A harmful religio-cultural practice (Chhaupadi) during menstruation among adolescent girls in Nepal: Prevalence and policies for eradication

Abstract

Background Chhaupadi is a deeply rooted tradition and a centuries-old harmful religio-cultural practice. Chhaupadi is common in some parts of Karnali and Sudurpaschim Provinces of western Nepal, where women and girls are considered impure, unclean, and untouchable in the menstrual period or immediately following childbirth. In Chhaupadi practice, women and girls are isolated from a range of daily household chores, social events and forbidden from touching other people and objects. Chhaupadi tradition banishes women and girls into menstruation huts’, or Chhau huts or livestock sheds to live and sleep. These practices are guided by existing harmful beliefs and practices in western Nepal, resulting in poor menstrual hygiene and poor physical and mental health outcomes. This study examined the magnitude of Chhaupadi practice and reviewed the existing policies for Chhaupadi eradication in Nepal. Methods We used both quantitative survey and qualitative content analysis of the available policies. First, a quantitative cross-sectional survey assessed the prevalence of Chhaupadi among 221 adolescent girls in Mangalsen Municipality of Achham district. Second, the contents of prevailing policies on Chhaupadi eradication were analysed qualitatively using the policy cube framework. Results The current survey revealed that most adolescent girls (84%) practised Chhaupadi in their most recent menstruation. The Chhaupadi practice was high if the girls were aged 15–17 years, born to an illiterate mother, and belonged to a nuclear family. Out of the girls practising Chhaupadi, most (86%) reported social and household activities restrictions. The policy content analysis of identified higher-level policy documents (constitution, acts, and regulations) have provisioned financial resources, ensured independent monitoring mechanisms, and had judiciary remedial measures. However, middle (policies and plans) and lower-level (directives) documents lacked adequate budgetary commitment and independent monitoring mechanisms. Conclusion Chhaupadi remains prevalent in western Nepal and has several impacts to the health of adolescent girls. Existing policy mechanisms lack multilevel (individual, family, community, subnational and national) interventions, including financial and monitoring systems for Chhaupadi eradication. Eradicating Chhaupadi practice requires a robust multilevel implementation mechanism at the national and sub-national levels, including adequate financing and accountable systems up to the community level.

Chhaupadi practice in Nepal: A literature review

“…The number of participants ranged from 88 to 672 in the surveys. Among the studies using mixed methods (Amatya et al, 2018; Gautam, 2017; Joshi, 2015; Pandit et al, 2021; Parajuli et al, 2018; Thakuri et al, 2021; Thomson et al, 2019), interviews and focus group discussions were used to triangulate the survey. Studies using qualitative methods (Baumann, Merante, et al, 2021; Baumann, Lhaki, et al, 2021; Joshi & Maharjan, 2021; Karki & Khadka, 2019a; Khadka, 2020; Thapa et al, 2019; Wong, 2018) elicited more nuanced information on the underlying phenomena and provided critical, detailed information regarding chhaupadi .…”

“…One participant in Amatya et al (2018) said that if she did not follow chhaupadi , it would bring bad luck and something bad would happen. Thakuri et al (2021) also found that their participants continued the practice because they thought that they were impure during menstruation, were afraid of gods, and worried that family members would get sick.…”

“…The consequences of not following restrictions are passed from one generation to the next, mainly by the elderly women and traditional healers. When a villager gets sick, they go to healers, who then blame women—often the most vulnerable ones in the village, such as a widow—for not following the restrictions strictly (Bam, 2020; Pandit et al, 2020; Thakuri et al, 2021; Thapa et al, 2019). If a woman is seen not following the restrictions, she is blamed and ostracized for anything that goes wrong in the community.…”

“…Gautam (2017) found that respondents were not allowed to participate in religious activities, and 80% were not allowed to touch other people, animals, and plants. Thakuri et al (2021), Bam (2020), Parajuli et al (2018), and reported similar restrictions regarding cleaning, cooking, eating and drinking, touching, worshipping, sleeping, and maintaining physical distance. Furthermore, found that the range of restrictions varied from less restrictive to more restrictive based on caste and ethnicity.…”

“…However, after learning the practice is punishable with fines and jail-time, one-third of the respondents reported that they would change their behavior. Thakuri et al (2021) pointed to the lack of monitoring and budgetary mechanisms at regional and local levels of the government as the possible reason for the ineffectiveness of the law. Another reason for the ineffectiveness might be the high cohesion among community members against the regulations as indicated in Jun and Jang (2018).…”