SUSWA is supporting municipalities and collaborating with other organizations across Karnali in order to rewrite the narrative surrounding menstrual rights – creating a province where menstrual rights and needs are recognized, respected and protected for everyone*. As a steering committee member of the national Menstrual Hygiene Management Partnership Alliance (MHMPA) and a funding member and secretary of Karnali Alliance for Dignified Menstruation Management (KADMM), SUSWA Project Support Unit and municipality WASH Units took part in Menstrual Hygiene Day celebrations across municipalities in Karnali, online and in Kathmandu under the slogans #PeriodPride #WeAreCommitted and #DignifiedMenstruation.
In this blogpost, we’ll take a look both at what constitutes Dignified Menstruation, the current situation for persons menstruating in Karnali and what activities SUSWA supports for dignified menstruation for all. At the end of the post you can find information about some of the many events organized at the beginning of this week for Menstrual Hygiene day 28.5.2023.
Dignified Menstruation: Promoting Health, Hygiene, and Equality
Dignified menstruation refers to the idea that every person who menstruates should have access to safe, affordable, and high-quality menstrual products, as well as appropriate sanitation facilities. It also involves promoting education and awareness about menstrual health and hygiene, and reducing the stigma and shame associated with menstruation. In Hindu religio-culture in Nepal, menstruation is often associated with impurity, and can lead to discrimination and exclusion from social and religious activities. These norms can have a negative impact on the health and well-being of women and girls. In some communities, e.g., in the districts of Jumla and Humla of Karnali, women and girls sleep outside in unhygienic and unsafe conditions, such as in menstrual huts or sheds during their periods, putting them at risk of injury, attack and e.g., death from smoke inhalation. In a recent household survey in each household in current SUSWA working scheme areas in eight municipalities, 26% of respondents reported that the women/girls in the family stay in animal sheds outside the house during their menstruation, with only 15% staying with the family as usual, and the rest staying in a separate part of the house during their menstruation.
Ultimately, dignified menstruation is about ensuring that menstruation is not a barrier to a person’s health, well-being, or participation in society.
The Right to a Safe and Clean Toilet: Access to toilets for dignified menstruation & improved menstrual hygiene management
According to a survey covering all households in current SUSWA scheme areas, nearly 25% of households** lack access to a toilet, with open defecation being unhygienic and unsafe, putting women and girls at risk of harassment and assault, especially during their periods.
As a Water, Sanitation & Hygiene project, an important objective is ensuring access to period friendly toilets for all. Access to toilets will not only improve overall hygiene but also ensure that women and girls can manage their periods with dignity. Together with other WASH organizations in Karnali SUSWA plays an obvious role in promoting toilet construction and improvement at household level with the target of reaching 22 000 households, as well as constructing 300 inclusive and accessible toilets in schools and health facilities, to ensure that all women and girls, including those with disabilities, have access to safe and private facilities.
However, ensuring a toilet facility exists is not enough on its own to ensure access, with discriminatory practices related to menstruation needing to be addressed as well. According to the SUSWA survey, 17% of women and girls are not allowed to use toilets during their menstruation, in the same way they may be restricted from washing or touching taps. These restrictions can limit their opportunities and reinforce the idea that menstruation is shameful or dirty.
From Stigma to Dignity: Changing Social Norms around Menstruation
In the household survey, the main reason for restricting women and girls behaviour during menstruation was reported to be fear of angering deities / religion. This highlights the importance of working with religions leaders in SUSWA working area in order to find alternative ways to ensure ritual purity during menstruation and after child birth. In other words, change what is considered to anger or please deities and separate the natural process of menstruation from this. Staying in a separate room inside the house, instead of outside in a hut, seems to be a successful solution in the negotiation of changing social norms related to menstrual impurity in many households/communities and seems to correlate with using taps and toilets during menstruation. However, this ‘solution’ or first step is not available to households consisting of only room, meaning the poorest households are at risk of becoming particularly stigmatized at households still following ‘chau hut’ customs. With that said, it is important for SUSWA to continue holistic efforts to change cultural attitudes towards menstruation through awareness campaigns, school and community outreach, and creating an enabling policy environment on municipality, provincial and national level.
In this blogpost we mentioned the number of households reporting women staying outside the house and not using toilets. The important numbers here for changing social norms related to these restrictions are actually the ones not mentioned here – the majority of women and girls in SUSWA working area report using the toilet during their menstruation and staying in their home (even if in a separate room) at 83 % and 74% respectively. It is important to note that these numbers are likely to be lower in reality, due to the awareness households in Karnali already have of these practices being seen as ‘undesired’ by WASH organizations and therefore choosing not to reply honestly. With that said, A WASH project such as SUSWA must be careful not to normalize harmful practices that are being targeted and making it appear as if ‘everybody else’ follows restrictions. These numbers therefore provide us with a tool to use in messaging in Karnali – those following strict restrictions during menstruation are a minority and need to be talked about as such.
Devika Rokaya, Tara Rokaya and Durga Rawat from Simikot agree. On Menstrual Hygiene Day 28.5, all three women celebrated exactly the first step they had taken; staying in a separate room let them feel like they are still pleasing deities and following customs related to their religion, while simultaneously allowing them to take care of themselves when menstruating and distancing themselves from the stigma now associated with menstrual huts.
Among the younger generation who have received menstrual health education in school, restrictions are stigmatized to the degree that few would at least admit to following restrictions. Students from Ramdev Secondary school in Simikot share that all of them attend school normally when they are menstruating.
Women from the lama community in Simkot, who do not follow Hindu religion and do not share the concept of ritual impurity related to menstruation, participated in Menstrual Hygiene Day celebrations. The winning team of the traditional Deuda (question & answer) singing competition on menstruation that was held in Simikot 28.5.2023, a great way of combining tradition and alternative approaches to menstrual hygiene, explained that it was important for them to show the other communities they can change their norms regarding menstruation:
Empowering Communities: Training on Making and Using Reusable Sanitary Pads
For Dignified Menstruation access to good quality sanitary products matter. The availability and cost of sanitary pads is another significant issue, also in this communities in Karnali where discriminatory practices are not observed, such as the Lama communities in Upper Karnali. In SUSWA’s recent household survey 96% report that sanitary pads are not available. In Karnali, due to difficult transportation, pads are especially expensive, while households are often among the poorest in Nepal. Many women and girls cannot afford to buy disposable pads, which means they have to resort to using old rags or other unhygienic materials during their periods.
The disposal of sanitary pads is also a major challenge. Many women and girls do not have access to proper waste management facilities, which means that used pads often end up being thrown into open spaces or water bodies. In the first round of Stories of SUSWA photo series, two of the women shared that all pads being thrown directly into the river in their communities.
Adolescent girls in Karnali are receiving free disposable sanitary pads from school which is a great initiative by the Government of Nepal, yet lack of adequate knowledge and options for safe disposal of the pads means sanitary pads are left in fields streams and blocking school latrines. This not only creates a health hazard but also contributes to environmental pollution.
Reusable sanitary pads are an inexpensive solution that solves issues regarding disposal as well. SUSWA collaborates with the municipalities, health care facilities and other organizations to provide training and resources for the production of reusable sanitary pads. Having the skills to make your own reusable sanitary pads will not only make sanitary pads more affordable but also ensure that they can be easily disposed of without causing harm to the environment. Further, as part of SUSWA’s support for Nepal’s Total Sanitation indicators, proper waste management facilities at institutions and supporting municipalities to develop solutions for households and communities, are important efforts for SUSWA.
Images below from some of the sanitary pad making trainings from the past months:
Sanitary pad making training has so far been completed in Mudkechula, Mugum Karmarong, Hima, Kanakasundari and Simikot during the past months, with training ongoing in the remaining municipalities of Palata and Simikot. Karnali Alliance for DMM is currently looking into best practices in Karnali for the best quality reusable pads. SUSWA also recently started collaborating with TikTok content creators, with the first TikToks being on using sanitary pads, read more here.
During Menstrual Hygiene Day 28.5, the Sarkegad municipality together with the WASH unit organized a rally handing out sanitary pads in both schools and communities, see images below.
Breaking the Silence: Encouraging Open Dialogue and Community Engagement around Menstruation
Addressing menstrual hygiene requires a comprehensive approach that includes access to toilets, affordable and accessible sanitary pads, proper waste management facilities and changing norms related to religious impurity. SUSWA incorporates these interventions into its human rights based approach to WASH in working towards a more equitable future for all.
Awareness days such as Menstrual Hygiene Day are good opportunities to put an extra effort into raising awareness and sharing information in communities, and for municipalities SUSWA works with to show their commitment. By organizing events and rallies (demonstrations) with women and men, as well as girls and boys, publicly normalizing menstruation through speeches, songs, plays, writing and drawing, menstruation can no longer remain taboo and stigmatized.
Below are images and videos, as well as Nepali language news articles, of some of the activities from SUSWA working municipalities and communities on Menstrual Hygiene day 28.5.2023:
At Kalika and Saraswati secondary school in Palata, Kalikot, 60 students took part of essay writing and drawing competitions related to dignified menstruation.
Deuda and singing performances took place in Sarkegad, Humla; Palata, Kalikot; Simikot, Humla. In Palata, SUSWA TikTok collaborator Ibsal Sanjyan performed.
In Mugum Karmarong, Kanakasundari, Hima, Mudkechula and Thulibheri, quizzes, rallies, street drama and speech competitions took place to promote dignified menstruation.
In Simikot rural municipality, there was interaction with mothers groups on ending practice of staying in chauhuts during menstruation, while child clubs are receiving orientation on sanitary pad making. At the municipality level, Karnali Ambassador for Dignified Menstruation Management Sunita Budha Chhetri performed her new song on dignified menstruation. See images from the Simikot event below:
The Role of Partnerships and Ambassadors in working together for Dignified Menstruation
SUSWA is a proud steering committee member of Nepal’s Menstrual Hygiene Management Partnership Alliance. 28.5 the second music video for Menstrual Hygiene was released by Prakash Saput and Keki Adhikari at Menstrual Health and Hygiene Management Partners’ Alliance – MHM PA Nepal program in Kathmandu. You can re-watch the Kathmandu event here: MHM PA MH day 28.3.2023
For International Women’s Day and Menstrual Hygiene Day, Karnali Ambassador for Dignified Menstruation, singer Sunita Budha Chhetri, performed in Palata, Kalikot, Sarkegad, Humla, Birendranagar, Surkhet and Simikot, Humla, with songs about dignified menstruation. Importantly, Sunita spoke directly with the audience at each event about her own experience of choosing not to follow any restrictions, listing that she sleeps in her beds, she eats curd, she showers and uses the toilet, and she has not angered any deities, nothing bad has happened. She then discusses with audience members who wish to share their own experience of changing their behaviour and ending harmful practices. I highly recommend watching this interaction with both young and old women as well as a religious leader in the video below, which has English subtitles:
A week before Menstrual Hygiene Day, Karnali Alliance for Dignified Menstruation Management, KADMM, organized a ‘menstruation fair’ in the province headquarter of Karnali. Karnali ambassador Sunita Budha Chhetri performed, there was a deuda competition and stalls with information on menstruation and sanitary pads. See some images from the event below. Below you can also see a short video of one of the songs Sunita sang at the ‘Menstruation Fair’:
Sunita Budha Chhetri, Karnali Ambassador for Dignified Menstruation Management also shared a music video for a new song for Dignfied Menstruation called ‘Story of a daughter’. The video has English subtitles.
Finally, you can hear directly from some Karnali Alliance for DMM (KADMM) members on why working for menstrual hygiene in Karnali is important, here:
News on Menstrual Hygiene day in Karnali
Nepali language news articles on SUSWA Menstrual Hygiene day, the music video launch and sanitary pad making training:
A two-day training on menstrual hygiene and sanitary pad making was held in Sarkegad. :: MB Thapa :: Kachahari — A two-day training on menstrual hygiene and making sanitary pads was completed in Sarkegad. :: MB Thapa :: Kachahari
* In this post we often refer to ‘women and girls’, but SUSWA also acknowledges those menstruation not identifying as women. Further, SUSWA includes those with disabilities menstruating in all SUSWA efforts.
** 11% according to SUSWA baseline survey which was done in 42 municipalities