‘Menstrual blood is bad and should be cleaned’: A qualitative case study on traditional menstrual practices and contextual factors in the rural communities of far-western Nepal

Abstract

Objective: Unhealthy menstrual practices and the contexts surrounding them should be explored and clearly understood; this information could be useful while developing and implementing interventions to increase hygienic practices during menstruation and consequently increase health and well-being of women. Therefore, this study was conducted to explore traditional menstrual practices and the contextual factors surrounding the practices in the rural communities of far-western Nepal. Methods: This was a qualitative case study conducted in the Achham district of Nepal. Semi-structured interviews were conducted among four women, three men and two female community health volunteers to collect data and thematic analysis was performed to analyze the data. Results: We found two commonly reported menstrual practices: seclusion practice (Chhaupadi) and separation practice. In the Chhaupadi practice, women are secluded to stay in a small shed away from the house and restricted to wash or take a bath in public water sources for 5-7 days of the periods, whereas in the separation practice, women can stay in the house, but they still have several restrictions. The contextual factors that were reported to influence the cultural practices are as follows: cultural beliefs that symbolize menstruation as impure, menstrual stigma, poverty, illiteracy, the influence of traditional healers and family members, and limited effect of Chhaupadi elimination interventions. We also found that some development in the reduction of cultural myths and practices is happening, but the rate of change is rather slow. Conclusion: Most of the Nepalese women, especially in the rural areas of far-western Nepal, are forced to follow the harmful menstrual practices because of the socio-cultural context surrounding their lives. We believe the findings of this study would be relevant in terms of developing and implementing further menstrual health-related, community-based interventions that will be responsive to the local cultural context, beliefs, and practices.

‘Menstruation means impurity’: multilevel interventions are needed to break the menstrual taboo in Nepal

“…Despite several interventions to address menstrual taboo (e.g., awareness raising, community sensitization, and legislation), the majority of young girls and women are still forced to follow different traditional menstrual practices (e.g., chhaupadi, untouchability and restrictions) [ 15 ]. Anecdotal reports from the field [ 7 , 11 , 14 ] and empirical studies [ 9 , 10 ] have suggested that these interventions have only been effective for a short duration of time for several reasons. For instance, a baseline programme evaluation report published in 2015 suggested that community stakeholders were reluctant to participate in interventions aimed at abolishing such practices, although most of them initially showed their interest and support [ 7 ].…”

“…We did not follow a systematic process but based the review on general topic-related keyword search (e.g., "chhaupadi", "menstrual health interventions", "menstruation management intervention", "menstruation management programme", "menstrual restrictions", "menstrual stigma", "menstrual taboo") on PubMed, Google Scholar and official websites of non-governmental organizations implementing programmes and interventions to address menstrual taboo in Nepal. Altogether seven programme or news reports [5][6][7][11][12][13][14] and six peerreviewed papers [1,2,9,10,15,16] explaining menstrual taboo and/or menstrual management interventions were included in the review. We also looked for additional relevant programme reports and peer-reviewed papers [4,8,[17][18][19][20][21][22] to consider implementation perspectives on how the effectiveness of the interventions can be enhanced.…”

“…The interventions are believed to change the perceptions of women and community members, and the number of women practising chhaupadi is believed to have been declining over the years; however, the rate of change is rather slow [ 9 ]. It is also believed that the effectiveness of such interventions is only documented on paper and not in real-world practice, i.e., that the vast majority of families and women are still continuing to practice chhaupadi or other menstrual restrictions [ 5 , 7 ].…”

Perception and practices of menstruation restrictions among urban adolescent girls and women in Nepal: a cross-sectional survey

“…Despite the Nepal government's initiative of banning the practice of Chhaupadi in 2005, followed by the "Chhaupadi Pratha" Elimination Directive in 2008, the practice still exists in some areas and communities in Nepal [15,16]. Even though this extreme practice has never been prevalent among urban Nepalese women, some socio-cultural restrictions during menstruation still exist in other societies across Nepal, specifically among different castes [17][18][19]. Some of the common socio-cultural beliefs in various castes in Nepal related to menstruation include: not touching a male member of the family, plant, tree or fruit during menstruation, not consuming pickles or dairy products, eating alone during menstruation, not entering the kitchen or places of worship, not visiting relatives, or not attending social or religious gatherings [12,20]..…”

La copa menstrual, una alternativa de higiene femenina. Revisión de la literatura

“…El 88.0% dijo haber usado alguna vez toallas sanitarias, mientras que establecer confianza con la CM tardó aproximadamente 6 meses. Con todo, el costo inicial y la disponibilidad del dispositivo en estas zonas son barreras a considerar, en especial en las áreas que registran mayor problemática 15 .…”