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Menstrual Hygiene Day: Nepal’s movement for dignified menstruation gathers pace

More than 80 organisations and activists are now part of a growing alliance that is working to educate, advocate and break the silence surrounding menstruation.

In the village of Haatkholi, in the Sudur Paschim province of far western Nepal, practices around menstruation have eased somewhat over the years. ‘Nowadays there aren’t many restrictions,’ explains Bhagrathi Saud, a woman from the village. ‘I sleep in the house, but I don’t go in the kitchen or the room where we worship.’ 

Her daughter, Bimala, is 16 and studies in the 11th grade at Durga High School. She is growing up in different times, when more and more young people are questioning the stigma surrounding menstruation. Bimala advises her mother not to observe these monthly restrictions any more. But breaking with tradition is hard: ‘These are the norms of the village. Everyone does the same, and we follow that too,’ says Bhagrathi Saud. ‘We live here and we have to follow its values.’ 

Menstruation has long been a taboo topic in Nepal. Because of traditional beliefs which associate menstruation with impurity, girls and women are restricted from participating fully in domestic, religious and public activities during their periods. ‘These traditions are passed down from one generation to another,’ says Sami Pande, a technical advisor with the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH in Nepal. ‘It will take a long time until people stop seeing menstruation as something impure and accept it as a natural phenomenon. But it can happen – and teachers, local officials, religious leaders and other public figures can help to bring about this change.’ 

A menstrual movement takes shape

All across Nepal, organisations, activists and influencers – such as the actress Keki Adikhari, pictured above, with schoolgirls in Dhangadhi during the making of a film about menstrual taboos – are increasingly vocal about the harmful effects of menstrual taboos on women’s and girls’ health, safety and dignity. They are part of a growing movement that is striving to break the silence which surrounds menstruation and to make menstrual health a reality for Nepal’s 8.8 million women of reproductive age. 

Keki Adikhari, actress and menstrual health ambassador, with schoolgirls in Dhangadhi

© GIZ/Tabea Seiz

Germany supports these efforts. On behalf of the Federal Ministry for Economic Cooperation and Development, the GIZ-implemented Support to the Health Sector Program (S2HSP) is working to put menstruation on the national agenda and to make sure that adolescent girls in particular have the information and resources they need to manage their menstruation with dignity.

One of its main partners is the Menstrual Health and Hygiene Management Partners Alliance (MHM PA), which has emerged as the de facto hub for this movement. Established in 2017 as a knowledge-sharing platform for organisations and individuals working on menstrual health issues, the Alliance now counts among its members more than 80 local and international NGOs, United Nations agencies, bilateral development partners, academics, activists and private companies.  

MHM PA:  A platform for exchange – and for action

Guna Raj Shrestha is the founder and convener of the MHM PA. He became interested in menstrual health through his work on Nepal’s campaign to end open defecation, where he saw how menstrual taboos prevent women and girls from using the same toilets as the men in their families during their periods. 

When he initiated the Alliance, it was largely with the goal of fostering exchange between organisations from very different sectors – water and sanitation, education, health, rural development – that were addressing the issue of menstruation in their programs.

‘Everyone was working in siloes, without any awareness of what others were doing,’ Shrestha recalls. ‘Why not have a platform where people working on this issue can share what they’re doing and what they’ve learned?’

Guna Raj Shrestha at MenstruAction Summit
Guna Raj Shrestha at MenstruAction Summit

Over time, Shrestha explains, the Alliance’s focus has broadened to include advocacy and other strategic interventions aimed at establishing dignified menstruation in Nepal. Many of the Alliance’s priorities have been informed by the recommendations which emerged from the 2018 MenstruAction Summit, a major national gathering of menstrual health activists and practitioners which was organised by the MHM PA, with support from GIZ, in December 2018. ‘This workshop was fundamental for identifying the issues and types of interventions that are needed,’ says Shrestha. 

Focus on schools: Sanitary pad distribution and curriculum reform

 Over the past three years members of the Alliance have advocated for and advised the government on the implementation of the Free Sanitary Pad program, which was announced by the President of the Federal Republic of Nepal, Bidya Devi Bhandari, in May 2019. Under the program, 1.4 million schoolgirls across the country receive sanitary pads free of cost every month. They have also helped to develop guidelines to ensure that the sanitary pads which are procured and distributed are biodegradable and do not exacerbate the country’s existing environmental and waste management challenges. 

Students at Durga High School
Students at Durga High School

MHM PA members have also worked with the Curriculum Development Center of the Ministry of Education, Science and Technology to revise the official school curriculum and textbooks, so that menstruation is placed in a broader social and cultural context and not taught in a cursory way as part of biology lessons. Now, starting in grade 4 – before the onset of puberty – girls and boys will learn what menstruation is, why taboos around menstruation are harmful for women and girls, and how menstruation can be managed safely and hygienically using different menstrual hygiene products.

A new menstrual education toolkit to complement the formal curriculum 

BK Shrestha is the director of Global Action Nepal, an NGO focused on improving the quality of teaching and learning in Nepal’s public schools. He welcomes the curriculum revisions – and knows that for teachers to become comfortable teaching about menstruation they will need support. ‘Teachers usually come from the same community,’ he says. ‘They are someone’s father or brother or aunt, and they’re hesitant to discuss these topics.’ 

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With this challenge in mind Global Action Nepal has launched a collaborative project with the MHM PA to compile and pilot a menstrual education toolkit for teachers as a complement to the curriculum and textbooks produced by government. The idea for the toolkit emerged from the Dignity without Danger research project, led by Dr Sara Parker of Liverpool John Moores University, which investigated menstrual stigmas and taboos in different parts of Nepal. S2HSP and Liverpool John Moores University are supporting the toolkit initiative; members of the steering committee include representatives of the Curriculum Development Committee, the Health Training Centre of Bagmati Province, and the Center for Education and Human Resource Development of the Ministry of Education.

 Representatives of more than 35 MHM PA member organisations and government agencies have come together in a series of workshops to present the menstrual education materials they have developed and work with – from posters, books and pamphlets to kits for storytelling and body mapping. In small groups, they have discussed and assessed these with reference to the new school curriculum, identifying materials that would be appropriate for different age groups.

‘There was a real collaborative spirit at the workshops,’ says Tabea Seiz, a GIZ Development Advisor working with the MHM PA. ‘For the first time, Alliance members were creating something together.’ After piloting, the aim is for the toolkit to be officially endorsed by the Ministry of Education and included in ‘learning corners’ in schools across Nepal.

Menstrual education materials
Menstrual education materials

The next chapter for the Alliance – and for Nepal’s menstrual movement

Now well into its fifth year, the Alliance remains a volunteer-run network with a diverse and growing membership. A six-person steering committee was recently established to help guide the Alliance’s work, and a full-time staff person will soon join the small Secretariat. These changes are likely to result in a further sharpening of the Alliance’s mission and strategy in the coming years.

Guna Raj Shrestha, the convener of the Alliance, thinks the MHM PA can help to bring about a unified policy framework for dignified menstruation in Nepal. It is currently advocating for the establishment of a high-level advisory board under the National Planning Commission which can coordinate the government’s actions in support of menstruation-related issues across various ministries. ‘Once there’s a policy and a coordination structure, there will be a lot of need for technical support both for implementation and for monitoring,’ he says. Members of the MHM PA can offer expertise in this regard.

The Alliance’s networking and knowledge sharing function will continue to be important – and not only within Nepal. The Alliance has recently become a member of the Sustainable Sanitation Alliance (SuSanA), an informal network of people and organisations around the world with a common vision of sustainable sanitation. Engagement with SuSanA will provide Nepali organisations with the opportunity to share their work with a larger audience, to benefit from funding and capacity development opportunities, and to learn from the experiences of others active in the global movement for menstrual health.

The COVID pandemic, which has inflicted enormous disruptions and losses upon Nepal, has also been a setback for the country’s menstrual movement: schools have been closed, physical meetings and activities have been postponed, attention has been directed elsewhere. But members of the MHM PA have continued to meet regularly – and virtually – throughout the pandemic. Their energy and focus have not been diluted and the issues they are working on have not been forgotten. The social movement for dignified menstruation in Nepal is only gaining in strength.  

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© GIZ/Tabea Seiz
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© GIZ/Tabea Seiz
© GIZ/Tabea Seiz
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