constant dampness can cause cloths to remain wet for extended periods, creating an ideal environment for mold and mildew, which can cause skin irritation and infections when the cloths are reused.

For further reading and detailed analysis, see:
Hennegan, J., Shannon, A.K., Rubli, J., Schwab, K.J. and Melendez-Torres, G.J. (2019). Women’s and girls’ experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesis. PLoS Medicine, [online] 16(5). doi:10.1371/journal.pmed.1002803.
Hennegan, J., Winkler, I.T., Bobel, C., Keiser, D., Hampton, J., Larsson, G., Chandra-Mouli, V., Plesons, M. and Mahon, T. (2021). Menstrual health: a definition for policy, practice, and research. Sexual and Reproductive Health Matters, 29(1), p.1911618. doi:10.1080/26410397.2021.1911618.
Tellier, M., Farley, A., Jahangir, A., Nakalema, S., Nalunga, D. and Tellier, S. (2020). Practice Note: Menstrual Health Management in Humanitarian Settings. In: C. Bobel, I.T. Winkler, B. Fahs, K.A. Hasson, E.A. Kissling and T.-A. Roberts, eds., The Palgrave Handbook of Critical Menstruation Studies. Singapore: Springer Nature Singapore Pte Ltd., pp.593–604.

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Menstruation is often shrouded in taboo and silence in the workplace. Failure to provide adequate facilities for menstruating employees constitutes a form of gender discrimination in the workplace. Adequate toilet or latrine facilities are equipped with soap, running water, a dustbin or equivalent receptacle, and a locking mechanism from the inside. Neglecting to provide such facilities can exacerbate women’s feelings of insecurity in their work environment.

The absence of accessible facilities hampers the fulfilment of menstrual hygiene management (MHM) standards. Over the past half-decade, the term “MHM” has garnered significant attention, prompting numerous interventions by the international development community aimed at integrating MHM into school health curriculums. However, in contrast to educational institutions, the topic of MHM in the workplace has been largely overlooked in low and middle-income countries.

Women encounter menstruation across diverse settings, including the workplace. Whether workplaces, spanning businesses, institutions, or governmental bodies, choose to recognise this reality remains within their purview. Nevertheless, these workplaces, such as hospitals, government offices, and NGOs, offer a microcosmic view of the broader dynamics within Nepal. Despite seeming modest, providing female staff with private and hygienic toilet facilities equipped with essential amenities acknowledges their significance as valued members of the workplace community. Offering appropriate support in the workplace can make people feel included, offer dignity and reduce embarrassment.

For further reading and detailed analysis, see:
Mitchell, J. (2017). Power to the Period: The Role of Menstruation in the Workplace. SIT Study Abroad. https://digitalcollections.sit.edu/cgi/viewcontent.cgi?article=3588&context=isp_collection

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In Nepal, health volunteer workers and grassroots initiatives play a pivotal role in helping women understand the importance of proper menstrual hygiene management (MHM). These efforts are crucial in a country where traditional beliefs and lack of resources often hinder women’s ability to manage their menstruation safely and hygienically.

Health volunteer workers, often local women who are trusted members of their communities, are at the forefront of these efforts. They visit households, schools, and community centres to provide education on MHM. These volunteers teach women and girls about the biological aspects of menstruation, debunking myths and misconceptions that contribute to stigma and shame. They also demonstrate how to use and maintain sanitary products, whether disposable pads or reusable cloths, and emphasise the importance of cleanliness to prevent infections.

One key aspect of their work is to address the cultural taboos that surround menstruation. By engaging in open and respectful conversations, health volunteers help break the silence and normalise discussions about menstruation. This helps reduce the stigma and encourages women and girls to seek the support and information they need.

Grassroots initiatives complement the work of health volunteers by implementing community-based programs aimed at improving menstrual hygiene management. These initiatives often involve the distribution of menstrual products, such as sanitary pads, menstrual cups, and reusable cloth pads, especially in rural and low-income areas where access to these products is limited. For instance, organisations like Days for Girls Nepal, the Radha Poudel Foundation and the Nepal Red Cross Society run programs that provide free or subsidised sanitary products and build private, hygienic facilities for women to use during their menstrual periods.

Educational workshops and training sessions organised by these initiatives are crucial in empowering women and girls with knowledge. These programs often include men and boys to foster a supportive community environment. By educating the entire community, these initiatives help to create a more inclusive and understanding atmosphere regarding menstrual health.

Moreover, grassroots initiatives often advocate for policy changes at the local and national levels to improve MHM infrastructure and resources. They work with schools to ensure that girls have access to private and clean toilet facilities and with local governments to improve water and sanitation services.

For further reading and detailed analysis, see:
Toldy, T., Urbaniak, Ł., Divry, T., Dipisha Bhujel, and Muhamed Hasnain Ansari (2024). The Sparśa Project: Building a Comprehensive Menstrual Health Management Intervention in Nepal. Glocalism. doi:https://doi.org/10.54103/gjcpi.2024.22627.‌
Evans, R., Alvarez Broch, V. (2018) (NEPAL’S MENSTRUAL MOVEMENT: How ‘MenstruAction’ is making life better for girls and women in Nepal — month after month. Available at: https://www.giz.de/de/downloads/giz2019-en-nepals-menstrual-movement-report.pdf (online)

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Improper menstrual management practices can have profound consequences on women’s health, such as reproductive tract infections (RTIs) and urinary tract infections (UTIs). Using unhygienic materials like cloth or leaves or lacking access to clean water and soap during menstruation creates an environment conducive to bacterial growth, leading to infections that can cause discomfort, pain, and long-term health complications if left untreated. Unsuitable MHM can contribute to gynaecological issues such as vaginal irritation, itching, and inflammation. Prolonged use of unclean or inappropriate menstrual products can disrupt the natural pH balance of the vagina, leading to irritation and discomfort.

Poor menstrual hygiene practices and the absence of appropriate healthcare services can impact reproductive health outcomes, including fertility and maternal health. Chronic infections can lead to pelvic inflammatory disease (PID), which can cause infertility or increase the risk of ectopic pregnancy and complications during childbirth.

Hysterectomy may be recommended as a treatment option for conditions such as severe menstrual disorders, uterine fibroids, or gynecological cancers that cannot be managed effectively through conventional treatments. However, the prevalence of hysterectomy in Nepal may also be influenced by factors such as limited access to alternative treatment options, cultural beliefs, and socioeconomic factors.

Menstrual health complications leading to hysterectomy are more commonly linked to conditions like severe uterine fibroids, endometriosis, pelvic inflammatory disease, and uterine prolapse. These conditions can be exacerbated by factors such as inadequate healthcare, poor nutrition, and lack of access to menstrual hygiene products, rather than directly by lifting heavy loads.

Although it is a commonly spread information across Nepal, there is currently no scientific evidence directly proving a correlation between lifting heavy loads during menstruation and complications leading to the removal of the uterus. However, the broader context of physical strain and inadequate menstrual health management in certain environments can contribute to reproductive health issues that might necessitate such interventions.

In Nepal, where many women often engage in physically demanding work and have limited access to healthcare and menstrual hygiene products, the compounded stress and inadequate menstrual health management can lead to more severe reproductive health issues. These issues might eventually require surgical interventions, including hysterectomy, but the direct causal link to lifting heavy loads specifically is not established in medical literature.

For further reading and detailed analysis, see:
Khadgi, J., Poudel, A. (2018). Uterine prolapse: a hidden tragedy of women in rural Nepal. International urogynecology journal, [online] 29(11), pp.1575–1578. doi:https://doi.org/10.1007/s00192-018-3764-6.
Boosey, R. (2013). A Vicious Cycle of Silence: What are the implications of the menstruation taboo for the fulfilment of women and girls’ human rights and, to what extent is the menstruation taboo addressed by international human rights law and human rights bodies? Sheffield: Sheffield School of Health and Related Research (ScHARR), University of Sheffield.
Hennegan, J., Winkler, I.T., Bobel, C., Keiser, D., Hampton, J., Larsson, G., Chandra-Mouli, V., Plesons, M. and Mahon, T. (2021). Menstrual health: a definition for policy, practice, and research. Sexual and Reproductive Health Matters, 29(1), p.1911618. doi:10.1080/26410397.2021.1911618.
United Nations Population Fund. (2022). Fallen Wombs, Broken Lives: Responding to Uterine Prolapse in Nepal. [online] Available at: https://www.unfpa.org/news/fallen-wombs-broken-lives-responding-uterine-prolapse-nepal [Accessed 23 May 2024].

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In Nepal, menstrual stigma and shame often cast a shadow over the lives of young girls, perpetuating harmful cultural taboos and impacting their physical, emotional, and social well-being.

The consequences of menstrual shame on young girls are profound and far-reaching. Firstly, it affects their physical health, as restrictive practices and lack of access to proper menstrual hygiene resources increase the risk of infections and reproductive health issues. Secondly, it impacts their emotional well-being, leading to feelings of embarrassment, low self-esteem, and anxiety about menstruation. These negative emotions can hinder their ability to concentrate in school and engage in social interactions, affecting their overall academic performance and personal development.

Moreover, menstrual shame perpetuates cycles of gender inequality by reinforcing harmful stereotypes and limiting girls’ opportunities for education and empowerment. When girls are made to feel ashamed of their bodies and natural bodily functions, it hampers their confidence and agency, perpetuating a culture of silence and subordination.

Empowering girls with accurate information about menstruation, providing access to menstrual hygiene products, and challenging discriminatory practices are essential steps towards dismantling the stigma surrounding menstruation and fostering a culture of dignity, respect, and equality for all.

For further reading and detailed analysis, see:
Crawford, M., Menger, L. M. & Kaufman, M. R. (2014). ‘This is a natural process’: managing menstrual stigma in Nepal. Culture, Health & Sexuality, 16(4), 426–439. https://doi.org/10.1080/13691058.2014.887147
Sapkota, D., Sharma, D., Pokharel, H. P., Budhathoki, S. S. & Khanal, V. K. (2014). Knowledge and practices regarding menstruation among school going adolescents of rural Nepal. Journal Of The Kathmandu Medical College, 2(3), 122–128. https://doi.org/10.3126/jkmc.v2i3.9962

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In Hinduism, the concepts of childbearing and ritual impurity are deeply intertwined, influencing cultural practices and social norms in countries like Nepal, where traditions such as Chhaupadi are still observed.

Childbirth, like menstruation, is often considered a period of ritual impurity (asauch or sutak) in Hindu culture. After giving birth, women are believed to be in a state of impurity, requiring them to undergo specific purification rituals and observe certain restrictions to restore their ritual cleanliness. These beliefs stem from the notion that the processes of birth and menstruation involve bodily fluids that are considered impure.

In Nepal, where in some regions Chhaupadi culture persists, the restrictions imposed on women after childbirth can be particularly severe. Chhaupadi dictates that women who have recently given birth must be isolated from their families and communities, often confined to separate huts or cowsheds. During this period, which can last from several days to weeks, women are prohibited from entering their homes, temples, kitchens, and other communal spaces. They are also restricted from touching household items, food, and water sources, based on the belief that their presence can contaminate these areas.

These practices can have serious implications for the health and well-being of new mothers and their infants. Isolation in poorly ventilated and unsanitary conditions increases the risk of infections, complications from childbirth, and exposure to harsh environmental elements. The lack of access to proper nutrition, clean water, and healthcare during this critical period can further jeopardise the health of both mother and child.

For further reading and detailed analysis, see:
Joshi, S. (2022). Chhaupadi practice in Nepal: A literature review. World Medical & Health Policy 14(12), doi:10.1002/wmh3.491
Mukherjee, A., Lama, M., Khakurel, U., Jha, A. N., Ajose, F., Acharya, S., Tymes-Wilbekin, K., Sommer, M., Jolly, P. E., Lhaki, P. & Shrestha, S. (2020d). Perception and practices of menstruation restrictions among urban adolescent girls and women in Nepal: a cross-sectional survey. Reproductive Health, 17(1). https://doi.org/10.1186/s12978-020-00935-6
Prabisha Amatya, Saruna Ghimire, Callahan, K.E., Binaya Kumar Baral and Poudel, K.C. (2018). Practice and lived experience of menstrual exiles (Chhaupadi) among adolescent girls in far-western Nepal. PloS one, [online] 13(12). doi:https://doi.org/10.1371/journal.pone.0208260.

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In Nepal, many women and girls face significant challenges in accessing conventional menstrual products such as disposable pads, particularly in rural and low-income areas. This lack of access forces them to rely on various alternatives to manage their menstruation. Common alternatives include reusable cloths made from old saris and dhotis, which are often cut into manageable pieces. However, maintaining proper hygiene with these cloths can be difficult due to the lack of clean water and privacy, increasing the risk of infections.

In extreme cases where even cloth is scarce, women may resort to using leaves, paper, or other improvised materials. These makeshift solutions are often uncomfortable and less absorbent, leading to irritation and potential health issues. Some women and local initiatives have also started creating homemade pads using absorbent materials like cotton and layers of fabric, offering a more sustainable option compared to improvised materials.

To address these challenges, community-based initiatives and NGOs have been promoting menstrual health education and distributing affordable and sustainable menstrual products. These efforts are crucial in improving menstrual health and reducing the stigma associated with menstruation.

The introduction of Nepal’s national pad distribution program has significantly changed the situation. This program has helped increase access to hygienic menstrual products, especially in underserved areas. The distribution of free or subsidised sanitary pads at schools has improved menstrual health practices, reduced absenteeism from school, and empowered women and girls to manage their menstruation with dignity. This initiative, although not without flaws, marks a positive step towards ensuring that all women and girls in Nepal have the resources they need to maintain their health and well-being during menstruation.

For further reading and detailed analysis, see:
Kaur, R., Kaur, K. & Kaur, R. (2018). Menstrual Hygiene, Management, and Waste Disposal: Practices and Challenges Faced by Girls/Women of Developing Countries. Journal Of Environmental And Public Health, 2018, 1–9. https://doi.org/10.1155/2018/1730964
Loughnan, L. C. L. L. C., Bain, R. B. R., Rop, R. R. R., Sommer, M. S. M. & Slaymaker, T. S. T. (2016). What can existing data on water and sanitation tell us about menstrual hygiene management? Waterlines, 35(3), 228–244. https://doi.org/10.3362/1756-3488.2016.019
Boosey, R. (2013). A Vicious Cycle of Silence: What are the implications of the menstruation taboo for the fulfilment of women and girls’ human rights and, to what extent is the menstruation taboo addressed by international human rights law and human rights bodies? Sheffield: Sheffield School of Health and Related Research (ScHARR), University of Sheffield.

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The issue of menstrual product accessibility in Nepal is a multifaceted challenge that significantly impacts the health, dignity, and well-being of women and girls across the country.

Limited access to affordable and hygienic menstrual products poses a major barrier to menstrual hygiene management (MHM) for many women and girls in Nepal. Commercial menstrual products are often expensive and inaccessible, particularly for those living in rural and remote areas or from low-income households. As a result, women and girls are forced to resort to improvised materials like cloth, old rags, or even leaves, which are not only ineffective but also unhygienic, leading to an increased risk of infections and other health complications.

The consequences of inadequate menstrual product accessibility extend beyond physical health to encompass broader socio-economic implications. Women and girls who are unable to manage their menstruation effectively may experience limitations in daily activities, education, and employment opportunities. The inability to access menstrual products can contribute to absenteeism from school or work, perpetuating cycles of poverty and inequality.

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For further reading and detailed analysis, see:
Kaur, R., Kaur, K. & Kaur, R. (2018). Menstrual Hygiene, Management, and Waste Disposal: Practices and Challenges Faced by Girls/Women of Developing Countries. Journal Of Environmental And Public Health, 2018, 1–9. https://doi.org/10.1155/2018/1730964
Loughnan, L. C. L. L. C., Bain, R. B. R., Rop, R. R. R., Sommer, M. S. M. & Slaymaker, T. S. T. (2016). What can existing data on water and sanitation tell us about menstrual hygiene management? Waterlines, 35(3), 228–244. https://doi.org/10.3362/1756-3488.2016.019
Tiwary, A. R. (2018). Role of Menstrual Hygiene in Sustainable Development Goals. International Journal Of Health Sciences & Research, 8(5), 377–387. https://www.ijhsr.org/IJHSR_Vol.8_Issue.5_May2018/53.pdf .

In Nepal, the family plays a central role in shaping and enforcing menstrual restrictions on women and girls, with both positive and negative implications. These influences stem from deeply rooted cultural and religious beliefs, as well as evolving perspectives influenced by education and awareness.

Traditional families often impose strict menstrual restrictions on women and girls. These restrictions are based on the belief that menstruating women are impure and must be isolated to avoid contaminating others and displeasing the gods. In such families, women and girls may be forced to stay in separate huts or cowsheds, barred from entering homes, kitchens, temples, and participating in social activities. These practices are maintained out of fear of divine retribution and social ostracism, with older family members—particularly mothers and grandmothers—playing a key role in enforcing these norms. This environment can lead to significant physical and mental health issues, including increased risk of infections, anxiety, and a sense of isolation.

However, the family can also have a positive role in challenging and changing these restrictive practices. With the increasing spread of education and awareness about menstrual health, many families are beginning to question traditional taboos and adopt more progressive attitudes. Educated parents, especially mothers who understand the importance of menstrual hygiene, can provide their daughters with accurate information and access to sanitary products, helping them manage their menstruation with dignity and confidence.

In families where there is open communication and support, girls are more likely to feel empowered and less stigmatized about their menstruation. Fathers and brothers, when involved and educated about menstrual health, can also contribute to creating a supportive environment. These families reject the notion of impurity and instead view menstruation as a natural biological process, thus breaking the cycle of stigma and restrictions.

For further reading and detailed analysis, see:
Thapa, S. & Aro, A. R. (2021). ‘Menstruation means impurity’: multilevel interventions are needed to break the menstrual taboo in Nepal. BMC Women’s Health, 21(1). https://doi.org/10.1186/s12905-021-01231-6
Subedi, M. & Parker, S. (2021). Menstrual Exclusions in Nepal: Some Evidence of Transition. Dhaulagiri, 15, 1–9. https://doi.org/10.3126/dsaj.v15i01.41921

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Urbanisation is often associated with gender-related transformation, such as women’s greater engagement in paid employment and public life, which is linked to a broader range of opportunities than in rural areas.

In Nepal, there are notable differences in menstrual health knowledge, practice, and product accessibility between urban and rural areas, reflecting diverse socio-economic contexts and infrastructural disparities.

Urban Nepali girls and women often have better access to information about menstrual health due to higher levels of education and exposure to media and healthcare services. They may be more likely to possess accurate knowledge about menstruation, including hygiene practices and available menstrual products. Additionally, urban areas typically have better infrastructure, including clean water and sanitation facilities, which contribute to improved menstrual hygiene management.

In contrast, rural Nepali girls and women face various challenges related to menstrual health. Limited access to education and healthcare services in rural areas results in lower levels of menstrual health knowledge among this demographic. Furthermore, inadequate sanitation facilities and lack of access to clean water exacerbate difficulties in managing menstruation hygienically.

Product accessibility also differs between urban and rural areas. Urban centres generally have better availability of commercial menstrual products such as pads or even menstrual cups through pharmacies and supermarkets. In rural areas, however, access to such products may be limited or non-existent, forcing women to rely on less hygienic alternatives or travel long distances to obtain them. Many rural women thus rely on traditional practices or makeshift solutions, such as cloth or leaves.

For further reading and detailed analysis, see:
Mukherjee, A., Lama, M., Khakurel, U., Jha, A. N., Ajose, F., Acharya, S., Tymes-Wilbekin, K., Sommer, M., Jolly, P. E., Lhaki, P. & Shrestha, S. (2020c). Perception and practices of menstruation restrictions among urban adolescent girls and women in Nepal: a cross-sectional survey. Reproductive Health, 17(1). https://doi.org/10.1186/s12978-020-00935-6
Subedi, M. & Parker, S. (2021). Menstrual Exclusions in Nepal: Some Evidence of Transition. Dhaulagiri, 15, 1–9. https://doi.org/10.3126/dsaj.v15i01.4192

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The caste system is a social hierarchy prevalent in parts of South Asia, where society is stratified into distinct hereditary groups. Individuals are born into a specific caste that determines their social status, occupation, and interactions within society. The system is based on ritual impurity, which has been used to limit certain groups from acquiring land, attaining an education, and acquiring leadership roles in the government. Movement between castes is traditionally restricted, and discrimination based on caste identity persists despite legal efforts to abolish it.

Caste-based discrimination intersects with gender dynamics, exacerbating challenges for women and girls. Women traditionally perceived as belonging to the lower castes are less likely to have high menstrual knowledge compared to women and girls who identify as Brahman/Chhetri (higher castes). Reasons for poorer menstrual knowledge may be linked to historically situated discriminatory practices against them in Nepal. Yet, it has been observed that socio-cultural and religious restrictions during menstruation are more pervasive among caste groups considered higher in the hierarchy.

Access to menstrual health resources is unevenly distributed along caste lines. Women from lower castes often face limited access to sanitary products, clean water, and hygienic facilities during menstruation. This disparity contributes to health risks and reinforces stigmas surrounding menstruation, affecting physical well-being and dignity.

Caste/ethnicity influences educational opportunities for girls, particularly during menstruation. Cultural taboos and lack of proper facilities lead to absenteeism and dropout rates among menstruating girls, disproportionately affecting those from marginalised castes. This impediment to education perpetuates cycles of poverty and reinforces caste-based inequalities.

For further reading and detailed analysis, see:
Baumann, S. E., Lhaki, P. & Burke, J. G. (2019). Assessing the Role of Caste/Ethnicity in Predicting Menstrual Knowledge, Attitudes, and Practices in Nepal. Global Public Health, 14(9), 1288–1301. https://doi.org/10.1080/17441692.2019.1583267
Mukherjee, A., Lama, M., Khakurel, U., Jha, A. N., Ajose, F., Acharya, S., Tymes-Wilbekin, K., Sommer, M., Jolly, P. E., Lhaki, P. & Shrestha, S. (2020b). Perception and practices of menstruation restrictions among urban adolescent girls and women in Nepal: a cross-sectional survey. Reproductive Health, 17(1). https://doi.org/10.1186/s12978-020-00935-6

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Stigma, misconceptions, and exclusion can result in harmful consequences. When combined with the additional stigma surrounding menstruation, these factors significantly impede girls and women with disabilities from accessing necessary information, resources, and support for managing menstrual health and hygiene (MHH). Girls and women with disabilities often experience dual stigma stemming from societal norms regarding gender and menstruation, as well as from their disability status. Menstruation-related challenges contribute to feelings of shame among those with disabilities, leading to social isolation and, in some cases, even coerced sterilisation.

The lack of accessible water, sanitation, and hygiene (WASH) facilities in various settings exacerbates the challenges faced by girls and women with disabilities. These inaccessible facilities in communities, schools, healthcare settings, and public spaces create additional barriers, hindering their full participation in social and economic activities. The absence of disability-friendly WASH facilities also prevents girls with disabilities from attending school regularly.

Effective MHH education and support are essential components of both in-school and out-of-school programs to ensure that girls with disabilities receive the necessary assistance. It is a common misconception that girls with disabilities do not menstruate, highlighting the importance of dispelling myths surrounding menstruation and disability through education initiatives.

Menstruating girls and women with different types of disabilities have diverse needs. For instance, individuals with physical impairments affecting their upper body and arms may encounter challenges in properly placing sanitary protection materials and maintaining personal hygiene during menstruation. Those with visual impairments may struggle to ensure thorough cleanliness, while those with intellectual and developmental impairments may require accessible and simplified materials tailored to their communication and learning needs regarding MHH.

For further reading and detailed analysis, see:
UNICEF. (n.d.). Menstrual health & hygiene for girls and women with disabilities. In UNICEF. Retrieved May 17, 2024, from https://www.unicef.org/documents/menstrual-health-hygiene-girls-and-women-disabilities
Wilbur, J., Torondel, B., Hameed, S., Mahon, T., & Kuper, H. (2019). Systematic review of menstrual hygiene management requirements, its barriers and strategies for disabled people. PloS One, 14(2), e0210974. https://doi.org/10.1371/journal.pone.0210974

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Nepal is changing. There is growing awareness about the health, education and social consequences of poor menstrual hygiene and harmful menstrual practices for girls and women. In the recent decade, menstruation has started to go from a ‘taboo subject’ to a nationwide ‘menstrual movement’.

In Nepal, perceptions of menstrual restrictions vary notably between younger and older women, reflecting generational shifts in cultural attitudes and social norms. Older women, often deeply rooted in traditional beliefs and customs, tend to uphold stricter views on menstrual restrictions. They may adhere closely to practices such as Chhaupadi and view menstruation as a time of segregation and impurity, influenced by long-standing cultural and religious beliefs passed down through generations.

On the other hand, younger women, especially those with access to education and exposure to modern ideas, often challenge traditional perceptions of menstrual restrictions. They advocate for more progressive attitudes, viewing menstruation as a natural biological process rather than a source of impurity or shame. This younger generation is more likely to seek information on menstrual health and hygiene, rejecting practices like Chhaupadi as outdated and harmful.

These generational differences highlight a shifting landscape in Nepal regarding attitudes toward menstruation. While older women may uphold traditional beliefs out of reverence for cultural heritage, younger women are more inclined to question and challenge these beliefs in pursuing gender equality and social progress. Bridging these generational gaps requires open dialogue, education, and promoting menstrual health awareness to foster understanding and acceptance across all age groups.

For further reading and detailed analysis, see:
Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Evans, R. & Alvarez, V. B. (Hrsg.). (2019). NEPAL’S MENSTRUAL MOVEMENT: How ‘MenstruAction’ is making life better for girls and women in Nepal — month after month. In GIZ.
Mukherjee, A., Lama, M., Khakurel, U., Jha, A. N., Ajose, F., Acharya, S., Tymes-Wilbekin, K., Sommer, M., Jolly, P. E., Lhaki, P. & Shrestha, S. (2020). Perception and practices of menstruation restrictions among urban adolescent girls and women in Nepal: a cross-sectional survey. Reproductive Health, 17(1). https://doi.org/10.1186/s12978-020-00935-6

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The influence of poor menstrual hygiene management (MHM) and menstrual shaming on girls’ education and school performance in Nepal is profound, hindering school girls’ performance and general well-being.

Inadequate MHM practices, including limited access to menstrual products and sanitation facilities, pose significant challenges for girls attending school. Many girls resort to using unhygienic materials or improvised solutions during menstruation, which can lead to discomfort, embarrassment, and distraction in the classroom. The lack of proper facilities for changing and disposing of menstrual products also contributes to absenteeism, as girls may choose to stay home rather than risk embarrassment or discomfort at school.

Menstrual shaming exacerbates the barriers to girls’ education in Nepal. Cultural taboos surrounding menstruation often result in stigma, discrimination, and bullying directed towards menstruating girls. This stigma may lead to feelings of shame, low self-esteem, and reluctance to attend school, particularly during menstruation. As a result, girls may miss valuable learning opportunities, leading to gaps in their education and compromised academic performance.

The impact of menstrual shaming on girls’ education extends beyond the classroom. Girls who experience stigma and discrimination during menstruation may internalise negative beliefs about their bodies and natural bodily functions, affecting their confidence, motivation, and aspirations for the future. This psychological toll can hinder their overall academic engagement and achievement, perpetuating cycles of poverty and inequality.

For further reading and detailed analysis, see:
Hennegan, J., Shannon, A. K., Rubli, J., Schwab, K. J. & Melendez-Torres, G. J. (2019). Women’s and girls’ experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesis. PLoS Medicine, 16(5), e1002803. https://doi.org/10.1371/journal.pmed.1002803
Kaur, R., Kaur, K. & Kaur, R. (2018). Menstrual Hygiene, Management, and Waste Disposal: Practices and Challenges Faced by Girls/Women of Developing Countries. Journal Of Environmental And Public Health, 2018, 1–9. https://doi.org/10.1155/2018/1730964

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