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The monthly exile: Making life better for menstruating girls and women

Basanti’s shelter when menstruating

In many parts of the developing world, sanitary products and hygiene facilities for menstruating women and girls are unavailable or inadequate. A German-supported project in Nepal is trying to change this.

‘Women are the fabric that holds families and communities together.

Everywhere in the world, women weave and mend the social fabric of our communities.’ 

Women Are The Fabric (UNFPA, 2012)

Whilst women are seen as the fabric that holds families and communities together, in many parts of the world the absence of any sort of affordable or available fabric that enables them to menstruate discreetly and hygienically has a devastating effect on millions of lives.

In some parts of Nepal, women and girls are considered unclean and untouchable when they have their period, and they are banished from their homes, sometimes with deadly consequences. Even in areas where these practices are not followed, women and girls have limited access to sanitary products, toilets, water and soap, and this can cause great embarrassment and distress and affect their school attendance and participation in society. What can be done to address these issues?

Banished to a cow shed

Basanti dreads a certain time of month, when her menstruation starts. Like many of the girls in her remote mountain village in Nepal’s Mid-Western region, she is banished from her home, and has to seek shelter in the leaking cowshed or freezing cold cave until her period is over. “I am really frightened of being attacked by wild animals, of being alone if there’s an emergency, and even of being raped,” she says, “But according to our tradition, women have to hide from society, stay away form religious activities during menstruation.” Apart from the social stigma, it is a time of great discomfort and embarrassment, and she misses her family, friends and young child. When she was younger, she was unable to attend school during her period: “I was not allowed to touch my school books because books are associated with Saraswati, the goddess of knowledge and wisdom”.

Ancient taboos still prevail

Although declared illegal in Nepal in 2007, the ancient Hindu tradition of chhaupadi – which considers women to be untouchable and unclean during menstruation and forces girls and women like Basanti to quarantine themselves – is still widely practised in Nepal’s western-most regions, where 23% of the population lives, often in isolated villages clinging to high mountain sides. Even in areas that do not follow chhaupadi, women and girls usually have limited access to sanitary products, water, toilets and soap, and this can seriously affect their participation in society and impact on school attendance. Cultural taboos and social stigma, combined with low levels of education or understanding about menstruation, as well as the unavailability and unaffordability of sanitary materials, means that many Nepali women are unable to manage menstruation conveniently and hygienically. As a result, they are excluded from participating in family life, education, work, as well as religious and social activities for on average 1,400 days in their reproductive lifetime.

Breaking the silence

Of course, Nepal is not alone in discriminating against women and girls in this way. In Africa for example, it is estimated that more school days are now lost to menstruation than to malaria.  In many parts of the world, this perfectly natural bodily function is known as “the curse” and religious leaders and other opinion makers, even the media, either perpetuate such beliefs or are completely silent about them. “If you cannot talk about the problem, how can you talk about the solution?” asks Valerie Broch Alvarez, Senior Technical Adviser for ‎Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH in Nepal.

Is menstrual hygiene management the answer?

In most rural and urban public schools in Nepal, sanitation and hygiene facilities for menstruating girls are either unavailable or completely inadequate: There are no separate toilets for girls, soap for hand washing or bins for disposal of sanitary pads – even assuming that these are available and affordable, which they rarely are. This means that large numbers of perfectly healthy girls like Basanti are forced to miss school for several days each month. Sustainable initiatives that not only tackle the taboos but also promote practical, low-cost, locally sourced, and locally available sanitary solutions are needed urgently. 

Nepal’s Family Health Division of the Department of Health Services in cooperation with the Department of Education, and with the support of German Technical Cooperation and other development partners, has started a pilot school-based programme to improve menstrual hygiene management in over 500 schools in the 14 districts most affected by the 2015 earthquake. This programme focuses on increasing general awareness about the issues, and training teachers and health workers in how to educate girls – and boys – about menstrual hygiene management. 

The programme also aims to teach lower secondary and secondary school children how to make reusable sanitary napkins out of cloth.

As part of this programme, the team working on Maternal, Adolescent Reproductive Child Health and the earthquake Recovery Programme decided to travel to India to find out more about an exciting new low-cost sanitary pad machine and model of social entrepreneurship.

The ‘menstrual man’ – an unlikely sanitary pad revolutionary

A. Muruganantham, centre, receives team from Nepal
A. Muruganantham, centre, receives team from Nepal

In India, one man has become an unlikely menstrual missionary. In 1998, shocked at the unsanitary rags that his wife and millions of other Indian women were forced to use during menstruation, Arunachalam Muruganantham decided he would try to create a simple, locally adapted technology for producing low-cost sanitary pads.  Based in Tamil Nadu, his mission was to increase the use of sanitary pads in rural and hard to reach areas, while at the same time creating jobs for poor rural women. 

After several years of research, he came up with a prototype, easy-to-use machine for producing low-cost pads, both for regular periods and for maternity pads for mothers who had just given birth.  These sanitary pads out of cotton are totally organic, free of chemicals and well finished. Mr Muruganantham, however, did not want to sell the pads himself: He wanted women to make and sell their own. His aim is to create a million jobs for poor rural women in India. He installs the machine and teaches women how to operate it, and then they take over the procurement, production, branding and distribution processes. Below this article, a series of pictures shows this production process. Both manually operated and semi-automated machines have now been sold in 27 states in India and have recently begun to be exported to other developing countries.

Mr Muruganantham has received many awards for his invention and TIME magazine named him one of the 100 most influential people in the world in 2014. A recent study in India found that, because of his work and other such initiatives, girls’ attendance in school increased substantially after they learnt about puberty and received free sanitary pads.

Making sanitary pads in Nepal

Each machine can produce 480,000 sanitary pads a year
Each machine can produce 480,000 sanitary pads a year

Mr Muruganantham’s model could be replicated in Nepal and GIZ‘s Support to the Health Sector Programme (S2HSP) now plans to help establish low-cost sanitary pad production units in rural communities in GIZ-supported districts. Two village development committee women’s cooperatives have been identified for this pilot project, which will not only provide women and girls with hygienic low-cost sanitary pads, but also give them an income and economic empowerment through sustainable and scalable business models. Each machine, which GIZ will support for inclusive business, will cost approximately US$ 3,500 and, operated by five to seven women on a single shift basis, will be able to produce 1,600 sanitary pads a day, or 480,000 a year at a cost of six Nepali rupees (0.5 cents US) per sanitary pad.

A woman’s right to dignity

At the same time as these practical initiatives have begun, there has been increasing newspaper coverage and growing awareness in Nepal about the harmful practice of chhaupadi and its health and social consequences for girls and women. In particular, the social media campaign #PeriodsAreNotAnInsult has catapulted the topic of women’s reproductive health into the open. 

There is a growing global recognition that access to sanitary products is a vital part of part of women and girls’ right to health, safety and dignity. With access to hygiene products, girls and women gain some control and can make choices about their lives and bodies. Sanitary products can also be a tool for increasing school enrolment and, more broadly, for achieving gender equity. 

This German-supported initiative in Nepal is a first tentative step towards radically improving the lives of girls like Basanti and many millions more, bringing their unnecessary shame and distressing monthly exile to an end. 

By Valerie Broch Alvarez and Ruth Evans

March 2016


Women Are The Fabric – reproductive health for communities in crisis, UNFPA, 2012 

Good Policy and Practice in Health Education: Puberty Education and Menstrual Hygiene Management, Booklet 9, UNESCO, 2014

Production process

© GIZ Nepal
© GIZ Nepal
© GIZ Nepal
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