Menstrual hygiene management – the management of the menstrual process with hygiene and dignity– is critical for the health and education of girls, yet it is often overlooked.

This is true in many areas of the world, including Nepal, a landlocked and mountainous country of 30 million which has made impressive progress in improving access to sanitation in recent years.

Despite this progress, there are still shocking stories of chhaupadi – particularly in the mid and far west of Nepal - an ancient custom in which women and girls are banished to isolated huts or sheds when they have their period, exposing them to life-threatening risks.

Other less extreme forms of Chauppadi exist even in educated households and in urban areas that nevertheless impede women’s empowerment and full participation in social and cultural life. Women and girls may be barred from seeing the sun, consuming dairy products, entering certain rooms in the house (e.g. the kitchen or worship room), or touching other family members.

Chhaupadi was outlawed in 2005, while discrimination and exclusion based on menstruation were criminalized in 2018. Despite this, many women (in Accham district, as many as 60%) cannot sleep in the same house as the rest of the family while on their period.

Some have died from exposure or pneumonia, or from fire or suffocation as they try to keep warm in poorly constructed sheds, which they may have to share with cattle. The isolation leaves women vulnerable to sexual assault or animal attacks. Psychological problems linked to stigmatization and isolation are often a consequence of the practice.

The majority of adolescent girls and women face difficulty in accessing appropriate sanitary pads either due to unavailability or unaffordability, particularly in low income and rural settings.

Girls are also missing school because of their period. 

Around a quarter of adolescent girls may be missing school due to menstruation, with disadvantaged groups particularly affected. Many school toilet facilities are still “gender unfriendly”, lacking separate toilets for girls, consistent water supplies, waste disposal facilities, lockable doors, access to soap and sanitary materials, a maintenance plan, and access for persons with disabilities. 

The majority of adolescent girls and women face difficulty in accessing appropriate sanitary pads either due to unavailability or unaffordability, particularly in low income and rural settings. The economic crisis resulting from the pandemic has exacerbated the issue. In a welcome move, the government has allocated funding for the distribution of sanitary pads to schools, though reports suggest lockdowns are preventing some girls from accessing products. Sanitary pads continue to be considered as luxury items and hence subject to a 13% value-added tax, despite a grassroots movement to remove it.

This is a particularly critical issue during disaster response. A study on menstrual hygiene management among women and adolescent girls was conducted in the aftermath of the 2015 Nepal earthquake that killed almost 9,000 people. The results showed that while 19% of respondents perceived menstrual hygiene as an immediate need, and about 43% of women and girls menstruated within a week of the earthquake, none reported receiving menstrual adsorbents as relief materials in the first month following the earthquake.

Although disposable pads are often the preferred option, they are more widely used by girls in urban schools than in rural schools, where reusable cloth is more common. This largely boils down to awareness, cost and availability. Disposable pads can take 500 to 800 years to decompose, and their use is growing.

The dialogue surrounding “pad pollution” often seems to attribute responsibility for waste generation squarely with menstruating women and girls, who may not have a viable alternative to managing their period comfortably and with dignity in the first place. Sometimes it seems like there is greater condemnation of the waste management challenges, than of the fact that women are struggling to access materials so critical to their health and wellbeing.   

At a policy and institutional level, an important starting point is to acknowledge the reality that sanitary pads containing plastic will continue to be used (at least in the near term), and hence need to be factored into waste management planning.

To move towards a greener future, solutions will lie with knowledge, personal choice, and the availability of affordable alternatives. Promisingly, acknowledgement of the environmental impacts is already driving innovation, including the development of biodegradable sanitary pads. 

There is much that can be done. In Nepal, these actions should be considered to help girls and women, as well as transgender men and non-binary individuals who menstruate.

1. Efforts to tackle negative associations and social practices surrounding menstrual hygiene management require engagement of mothers (who are often the main sources of information for girls), elders, communities, and boys, to foster greater sensitivity and awareness. Teachers need to be equipped with the resources to answer questions and provide accurate information.
2. There’s an incredible wealth of knowledge and capacity in the civil society space, with many having an intimate understanding of the context on the ground. The empowerment of local entities (such as mothers’ groups) in particular, may require targeted support to strengthen financial sustainability and the enabling environment.
3. The private sector has a role to play in MHM, including supply chains for low-cost, practical and bio-degradable sanitary products. One entry point could be through the corporate social responsibility commitments that are required by Nepali law in some industries.
4. The increased attention to water, sanitation and hygiene during the pandemic is an opportunity to “build back better” with respect to menstrual hygiene management.

The knowledge, insights and urgency are there. For women and girls to participate fully in the development of Nepal, efforts to address the issue of menstrual hygiene management must be strengthened and expanded.